Lymph nodes cytology in HIV seropositive cases with haematological alterations

BACKGROUND & OBJECTIVES Lymphadenopathy and haematological alterations are the earliest manifestations with other associated opportunistic infections and malignancies. Hence, there is a need for simple investigations like fine needle aspiration cytology (FNAC) for evaluation of HIV lymphadenopathy and a haemogram to interpret the haematological alterations. This study was undertaken to analyze the cytological patterns of lymph node lesions in HIV/AIDS patients, to compare with available clinico-pathological and haematological parameters to segregate lymphadenopathy cases for further evaluation. METHODS In the present study, 129 HIV seropositive patients were included. Lymph node aspirates were stained routinely with hematoxylin and eosin and Ziehl-Neelsen (Z-N) stains. Special stains and cultures were done in selected patients. Peripheral smears were taken from all the patients and CD4 counts were recorded. Tuberculous lymphadenitis was further categorized. Acid fast bacilli (AFB) grading was done on Z-N positive smears. Each lesion was compared with CD4 counts, WHO clinical staging and haematological picture. RESULTS Cytological diagnosis in 129 patients included tuberculous (n=54, 41.9%), reactive lymphadenopathy (n=46, 35.6%), suppurative (n=16, 12.4%) lymphadenitis, non-Hodgkin's lymphoma (n=4, 3.1%), and Hodgkin's lymphoma, secondary deposits, other granulomatous lesions, and cryptoccocal lymphadenitis in one patient each. The predominant cytomorphological pattern in tuberculous lymphadenitis was caseous necrosis + epithelioid granuloma formation (51.85%). Grade 2+ Z-N grading was noted in 62.96 per cent of AFB positive smears. CD4 counts showed a descending pattern with progression of WHO clinical staging. Cytopenia was more common in WHO clinical stage IV disease. INTERPRETATION & CONCLUSIONS Lymph node cytology was found to be a useful tool for segregating lymphadenopathy cases for further evaluation and for identification of opportunistic infections, neoplastic and non-neoplastic lesions. Comparison of lymph node lesions with CD4 counts, WHO clinical staging, haematological alterations and AFB grading reflects immunity, stage of disease and disease activity aiding better treatment.