Patterns of Lymph Node Pathology; Fine Needle Aspiration Biopsy as an Evaluation Tool for Lymphadenopathy: A Retrospective Descriptive Study Conducted at the Largest Hospital in Africa

Abstract

BackgroundLymphadenopathy is a common clinical presentation of disease in South Africa (SA), particularly in the era of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) co-infection.MethodsData from 560 lymph node biopsy reports of specimens from patients older than 12 years at Chris Hani Baragwanath Academic Hospital (CHBAH) between 1 January 2010 and 31 December 2012 was extracted from the National Health Laboratory Service (NHLS), division of Anatomical Pathology. Cytology reports of lymph node fine needle aspirates (FNAs) performed prior to lymph node biopsy in 203 patients were also extracted from the NHLS. Consent was not obtained from participants for their records to be used as patient information was anonymized and de-identified prior to analysis.ResultsThe majority of patients were female (55%) and of the African/black racial group (90%). The median age of patients was 40 years (range12–94). The most common indication for biopsy was an uncertain diagnosis (more than two differential diagnoses entertained), followed by a suspicion for lymphoma, carcinoma and TB. Overall, malignancy constituted the largest biopsy pathology group (39%), with 36% of this group being carcinoma and 27% non-Hodgkin lymphoma. 22% of the total sampled nodes displayed necrotizing granulomatous inflammation (including histopathology and cytology demonstrating definite, and suspicious for mycobacterial infection), 8% comprised HIV reactive nodes; in the remainder no specific pathology was identified (nonspecific reactive lymphoid hyperplasia). Kaposi sarcoma (KS) accounted for 2.5% of lymph node pathology in this sample. Concomitant lymph node pathology was diagnosed in four cases of nodal KS (29% of the subset). The co-existing pathologies were TB and Castleman disease. HIV positive patients constituted 49% of this study sample and the majority (64%) of this subset had CD4 counts less than 350 cells/ul. 27% were HIV negative and in the remaining nodes, the HIV status of patients was unknown. The most common lymph node pathologies in HIV positive patients were Mycobacterial infection (31%), HIV reactive nodes (15%), non-Hodgkin lymphoma (15%) and nonspecific reactive lymphoid hyperplasia (15%). Only 8.7% were of Hodgkin lymphoma. In contrast, the most common lymph node pathologies in HIV negative patients were nonspecific reactive lymphoid hyperplasia (45%), carcinoma (25%) and Mycobacterial infection (11%). In this group, non-Hodgkin lymphoma and Hodgkin lymphoma constituted 9% and 8%, respectively. There were more cases of high-grade non-Hodgkin lymphoma in the HIV positive group compared to the HIV negative group. FNA and lymph node biopsy had statistically significant good agreement with regard to Hodgkin lymphoma (K 0.774, SE 0.07, 95% CI 0.606-0.882, p=0.001), non-Hodgkin lymphoma (K 0.640, SE 0.07, 95% CI 0.472-0.807, p=0.001), carcinoma (K 0.723, SE 0.069, 95% CI 0.528-0.918, p=0.001), and mycobacterial infection (K 0.726, SE 0.07, 95% CI 0.618-0.833, p=0.001).ConclusionsThe most common lymph node pathologies in CHB...

Aspiration cytology study of lymphadenopathy: Is EPTB a common pathology? A three-year retrospective study in Melmaruvathur teaching hospital

“…In our study the predominant age group affected with lymphadenopathy were between 5-10 years among children (57%) and 15-30 years among adult (52%) whereas study by Srivatsav showed predominance of lymphadenopathy among 21-50 years (49.11%) followed by 0-20 years (36.98%) [4] . Our study showed females preponderance for lymphadenopathy (60%) especially among adult between 15-30 years of age than male which was supported by other studies where the female predominance observed were 55% and 61% respectively [5,6] . Similar to other studies, cervical lymphadenopathy was a common presentation in our study.…”

Cytological Findings of Malignant and Benign Head and Neck Masses in Somalia

“…However, Africa has seen an increase in the TB burden [10]. In particular, TB lymphadenitis is the most common extrapulmonary manifestation in developing countries [11].…”

“…For example, in diagnosing TB lymphadenitis, FNAB is widely regarded as the diagnostic modality of choice. A study by Reddy et al [10] showed a good correlation between FNAB diagnosis and biopsy diagnosis in lymph node specimens. According to the study, in the event of inadequate FNAB samples, the result should be treated with reserve.…”

“…According to the study, in the event of inadequate FNAB samples, the result should be treated with reserve. If there is a clinical concern for nodal-based mycobacterial disease or malignancy despite a noncontributory FNAB, a clinically appropriate lymph node should be submitted for histopathologic assessment [10]. Fistula formation is seen in almost 10% of mycobacterial cervical lymphadenitis cases.…”

Lung Disease in Primary Antibody Deficiencies

“…Notably, skin biopsies from patients with unrestrained lymphoproliferation as a result of autoimmune lymphoproliferative syndrome show granulomatous pathology. 142 The progression of lymphoid hyperplasia to granulomatous inflammation is also observed in broader patient populations, where granulomatous inflammation was found in 22% of lymph node fine needle aspirations done to evaluate lymphadenopathy 143 as well as 20 of 38 biopsies for mediastinal lymphadenopathy in patients without CVID or known primary immune dysregulation disorder. 144 …”