Kanagavel, V (2022) A Prospective Clinico Pathological study on Cervical Lymphadenopathy among Patients in a Tertiary Care Centre. Masters thesis, Stanley Medical College, Chennai.
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Abstract
The clinical material for this study includes the detailed history and investigation reports of 110 cases of cervical lymphadenopathy who had attended the DEPARTMENT OF ENT & HEAD AND NECK SURGERY, Government Stanley medical college between October 2020 to September 2021. All patients were subjected to FNAC and in relevant cases open biopsy was done. Based on the cytopathological diagnosis the various etiologies and their clinico-pathological correlation have been summarized below. 1. TUBERCULOUS CERVICAL LYMPHADENOPATHY: Tuberculous cervical lymphadenitis forms the major etiology in this study accounting for about (47%) 52 patients with the maximum incidence among 21-40 years age group. The most common group of lymph node involvement is Level II and Level V respectively. Based on the cytomorphology pattern the tuberculous lymph nodes were divided into following categories among which maximum patients 20/52 (38%) were presented with Caseating epithelioid granuloma followed by only caseation with 18(35%) while, non-caseating epithelioid granuloma and purulent with caseation shows 15% and 12% each respectively. overall AFB positivity 65.3%. After confirmation they were started on Anti tuberculosis treatment and checked periodically. 2.NON-SPECIFIC REACTIVE LYMPHADENITIS: Non-specific reactive lymphadenitis constitutes 33% of cervical lymphadenopathy with maximum incidence among 12-20 years age group. The most common presenting symptom along with cervical adenopathy are fever and pain with mean duration of presentation within 2 months and size 2-2.5 cm. The most common group of lymph node involvement is Level I and II each constitute 16 (14.5%) and 12 (10.9%) respectively. In Non-specific reactive lymphadenitis greater number of cases were presented with solitary swelling, discrete mobile and firm in consistency. In the present study FNAC was diagnostic among which 36/110 (33%) patients showed the cytomorphology pattern of polymorphs admixed with histiocytes suggestive of Reactive lymphadenitis. All confirmed cases were treated symptomatically and checked periodically. 3. METASTATIC SECONDARIES AND LYMPHOMA: Malignant metastatic secondaries and Lymphoma accounting for 19(17%) and 3(3%) respectively with greater number of cases among > 60 years age group and male predominance. It presented most commonly as neck swelling in association with other presenting symptoms such as pain, difficulty in swallowing, voice change and ulcers in oral cavity. Among the metastatic secondaries, squamous cell carcinoma was most common (77%) with underlying occult primary frequently from pharynx and larynx involving corresponding nodal level distribution which was statistically significant. Lymphoma accounts for 3 (3%) patients 2 were non-Hodgkin and one was a case of Hodgkin lymphoma associated with multiple level of neck nodes. All primary lesions were confirmed either by brushing cytology and concurrent punch biopsy with pan endoscopy. Whereas in lymphoma all 3 cases were confirmed by open biopsy. In advanced neck secondary treatment started with concurrent chemotherapy and radiotherapy meanwhile for lymphoma concurrent chemotherapy was initiated. All cases were followed up periodically for outcomes. CONCLUSION: 1. Most of the patients in this study series, belonged to the age group of 21-40 years with 36% followed by the age group of 41-60 years with 28%. Thus, there is a male preponderance with 1.3:1 ratio and belonged to low socio-economic status. 2. The most common etiology diagnosed was Tuberculosis lymphadenitis accounting for 52 (47%) patients followed by Non-specific reactive lymphadenitis in 36 (33%) patients, Malignant secondaries in 19 (17%) patients and Lymphomas in 3 (3%) patients. 3. The most common TB cytomorphologic pattern was caseating epithelioid type 20 (38%) and only caseating type (35%) with overall AFB positivity of 65.3%. 4. Among the metastatic secondaries, squamous cell carcinoma was the most common constitute 77% with underlying occult primary more frequently from Pyriform fossa and oral cavity involving corresponding nodal level distribution which was statistically significant. 5. Open Biopsy was done in 30 cases FNAC reports was not consistent in two cases with that of biopsy report, so diagnostic accuracy of FNAC in this study is 91.66%. 6. The findings of the present study provided the first-hand information regarding the Demographic distribution of various etiologies causing cervical lymphadenopathies, their mode of presentation and level specific predilection with etiologies. FNAC is good and frontline investigation tool to diagnose the condition early and start the management accordingly.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221914053 |
| Uncontrolled Keywords: | Cervical Lymphadenopathy, Tertiary Care Centre, Prospective Clinico Pathological study. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 03 May 2021 10:14 |
| Last Modified: | 17 Dec 2023 08:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/15762 |
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