Association of Serum Adenosine Deaminase Levels in Cytologically Suggested Cases of Tubercular Lymphadenitis: The Experience of a Tertiary Care Centre

Background: Tuberculosis (TB), a communicable disease, caused by Mycobacterium tuberculosis requires a simple, rapid test, which can be easily carried out in a laboratory. Unfortunately, despite a battery of investigations, no definite test is available till date. Adenosine deaminase (ADA), a biochemical marker has been proposed as a useful surrogate marker for TB as its levels can be measured in body fluids. Methods: A one-and-a-half-year prospective study of 154 cases presenting with lymphadenitis from January 2019 to June 2020 was undertaken. Using cytology, lymphadenitis subjects were divided into two groups: Tubercular (104 patients) as a case group and Reactive (50 patients) as a control group. All cases were followed by serum ADA assay by colorimetric method. Nonparametric tests were performed to compare the two groups. Results: The mean age of the participants was 28.99 ± 13.26 years with a F:M ratio of 1.81:1. Involvement of cervical lymph nodes was most frequent (89.42% cases). The mean S.ADA level for tubercular and reactive lymphadenitis was 41.71 ± 11.53 U/L and 21.16 ± 4.16 U/L, respectively (P-value < 0.05). The cut-off value calculated was 32.6 U/L. The sensitivity, specificity, PPV, NPV, and accuracy were calculated as 79.81%, 100%, 100%, 70.42%, and 86.36%, respectively. Conclusion: A statistically significant increase was found in serum ADA levels in tubercular lymphadenitis cases compared to reactive lymphadenitis. Hence, it can be used as an adjunct to FNAC and is a fairly sensitive and specific test. Since it is difficult to always demonstrate AFB in FNAC smears, ADA can be helpful in establishing a definite diagnosis despite smear negativity. Keywords: adenosine deaminase, lymphadenitis, tuberculosis

TO STUDY THE CYTOMORPHOLOGICAL PATTERNS OF TUBERCULAR LYMPHADENOPATHY AND ITS HISTOPATHOLOGICAL CORRELATION

INTRODUCTION: Tubercular lymphadenopathy is one of the common clinical problems. Practically diagnosis of tuberculosis sometimes creates a challenge to the pathologist and clinician. A combined approach of cytology with aid of special stain and histopathological evaluation helps to conrm the diagnosis. AIM -The present study was carried out to evaluate the different cytological patterns of tuberculous lymphadenitis along with utility of special stain like Acid fast stain and further histopathological evaluation. MATERIAL AND METHOD: Smears from 833 cytologically diagnosed cases of tubercular lymphadenitis were prepared and stained with Hematoxylin and Eosin (H&E), Giemsa and Acid-fast stain. All the smears were categorized into four cytomorphological patterns and correlated with 250 histopathologically available cases. RESULT: Tuberculosis is the major cause of lymphadenopathy. Majority of cases (63 %) were in their second to third decades of life, with male to female ratio of 1:1.4. Cervical region was the most common site of involvement (83.5 %). Smear revealed epithelioid granulomas with caseous necrosis in maximum cases (46.9 %). AFB positivity was seen highest in smear revealing necrosis only with or without epithelioid cell (93,8 %). histopathological correlation was seen in 248 cases out of 250 available cases. CONCLUSION: FNAC has been proved very safe, highly sensitive, and rst line investigation in diagnosing tubercular lymphadenitis. The approach to tubercular lymphadenitis attains completeness with cytopathological, Acid Fast stain and histopathological evaluation.

A Giant Lymph Node—Liver Imposter

Abdominal tuberculosis has insidious course and is a diagnostic challenge. Tubercular lymphadenitis is associated with constitutional symptoms and multiple enlarged lymph nodes. Isolated giant lymph nodes are rare in tuberculosis and are common in lymphoma or malignancy. Peripancreatic mass on endosonography are commonly lymph node less than 4 cm. Isolated giant nonnecrotizing lymph node can mimic liver architecture on endoscopic ultrasound but lack a biliary connection.

