A Study of Cytomorphological Patterns and their Diagnostic Importance in Tubercular Lymphadenopathy

Tuberculosis [TB] is a specific communicable disease and is one of the most common disease in developing countries like India. There are 20-25 million cases of infectious tuberculosis in the world.In India alone there are 12-15 million cases of primary tuberculosis of which about 2 million are bacillary cases at any given period of time.[PARK&PARK 1986].Currently, more people die of tuberculosis than from any other infectious disease. Death from tuberculosis comprises 25% of all avoidable deaths in developing countries2. Every minute, a death occurs due to tuberculosis in our country. To add to the existing burden, the situation is compounded by the large scale increase of new TB cases associated with increasing HIV infection. India is estimated to have 3.5 million HIV patients, and about 1.8 million of these are co-infected with TB5. Tuberculosis usually affects lungs and the next common entity is the tubercular lymphadenopathy [TLN.]

Many a time exact diagnosis of TLN poses a great problem to the clinician.This is because of wide spread nature of the disease and consequently symptomatolgy produced is very vague. In TLN specilised investigation like ELISA test,PCR etc.are also not always diagnostic. In pulmonary cases diagnosis can be confirmed by demonstrating AFB in the sputum but the same is not true for TLN. Inabiity to demonstrate AFB in most of the patients of TLN has prompted many workers 2,4 to develop serological tests. However these attempts have not so far resulted in providing a single reliable serological test for either pulmonary or extrapulmonary TB. Open surgical biopsy is a time consuming procedure and also this facility is not available at all centres in developing country like India. Thus in the present scenario, fine needle aspiration biopsy[FNAB] is recommended for evaluation of cytomorphological pattern[CMP] and its utility in establishing the diagnosis of tuberculosis [TB].