Surgical Lymph Node Biopsy in the Diagnosis of Tuberculous Lymphadenopathy

Background: Lymphadenopathy is a common problem in medical practice. Tuberculous lymphadenitis is among the commonest causes of lymphadenopathy in the developing world. Objectives: To describe the clinical presentations and the investigations for the diagnosis of lymphadenopathy. To study cases of tuberculous lymphadenitis with a view to determining the value of clinical and investigative diagnostic indices. Materials & Methods: A prospective observational study was conducted to describe the clinical presentations and the pathological diagnoses resulting from (76) surgical lymph node biopsies in patients (44 male, 32 female) with enlarged lymph nodes admitted to Al-Yarmouk Teaching Hospital in Baghdad (during the period from 1 st Jan. 2001 to 31 st Dec. 2002). Results: 30 patients out of 76 (39.4%) had Tuberculous Lymphadenitis, while 20 patients (26.3%) had Non-specific lymphadenitis, 12 patients (15.8%) had Lymphoma, 10 patients (13.1%) had Neoplastic metastases, and the rest 4 (5.4%) had other diagnoses like brucellosis & toxoplasmosis. The epidemiological, clinical, and investigative results of 30 patients with tuberculous lymphadenopathy were analyzed. While cervical lymphadenopathy predominated (60%), the classical clinical features of tuburculous infection both local and general were frequently absent. Almost only third of the cases (33.33%) had a normal ESR (< 20mm/hr) and only (30%) had lymphocytosis. A clinical diagnosis of tuberculous lymphadenopathy was accordingly made in only (18) patients (60%). Conclusion: This study emphasizes the need of a high index of diagnostic suspicion of tuberculosis when confronted with peripheral lymphadenopathy in developing countries, and the need of surgical LN biopsy in confirming the diagnosis. : ةصلاخلا ثحبلا ةيفلخ ٜف ٔى باثسلاا ٌٕا ٍِ حٝٗافَيىا ذقؼىا ُرذذ زثرؼٝ ،ٜثطىا وَؼىا ٜف حؼئاش حينشٍ ٕ٘ حٞطٞحَىا حٝٗافَيىا ذقؼىا ٌخعذ : .ٍٜاْىا ٌىاؼىا فادهلاا .حٝٗافَيىا ذقؼىا ٌخعذ ٚظزٍ صٞخشرى جازجَىا خاص٘حفىاٗ حٝزٝزسىا خافصىا حسارد : ثحبلا ةقيرط فصىا حسارد ٌذ : ( ـــى حٝٗافَيىا ذقؼيى ٜجٞسْىا صٞخشرىاٗ حٝزٝزسىا خا 76 ) ٜف حٝٗافَيىا ذقؼىا ٌخعرت باصٍ ًاعٝزٍ ٍِ جزرفيى داذغت ٜف َٜٞيؼرىا كٍ٘زٞىا ٚفشرسٍ 1 / 1 / 2001 حٝاغى 31 / 12 / 2002 جئاتنلا ( ُأ ِٞثذ : 39.4 ونــش اَْٞت حٝٗافَيىا ذقؼىا ُرذذ ٍِ ُّ٘اؼٝ اّ٘ام ٌٍْٖ )% باٖرىا ىا ذقؼىا حٝٗافَي ( دذحَىا زٞغ 26.3 )% اٍا ( ُانف )اٍ٘فَيىا( ٜئاذرتلاا حٝٗافَيىا ذقؼىا ًرٗ 15.8 ( حٝٗافَيىا ذقؼىا ٚىإ جزشرَْىا حّٝ٘اثىا ًارٗلأاٗ )% 13.1 .)% خاشَٞىا باٞغ ظح٘ى اَم . حٞثقزىا ذقؼىا ٜٕ ُرذرىات حتاصَىا حٝٗافَيىا ذقؼىا ٌظؼٍ ُأ ِٞثذ ٜف ُرذريى حٝذٞيقرىا حٝزٝزسىا ٌظؼٍ زَحىا ًذىا خاٝزم ةٞسزذ هذؼٍ ُأ حظحلاٍ ٌذ . حٝساٖجىا ٗأ حٞؼظَ٘ىا ءا٘س ٚظزَىا E.S.R ف غفذزٝ ٌى ( ٜ 33,33 )% ٍِ ( ُأ اَم ُرذرىات ِٞتاصَىا ٚظزَىا 30 لىذى . )دٝاس٘فَيىا( حٝٗافَيىا طٞثىا ًذىا خاٝزم دذػ ٜف جداٝس ٌٖٝذى ػقف ٚظزَىا ٍِ )% ىا ُرذرى ٛزٝزسىا صٞخشرىا ُام ( ٜف ٜجٞسْىا صحفىا غٍ قتاطٍ حٝٗافَيىا ذقؼ 53,3 )% ػقف .ِٞتاصَىا ٚظزَىا ٍِ تاجاتنتسلاا ذقؼىا ٌخعرت ِٞتاصَىا ٚظزَىا ٙذى زٞثم ونشت ُرذريى ءاثغلأا غق٘ذ ٚىإ حجاحىا ٚيػ ء٘عىا حسارذىا ٓذٕ دطيس : ا اّزطق اٍْٖٗ حٍٞاْىا هٗذىا ٜف جزشرَْىا ضازٍلأا ٍِ ُرذرىا ُ٘م حٝٗافَيىا ذقؼيى حٞحازجىا عشخىا ٚىا حجاحىا لىذم . شٝشؼى . صٞخشرىا دٞثثرى حٝٗافَيىا Introduction: Tuberculosis is one of the most important infectious diseases in Iraq [1]. Several reports have alluded to the significance of tuberculosis in the developing world [2,3]. The early involvement of lymphatic system in the pathogenesis of tuberculosis is universally known [4]. Clinical rsity , Vol. 7 No.2 Scientific . 2009 Journal of Kerbala Unive 28 lymphadenopathy is accordingly a frequent feature of tuberculosis and publications from both western hemisphere [5, 6] and Iraq [7] rate as the commonest non-respiratory form of the disease. Surgical lymph node biopsy thus plays an important role in the diagnosis of tuberculosis. The importance of lymph node biopsy in the investigation of clinical lymphadenopathy in Iraq is high because of the prevalence of lymphoma and Tuberculosis in Iraq. The studies from western hemisphere proved that malignancies were the leading cause of lymphadenopathy [8], while in developing countries tuberculosis proved to be commonest cause of lymphadenopathy. This study reviews 76 cases subjected to surgical lymph node biopsy and further analysis of 30 patients in whom the histological findings were those of tuberculous lymphadenitis with a view to determining the value of clinical and investigative diagnostic indices. Materials & Methods: Seventy six cases had undergone excisional lymph node biopsy at Al-Yarmouk Teaching Hospital in Baghdad from 1 st January, 2001 to 31 st December 2002. The biopsy procedure involved the removal of one or more entire lymph nodes by surgical operation under general anesthesia.The histological findings in each case were analyzed. Thirty cases in which pathological diagnosis was tuberculosis were studied further. The age and sex distribution were determined. The clinical features and investigations results were reviewed with particular reference to the manifestations and diagnosis of tuberculosis. Results: There were 20 males and 10 females among the 30 patients with tuberculous lymphadenitis. The male: female ratio being 2:1, while in nonTB patients the ratio was nearly equal. The patients’ ages ranged from 2 years to 51 years (The mean age being 29 years). The age and sex distribution of the patients is depicted in Table 1. Table 1: A: Age and sex distribution of Tuberculous patients Age Males Females Total %