Cervical lymphadenopathy: a clinicopathological study

Background: Aim of the study was to evaluate the clinical presentation and histopathological findings in patients presenting with cervical lymphadenopathy.Methods: Patients presenting to the outpatient units and admitted in the wards of departments of general surgery and onco-surgery, Yenepoya medical college hospital, Mangalore from December 2017 to December 2019 were included in the study.Results: From December 2017 to December 2019, 130 patients had presented with cervical lymphadenopathy to our hospital. Cervical lymphadenopathy was most common in the age group of 50-60 years and in males. The most common histopathological diagnosis was found to be secondaries in the neck. Multiple lymph node level involvement was more common.Conclusions: To conclude, cervical lymphadenopathy is seen frequently. In this study conducted in a tertiary centre 130 cases were reported in a span of two years of the study period. Further analysis of age and gender distribution, clinical and histopathological analysis suggested that in majority, age group was found to be above 50 years, with male preponderance. Commonest cause was secondaries in the neck (28.5%) followed by tubercular lymphadenitis (24.6%).

Histopathology of extra-pulmonary tuberculosis at pathology lab of Patan Hospital, Nepal

Introduction: Tuberculosis is a common condition in underdeveloped countries, with approximately 100,000 cases in Nepal today. Tuberculosis is the 6th leading cause of death in Nepal. This study aims to find out the Extra Pulmonary Tuberculosis in the specimen received in the pathology lab. Method: This is a retrospective descriptive study of the histopathology database of Extra Pulmonary Tuberculosis at the pathology lab of Patan Hospital, Nepal from 2012 to 2019. Data were analyzed for prevalence, cite, and pathology details. Ethical approval was obtained from the Institutional review committee of Patan Hospital. Result: There were 300(1%) Extra Pulmonary Tuberculosis out of 29629 specimens. The majority 170(57%) were from the lymph nodes, 36(12%) skin, followed by intestine and urogenital each 28 and 26(9%). Male to female ratio was 2:3 (n=116, 39% vs n=184, 61%). The most common age group was 20-39 years comprising 194(64%). Granuloma was present in 288(96%), and 21(7%) tested positive for Acid Fast Bacilli. Conclusion: Among the Extra Pulmonary Tuberculosis, more than half of them had tubercular lymphadenitis with granuloma present in the majority.

Epidemiology and the diagnostic challenge of extra-pulmonary tuberculosis in a teaching hospital in Ethiopia

Background Ethiopia reported a high rate of extra-pulmonary tuberculosis (EPTB) and the cases are increasing since the last three decades. However, diagnostic evidence to initiate TB treatment among EPTB cases is not well known. Therefore, we described the epidemiology and assessed how EPTB is diagnosed in a teaching hospital in Ethiopia. Methods We conducted a retrospective review among all adult EPTB cases diagnosed in Yekatit 12 Hospital Medical College from 2015 to 2019. Using a standardized data abstraction sheet, we collected data from patients’ medical records on sociodemographic, sites, and laboratory diagnosis of EPTB cases. Results Of the 965 total TB cases, 49.8%(481) had a recorded diagnosis of EPTB during the study period. The mean age of EPTB patients was 32.9 years (SD±13.9) and 50.7% were males. Tubercular lymphadenitis (40.3%), abdominal (23.4%), and pleural TB(13.5%) were the most common sites of EPTB involvement, followed in descending order by the genitourinary, skeletal, central nervous system, abscess, breast, and laryngeal TB. We found a histopathology finding consistent with EPTB in 59.1% of cases, Acid-fast bacilli positive in 1.5%, and the rest diagnosed on radiological grounds. In the majority of cases, more than one diagnostic method was used to diagnose EPTB cases. Conclusions Nearly half of TB patients had a recorded diagnosis of EPTB that comprise heterogeneous anatomical sites. All EPTB patients were started anti-TB therapy without definitive microbiology results. This indicates the diagnostic challenge of EPTB faced in our setting and proves to be significant for TB control in Ethiopia.

Hyperplastic thyroid nodule masquerading as parathyroid adenoma in a patient with tubercular lymphadenitis induced hypercalcaemia

Serum intact parathyroid hormone (iPTH) levels are high or high normal in patients with parathyroid adenoma. Rarely these patients can have normal or low serum iPTH values. With sandwich immunometric assays, an exceptionally high serum iPTH level can lead to falsely low measurement due to the ‘hook effect’. Here, we describe the case of a 66-year-old female patient with PTH-independent hypercalcaemia which mimicked parathyroid adenoma. A multidisciplinary team approach helped in the diagnosis and management leading to complete recovery.