Masilamani Suresh, Arul P, Akshatha C
Department of Pathology, Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu, India.
J Nat Sci Biol Med. 2015 Aug;6(Suppl 1):S134-8. doi: 10.4103/0976-9668.166121.
One of the most common causes of lymphadenopathy in India is tuberculosis. It can be diagnosed by a minimally invasive procedure known as fine-needle aspiration cytology (FNAC), and thereby unnecessary surgical interventions are avoided.
This study was undertaken to evaluate cytomorphological patterns of tuberculous lymphadenitis including human immunodeficiency virus-positive cases, to correlate the acid-fast Bacilli (AFB) positivity with cytomorphological patterns and also to find out overall AFB positivity.
In this study, a total of 212 cases of cytologically proven tuberculous lymphadenitis were retrieved and analyzed retrospectively between March 2012 and March 2015 for three different cytomorphological patterns (epithelioid granuloma without necrosis [pattern A], epithelioid granuloma with necrosis [pattern B], and necrosis without epithelioid granuloma [pattern C]) and bacillary loads on Ziehl-Neelsen stain (ZN) for AFB.
Pattern A through C was observed in 40 (18.9%), 102 (48.1%), and 70 (33%) cases, respectively. AFB positivity was found in 2 (5%) cases of pattern A, 62 (60.8%) cases of pattern B, and 54 (77.1%) cases of pattern C. The highest percentage of AFB positivity (64.7%) was observed in aspirate containing purulent/pus and caseous/cheesy material. The overall AFB positivity was seen in 55.7% (118/212) cases. On grading of AFB positivity, Grade 1+ was observed in 29.7%, Grade 2+ was observed in 28.8%, and Grade 3+ was observed in 41.5% cases.
FNAC is a sensitive, simple, convenient, safe, minimally invasive procedure to diagnose tuberculous lymphadenitis. Study of both cytomorphological patterns and ZN staining for AFB can improve the diagnostic yield. Regardless of the presence of granuloma, ZN stain must be employed whenever infective pathology is suspected.
在印度，淋巴结病最常见的病因之一是结核病。它可通过一种名为细针穿刺细胞学检查（FNAC）的微创程序进行诊断，从而避免不必要的手术干预。
本研究旨在评估结核性淋巴结炎的细胞形态学模式，包括人类免疫缺陷病毒阳性病例，将抗酸杆菌（AFB）阳性与细胞形态学模式相关联，并找出总体AFB阳性率。
在本研究中，回顾性检索并分析了2012年3月至2015年3月期间共212例经细胞学证实的结核性淋巴结炎病例，观察三种不同的细胞形态学模式（无坏死的上皮样肉芽肿[模式A]、有坏死的上皮样肉芽肿[模式B]和无上皮样肉芽肿的坏死[模式C]）以及齐-尼氏染色（ZN）检测AFB的杆菌载量。
分别在40例（18.9%）、102例（48.1%）和70例（33%）病例中观察到模式A至模式C。在模式A的2例（5%）病例、模式B的62例（60.8%）病例和模式C的54例（77.1%）病例中发现AFB阳性。在含有脓性/脓液和干酪样/奶酪样物质的抽吸物中观察到最高的AFB阳性率（64.7%）。总体AFB阳性率在55.7%（118/212）的病例中可见。在AFB阳性分级中，1+级在29.7%的病例中观察到，2+级在28.8%的病例中观察到，3+级在41.5%的病例中观察到。
FNAC是诊断结核性淋巴结炎的一种敏感、简单、方便、安全的微创程序。对细胞形态学模式和AFB的ZN染色进行研究可提高诊断率。无论是否存在肉芽肿，只要怀疑有感染性病理情况，就必须采用ZN染色。
