Spectrum Of Cytological Findings In Patients With Lymphadenopathy In Rural Population Of Southern Haryana, India - Experience In A Tertiary Care Hospital
A Kochhar, G Duggal, K Singh, S Kochhar
fnac, lymphadenopathy, lymphoma, tuberculosis
A Kochhar, G Duggal, K Singh, S Kochhar. Spectrum Of Cytological Findings In Patients With Lymphadenopathy In Rural Population Of Southern Haryana, India - Experience In A Tertiary Care Hospital. The Internet Journal of Pathology. 2012 Volume 13 Number 2.
Lymphadenopathy is one of the most common clinical presentations of patients attending the outdoor department. Fine Needle Aspiration Cytology (FNAC) is a reliable, simple, safe, rapid and inexpensive method of establishing the diagnosis of lesions and masses at various sites and organs1. Lymph node aspiration is of great value for the diagnosis of lymphadenitis, lymphomas and metastatic carcinoma(6,7). The present randomized study was undertaken to study non-neoplastic and neoplastic lesions of enlarged lymph nodes by FNAC in patients presenting with lymphadenopathy referred to cytology section of pathology department from the OPD/IPD of Maharaja Agresen Medical College, Agroha, (Hisar) over a period of one year. A study was carried out to know the overall prevalence of various causes responsible for cervical lymphadenopathy. The study was also carried out to know the distribution of various lesions among the different age groups. The present study also tried to evaluate the FNAC as a diagnostic tool in our clinical setup. FNAC is also done for confirmation of peripheral lymph node metastasis of a known and occult primary lesion and it can help the clinician to know about the primary site.
Material And Method
A total of 182 patients presenting with superficial palpable lymph nodes, who were referred to cytology section of pathology department from the OPD/IPD of Maharaja Agrasen Medical College situated in Agroha village covering the rural population of southern Haryana, were studied over a period of one year. In each instance, a brief history and physical examination along with evaluation of relevant investigations, if available, was carried out. FNAC procedure performed by pathologist using 22-24 G needle attached to 10 - 20 mL syringe. Aspirated material was smeared on the slides in each case. Slides were immediately put into the fixative solution and air-dried. Alcohol-fixed smears were stained by Haematoxylin and eosin and Papanicolaou method. The air-dried smears were stained with May-Grunwald-Giemsa (MGG) stain. Special stains like Ziehl Neelson (ZN) stain for acid-fast bacilli and Periodic Acid Schiff (PAS) stain were used whenever required.
The study included 182 patients with lymphadenopathy swellings. Out of 182 patients with palpable lymphadenopathy, in two (1%) cases, FNAC was inconclusive due to unsatisfactory smears. There were 84 (46.15%) female and 98 (53.84%) male patients with an age range of 1–70 years. Tuberculous lymphadenitis and reactive hyperplasia were the most common lesions seen (35.7% and 31.3% respectively), followed by metastatic carcinoma in 20.3%, suppurative lymphadenitis in 9.8% and lymphomas in 2.7% (Hodgkin's 1.09%, Non Hodgkin's 1.64%) of the cases (Table-1). Reactive hyperplasia was seen most often (60%) in first two decades of life, 58.9% tuberculous lymphadenitis in the second and third decades (66%) and incidence of metastatic carcinoma are high during fourth decade of life and after 40 years of age. Males showed preponderance of reactive hyperplasia, lymphoma and metastatic carcinoma, while tuberculous lymphadenitis showed a slight female preponderance. Cervical lymph nodes were involved in all types of lymphadenopathies (Table-III). Squamous cell carcinoma is the most common metastatic lesions of lymph node and comprise of 81.63% of the cases. (Table-V). Metastatic lesions of lymph node are more common in males whereas metastatic lesions from carcinoma breast were seen exclusively in females (Table-V). Cervical lymph node is the most common site for metastasis of squamous cell carcinoma. (Table-V). Axillary lymph nodes are common site for metastasis from breast malignancy.
FNAC is inexpensive, completely safe and quick method for diagnosis of lymphadenopathy and it reduces the need for surgical biopsy. We have presented our experience with 182 cases of lymphadenopathies over a period of one year. In the present study, diagnosis was based on definite cytomorphological findings with clinicocytological correlation. Our primary aim was to help the clinician in arriving at an early diagnosis in cases presenting with lymphadenopathy. The pattern of lesions consisted of tuberculous lymphadenitis, reactive lymphadenopathy, metastatic carcinoma, suppurative lymphadenitis, lymphoma and metastatic lymphadenopathy seen in our study, more or less is same as reported in other studies in India and other developing countries2,8,10. Maximum numbers of cases in our study are of tuberculous lymphadenitis. In India, tuberculous lymphadenitis is one of the most common types of lymphadenopathy encountered in clinical practice2,8,9,10, whereas it is in sharp contrast to very low frequency of 1.6% in developed countries11. The highest incidence of tuberculous lymphadenitis was seen in second and third decades with female preponderance and decreasing incidence with age. Patra et al8 had 37.8% cases of tuberculosis while the present study has 35.71% cases. This was quite close to our studies. A similar study was done by Khajuria et al10, which showed Tubercular lymphadenitis as 52.3% and Bhaskara et al9 found 67.57% (Table VII). All these authors' studies, including our study, suggest that Tubercular lymphadenitis is the most common cause of lymphadenopathies. The discrepancy in results is due to a wide variation in study age group and socio-economic condition of the patients. The highest incidence of reactive hyperplasia was seen in first two decades of life (74.5%) with a male preponderance. These findings are in agreement with experiences of Gupta
Metastatic malignancies are significantly more common in males. The superficial lymph nodes are common sites of metastasis. On comparing lymph node group involved in metastatic lesions, it has been seen that cervical lymph nodes are most commonly involved in metastatic lesions. Squamous cell carcinoma is the most common metastatic lesion. In diagnosis of metastatic malignancy, lymph node aspiration is as rewarding as surgical biopsy. Metastatic carcinoma was observed in 14.5% of cases by Patra AK et al8, 3.8% cases by Ruchi Khajuria and 5.6% cases by Bhaskara et al2, which is in sharp contrast to our studies showing 20.7%
In conclusion, FNAC is a reliable diagnostic tool in evaluation of lymphadenopathy for both screening and follow-up and can be performed as an outpatient’s procedure. In our study, the predominant cause of enlarged neck nodes was tuberculous lymphadenitis, followed by reactive lymphadenitis and malignant neoplasm, especially metastatic carcinoma and lymphoma. We concluded from the present study that tuberculous lymphadenitis is the most common problem in patients presenting with lymphadenopathy in our set-up, followed by non-specific lymphadenitis and malignant neoplasms, especially metastatic carcinoma. In addition, FNAC is an easy and reliable procedure.