Cervical lymphadenopathy: a clinicopathological study
Keywords:Cervical lymphadenopathy, FNAC, Tubercular lymphadenitis, Reactive lymphadenitis, Malignant lymphadenitis
Cervical lymphadenopathy is one of the commonest presentations of underlying pathology of the head and neck region which has large number of differential diagnosis like neoplasms, infections (specific and non-specific), immune deficiency disorders and rare disorders like Inflammation. Pseudotumour (plasma cell granuloma) and Kikuchi-Fujimoto disease.
Methods: The present study is a prospective study conducted in our institution Dr B.A.M. Central Railway Hospital, Mumbai. Our study included 115 patients with cervical lymphadenopathy presenting with swelling of more than 1.5 cm size in longest diameter. All the patients included in our study are more than 12 years of age, in whom the lymph node did not regress after adequate antibiotic therapy in acute cases (i.e. Conservative management for at least 2 week), and all the chronic cervical lymphadenopathy patients.
Results: Tuberculosis was found to be the most common cause of cervical Lymphadenopathy in 54.78% cases followed by reactive lymphadenitis in 22.61% cases, chronic nonspecific lymphadenitis in 12.17% cases and metastatic lymphadenopathy in 7.83% cases. Other causes were unknown primary in 1.74% cases and non-Hodgkin’s lymphoma in 0.87% cases. Sensitivity and specificity of FNAC was 79.36% and 100% respectively.
Conclusions: Tuberculosis, reactive lymphadenitis and malignancy are the most important cause of cervical Lymphadenopathy. They present in different age groups with different clinical feature. Fine Needle Aspiration Cytology (FNAC) is extremely sensitive and highly specific investigation for early diagnosis
King D, Ramachandra J, Yeomanson D. Lymphadenopathy in children: refer or reassure?"Archives of disease in childhood. Education and practice. 2014;99:101–10.
Cummings Otolaryngology Head & Neck Surgery, Fifth Edition. Vol 2, Section 6. Chapter 116. Differential Diagnosis of Neck Masses.
Jha BC, Das A Nagarkar NM, Gupta R, Singhal S. Cervical Tuberculosis Lymphadenopathy: changing clinical pattern and concept in management.BMJ Post graduate Med J. 2000;7(7):185-7.
Bedi RS, Thind GS, Arora VK. A Clinico-Pathological, study of superficial Lymphadenopathy In Northern India. Intl J Tub. 1987;3(4):189-92.
Shafiullah S, Shah SH Rehman A, Arshad H, Norin B. Tuberculosis lymphadenitis in Afghan Refugee. J Ayub Med Coll Abottabad. 2001;20(2):463-5.
Mutiullah S, Ahmad Z, Yunus M, Marphani MS. Evaluation of tuberculous cervical Lymph-adenopathy. Pakistan J Surg. 2009;25(3):176-8.
Umer MF, Mehandi H, Muttaki A, Hussain A. Presentation and etiological aspects of cervical Lymphadenopathy at Jinnah Medical College Hospital Korangi, Karachi. Pak J Surgery. 2009;25(4):224-46.
Wahid F, Rehman H, Iftikhar A. Extrapulmonary tuberculosis in patients with cervical Lymphadenopathy. JPMA. 2013;6(3):94-6.
Saeed I, Anjum S, Akhlaq M. Frequency of Tuberculosis in Cervical Lymphadenopathy.
Maharjan M, Hirachand S, Kafiie PK, Bista M, Shrsth S. Incidence of tuberculosis in enlarge neck node our experience. Kathmandu Univ Med J. 2009;7(25):54-5.
Shresth D, Thapa P, Dalal M. Tuberculous and Non tuberculous cervical lympahdenities -A clinical review. Nepalise J ENT Head Neck Surg. 2012;1(2):12-3.
Maharjan M, Hirachand S, Kafiie PK, Bista M, Shrsth S et al. Incidence of tuberculosis in enlarge neck node our experience. Kathmandu Univ Med J. 2009;7(25):54-5.
Ismail M, Muhammad M. Frequency of tuberculosis in cervical lymphadenopathy. J Postgrad Med Inst. 2013;27(3):342-6.
Jalal BA, Elshibly EM. Etiology and clinical pattern of cervical Lymphadenopathy in Sudanese children. J Paediatr. 2012;12(1):97-100.
Baskota DK, Prasad R, Kumar, Sinha B, Amatya RL, Distribution of lymph nodes in the neck in case of tuberculous lymphadenitis. Acta Otolaryngol. 2004;124(9):1095-8.
Iqbal M, Subhan A, Aslam A. Frequency of tuberculosis in cervical Lymphadenopathy. J Surg Pak (Int). 2010;15(2):107-9.
Kim LH, Peh SC, Chan KS, Chai SP. Pattern of lymph node pathology in private pathology laboratory, Malaysia. J Pathol. 1999;21(2):87-93.
Jawahar MS, Sivasubramanian S, Vijayan VK. Treatment of lymph node tuberculosis-a randamised clinical trial of two 6 months regimens. Trop Med Int Health. 2005;10:1090-8.
Ahmad SS, Akhter S, Akhter NK, Mansoor, T Khalil S. Incidence of tuberculosis from study of fine needle aspitaion In Lymphadenopathy and acid fast staining. Indian J Comm Med. 2005;30(2).
Gupta KB, Sen R, Sen J, Verma R. Role of ultrasonography and CT in complicated cases of tuberculous cervical lymphadenopathy. Indian J Tuberculosis. 2007;54(2):71-8.
Hafeez M, Yusuf M, Inayatullah A, Khan R. Frequency of malignancy in cervical Lymphadenopathy. J Med science (Peshaver). 2011;19(3):138-40.
Rehman MA, Biswas MMA, Siddika ST, Sikder AM. Histomorphological pattern of Cervical Lymphadenopathy. J Enam Med. 2013;3(1):13-7.
Dwarsoki I. Tuberculosis of cervical Lymph nodes. Plucne Bolesti. 1989;4(34);169-71.