CORRELATION OF CYTOMORPHOLOGY WITH ZN AND AR POSITIVITY ON FNAC IN THE DIAGNOSIS OF EXTRA PULMONARY TUBERCULOSIS

BACKGROUND: FNAC is a minimally invasive procedure with a signicant diagnostic role in extrapulmonary tuberculosis. ZN Stain for demonstration of mycobacterium tuberculosis is extensively used. However, it has low sensitivity. Fluorochrome stain like Auramine- Rhodamine (AR) appear to be more likely to detect tubercular bacilli than ZN stain and also reduces the examination time. To study the OBJECTIVES: correlation of cytomorphology of extrapulmonary tuberculosis(EPTB) obtained on FNAC with ZN and AR positivity. MATERIALMETHODS: A total of 250 patients were taken, that were referred to the Department of Pathology, Jawaharlal Nehru Medical College, AMU, Aligarh from October 2015 to November 2017. Samples were collected by FNA and smears prepared were stained with H&E, ZN and AR stain. Smears were observed for positivity of Acid Fast Bacilli (AFB). Culture was taken as gold standard. RESULTS: The most common site of extra pulmonary tuberculosis was cervical lymph node seen in 76.4% cases and the most common cytomorphological pattern on FNAC was epithelioid cell granuloma with necrosis seen in 86.4% cases. The sensitivity of AR stain in picking up AFB was found to be 63.4% and the specicity was 81.9%, whereas ZN stain had a low sensitivity of 45.3% but had a high specicity of 87.9%. Statistically signicant difference between the two stains was seen on applying chi square test (p<0.001). Cohen's kappa coefcient for ZN vs AR stain was 0.65 and the strength of agreement between the two stains was substantial CONCLUSION: AR stain is more sensitive than ZN stain in diagnosing extrapulmonary tuberculosis and on combining it with cytomorphology it can help increase the diagnostic yield.

Diagnosis and differential diagnosis of pulmonary sarcoidosis

Pulmonary sarcoidosis is one of the most common interstitial lung diseases. The prevalence in Russia is 10-20 per 100 thousand population. Overwhelmingly it is found among working age population, and the peak of morbidity is 30-40 years. In half of the cases, sarcoidosis occurs in oligosymptomatic form. According to research conducted by our scientists, the adverse course of the disease with exacerbations and progressive decrease in pulmonary function found in 27,3% of patients. The diagnosis is based on clinical, X-ray and histological examination. Material for histological study was prepared depending on the extent of the process. Preference is given to minimally invasive methods of biopsy: transbronchial puncture of intrathoracic lymph nodes, peripheral lymph nodes, bone marrow aspiration, skin sarcoid items, etc. In the case of the intrathoracic localization of the disease, the treatment of choice is videothoracoscopy. The detection of epithelioid cell granuloma without necrosis confirms the diagnosis of sarcoidosis. First of all it is necessary to exclude tuberculosis, oncohematological diseases, disseminated lung diseases, combined with alveolitis syndrome and mediastinal lymphadenopathy. The primary diagnosis should be carried out under conditions of a multifunctional clinic. The verification of the pulmonary sarcoidosis should be held in close cooperation of different specialists: pulmonologists, radiologists, thoracic surgeons, pathologists, etc. Further treatment of the patient should be implemented by the pulmonologist in the place of residence. A clinical case of late diagnosis of diffuse diseases of connective tissue, which at its beginning started under the mask of sarcoidosis is demonstrated. The main mistake that led to deep disability of the patient, was absence of timely histological verification of the diagnosis.

Certolizumab Pegol-Induced Folliculitis-Like Lichenoid Sarcoidosis in a Patient with Rheumatoid Arthritis

Anti-tumor necrosis factor α (TNF-α) biologic agents are used for treating refractory sarcoidosis. However, sarcoidosis-like epithelioid cell granulomas may develop during anti-TNF-α treatment. A 63-year-old man suffering from rheumatoid arthritis was treated with oral methotrexate and methylprednisolone for 4 years. He subsequently started biweekly subcutaneous injections of certolizumab pegol. Three months later, light red follicular papules developed on his chest and they spread over the trunk and bilateral upper arms. Histopathology of a lesion showed a sharply demarcated noncaseating epithelioid cell granuloma with multi-nucleated giant cells in the upper perifollicular area. The follicular papules subsided following discontinuation of certolizumab pegol. Folliculitis-like lichenoid sarcoidosis should be included among the adverse cutaneous reactions of anti-TNF-α treatment.

Cytopathological and Microbiological Profile of Tuberculous Lymphadenitis in HIV-Infected Patients with Special Emphasis on Its Corroboration with CD4+ T-Cell Counts

Objectives: The present study was performed to evaluate various cytological patterns and acid fast bacillus (AFB) grades in HIV-infected patients with tuberculous lymphadenitis and to correlate these with each other as well as with peripheral CD4+ T-cell counts. Study Design: Ninety-two HIV-seropositive patients, cytologically diagnosed with tuberculous lymphadenitis, were evaluated. Fine needle aspiration cytology was performed as an outpatient procedure. Sonographic guidance was sought for internally sited lymph nodes. Cytopathological details were assessed on routinely stained and Ziehl-Neelsen-stained smears. Appropriate AFB grades were assigned. CD4+ T-cell counts were obtained immediately. Finally, the cytopathological findings, AFB grades and CD4+ T-cell counts were corroborated with each other. Results: Epithelioid cell granuloma in the presence of caseation appeared to be the most frequent (66.3%) cytomorphology on aspirated smears. AFB grades 3+ (37%) and 4+ (35.9%) were the commonest patterns of bacillary involvement. The mycobacterial density and cytological features significantly correlated with CD4+ T-cell counts. Conclusions: In HIV-associated tuberculous lymphadenitis, AFB grade and CD4+ T-cell counts worsen with the appearance of necrosis. Here, the peripheral CD4+ T-cell counts inversely correlated with bacillary load. Collectively, peripheral CD4+ T-cell counts, cytological findings and AFB grade exemplify the immune status in these patients.