Comparative Cytomorphological Profile of Paediatric and Adult Lymphadenopathy with Emphasis on Smear Characteristics in Tuberculous Lymphadenitis

Aims

1. To compare the cytological spectrum of pediatric and adult lymphadenopathy.

2. To analyze the differences between and cytomorphological appearances of the aspirates from tuberculous lymph nodes in the two age groups.

Material and Methods

Fine needle aspirate (FNA) smears from 500 consecutive patients with peripheral lymphadenopathy, each in paediatric (≤ 14 years) and adult (> 14 years) age groups, were retrospectively analyzed. Smear patterns in tuberculous lymphadenitis were studied in detail. The smears were air dried and stained by May Grunwald Giemsa (MGG) stain. Ziehl Neilson (ZN) staining to demonstrate acid fast bacilli (AFB) was performed where necessary.

Observations

The most frequent diagnosis on FNA was tuberculosis in both age groups (children 57%, adults 82 %), followed by reactive hyperplasia in children (37.8 %) and metastasis in adults (7.9%). Frequency of tuberculosis was significantly more in adults (p <0.001) while that of reactive process was significantly more in children (p<0.001). Cervical lymph nodes were involved most frequently by tubercular process (children 87%, adults 84 %). Caseous material or pus was aspirated in almost 2/3rd patients. The most frequent microscopic pattern was presence of granulomas against a lymphoid background, followed by necrosis only and the highest AFB positivity was found in necrotic smears in both age groups. Acute/ mixed inflammatory response, devoid of granulomas, was observed significantly more often in children as compared to adults. (p< 0.001).

Conclusions

FNAC is a useful, minimally invasive first line investigation to evaluate lymphadenopathy. An early diagnosis on FNA allows clinicians to plan and institute appropriate treatment in most cases.