Cytomorphological spectrum and Ziehl-Nelson staining in suspected tuberculous lymphadenitis: A study of 100 cases.

Authors

  • Indrani Dhawan VMMC and Safdarjung Hospital, GGSIPU
  • Oneal Gupta
  • Ankit Kaushik VMMC and SJH
  • Sunil Ranga
  • Dimple Kasana VMMC and SJH
  • Prem Kumar Gupta

Keywords:

Tuberculosis, Cytology, AFB, Lymphadenitis

Abstract

Background:  Tuberculosis (TB) is the leading cause of death from a curable infectious disease. The situation is further worsened by a resurgence of the disease in immunocompromised AIDS cases. Lymphadenitis is the most frequent form of extrapulmonary tuberculosis. The diagnosis of tuberculous lymphadenitis remains challenging in spite of the availability of various diagnostic tools.

Aims: The present study aims at studying different cytomorphological patterns in suspected cases of tuberculous lymphadenitis and the efficacy of cytology and Ziehl-Nelson (ZN) staining in diagnosing tuberculous lymphadenitis in these different patterns.

Methods: One hundred cases clinically suspected of tuberculous lymphadenitis were studied (over a period of one year) with the aid of fine needle aspiration cytology (FNAC) complemented with AFB staining. The cytomorphological spectrum along with AFB positivity in different groups was compared.

Results: Maximum AFB positivity was seen in cases showing cytomorphological features consistent with a granulomatous lesion with necrosis (i.e. in 10 out of 21 cases; 48%). The difference in AFB positivity between various cytomorphological groups was found to be statistically significant (p < 0.01) especially between cases showing caseating granuloma and those showing non-caseating granuloma or reactive lymphadenitis at 1% level of significance. The maximum sensitivity of ZN stain was found in cases showing caseating granuloma, and was nil in cases showing non-caseating granuloma and cases showing reactive lymphadenitis.

Conclusion: The maximum AFB positivity is seen in cases showing cytomorphological features consistent with a granulomatous lesion with necrosis.  A combination of conventional techniques (FNA and ZN staining for AFB) and newer diagnostic techniques must be applied for the rapid and early diagnosis of tuberculosis in paucibacillary specimens to achieve maximum sensitivity.

References

1. Goel MM, Ranjan V, Tapan N, Dhole. Polyme-rase chain reaction vs. conventional diagnosis in fine needle aspirates of tuberculous lymph nodes. Acta Cytol. 2001;45:333-40.
2. Maitra A, Kumar V. The lung. In Robbins Basic Pathology, eighth edition. Pennsylvinia: WB Saunders; 2007. p. 516-22.
3. Aljafari AS, Khalil EA, Elsiddig KE, et al. Di-agnosis of tuberculous lymphadenitis by FNAC, microbiological methods and PCR: a compara-tive study. Cytopathology. 2004;15:44-8.
4. Kishore Reddy VC, Aparna S, Prasad CE, et al. Mycobacterial culture of fine needle aspirate - A useful tool in diagnosing tuberculous lympha-denitis. Indian J Med Microbiol. 2008;26: 259-61.
5. Govt. of India (2010). TB India 2010, RNTCP Status Report. TB: Burden of the Disease in In-dia, Chapter 1. Ministry of Health and Family Welfare, New Delhi.
6. Agarwal D, Bansal P, Rani B, et al. Evaluation of etiology of lymphadenopathy in different age groups using fine needle aspiration cytology: A retrospective study. The Internet J Pathol. 2010;10.
7. Singh JP, Chaturvedi NK, Das A. Role of fine needle aspiration cytology in diagnosis of tu-berculous lymphadenitis. Indian J Pathol Mi-crobiol. 1989;32:101-4.
8. Khan RA, Wahab S, Chana RS, et al. Cervical lymphadenopathy, fine-needle aspiration cytology, children. Pediatr (Rio J). 2008;84:449-54.
9. Pahwa R, Hedau S, Jain S, et al. Assessment of possible tuberculous lymphadenopathy by PCR compared to nonmolecular methods. J Med Microbiol. 2005;54:873-8.
10. Laishram RS, Devi RK, Konjengbam R, et al. Aspiration cytology for the diagnosis of tuber-culous lymphadenopathies: A five-year study. Journal Indian Academy of Clinical Medicine. 2010;11:31-5.
11. Baskota DK, Prasad R, Kumar Sinha B, et al. Distribution of lymph nodes in the neck in cases of tuberculous cervical lymphadenitis. Acta Otolaryngol. 2004;124:1095-8.
12. Skoog L, Tani E. Lymph nodes. In: Gray W, Mckee GT (Eds). Diagnostic Cytopathology, 2nd edition. London: Churchil Livingstone; 2003 . p. 508.
13. Bezabih M, Mariam DW, Selassie SG. Fine needle aspiration cytology of suspected tuber-culous lymphadenitis. Cytopathology. 2002;13: 284-90.
14. Gupta AK, Nayar M, Chandra M. Critical ap-praisal of fine needle aspiration cytology in tu-berculous lymphadenitis. Acta Cytol. 1992; 36: 391-4.
15. Lakmini KB, Ajith De S Nagahawatte. Diagnosis of tuberculous lymphadenitis: Combining cytomorphology, microbiology and molecular techniques - A study from Sri Lanka. Indian J Pathol Microbiol. 2008;51:195-7.
16. Nataraj G, Kurup S, Pandit A, et al. Correlation of fine needle aspiration cytology, smear and culture in tuberculous lymphadenitis: a pros-pective study. J Postgrad Med. 2002;48:113-6.
17. Metre MS, Gita J. Acid fast bacilli in aspiration smear from tuberculous lymph nodes: An anal-ysis of 255 cases. Acta Cyto. 1987;31:17-9.
18. Wondwossen E, Alemayehu Bekele. Acid fast bacilli in aspiration smear from tuberculous pa-tients. Ethiop J Health Dev. 2000;14:99-104.
19. Sekar B, Selvaraj L, Alexis A, et al. The utility of IS6110 sequence based polymerase chain reaction in comparison to conventional methods in the diagnosis of extra-pulmonary tuberculosis. Indian J Med Microbiol. 2008;26:352-5.

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Published

06-02-2015

How to Cite

1.
Dhawan I, Gupta O, Kaushik A, Ranga S, Kasana D, Gupta PK. Cytomorphological spectrum and Ziehl-Nelson staining in suspected tuberculous lymphadenitis: A study of 100 cases. Ann of Pathol and Lab Med [Internet]. 2015 Feb. 6 [cited 2024 Dec. 23];2(1):A36-A41. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/60

Issue

Vol. 2 No. 1 (2015)

Section

Original Article

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Copyright (c) 2015 Indrani Dhawan, Oneal Gupta, Ankit Kaushik, Sunil Ranga, Dimple Kasana, Prem Kumar Gupta

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