Annals of Tropical Medicine and Public Health
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Year : 2014  |  Volume : 7  |  Issue : 6  |  Page : 255-262

Cytomorphological tissue reaction patterns in lymph node tuberculosis and their correlation with bacterial density

1 Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
2 Department of Pathology, University College of Medical Sciences, Guru Tegh Bahadur Hospital, Delhi, India

Correspondence Address:
Ruquiya Afrose
Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.155019

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Background: The diagnosis of extrapulmonary lymph node tuberculosis (TB) is made by the demonstration of different cytomorphological tissue reaction patterns on fine needle aspirations (FNA) smears; however, definitive diagnosis is made by demonstration of AFB by culture or Ziehl-Neelsen (ZN) stained smears. This procedure is technically demanding and time consuming, and is liable to fail on occasion for unexplained reasons. If the identification of cytomorphological patterns could predict bacterial density, it would help to improve diagnostic accuracy and also serve as a control on the acid-fast staining procedure. Therefore this study was being undertaken to determine the correlation between bacterial density and cytomorphological patterns in lymph node TB. Materials and Methods: FNA was performed on 505 clinically-suspected lymph node TB patients. May Grunwald Giemsa stained smears were used to analyze cytomorphological patterns and ZN stained smears for acid-fast bacilli (AFB) detection. Bacterial density (BI) was calculated by utilizing Ridley's logarithmic scale. Results: Seven distinct cytomorphological tissue reaction patterns were observed. Pattern 1 was predominantly an exudative response, comprising of neutrophils and mononuclear phagocytes and was the most common tissue reaction pattern, seen in 160 out of 505 patients (31.6%). Pattern 4, epithelioid cell granulomas with necrosis, was the second most common and seen in patients (29.3%). This study showed that multibacillary lesion (BI>1) was more often associated with pattern 1. Although the BI varied significantly across different cytomorphological tissue reaction patterns (P value = 0.004), no specific trend was observed as both paucibacillary as well as multibacillary lesions were noticed with different proportions among all tissue reaction patterns. Conclusion: The present study showed that multibacillary disease is more frequently associated with pattern 1 compared to pattern 4. However, more studies are needed to establish a trend among different cytomorphological tissue reaction patterns.

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