Title: Granulomatous Inflammation: A Comparative Study Using Special Stains on FNAC Smears
Authors: Sharma S, Rana R.
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.145
Abstract
Background: Tuberculosis is the most common infectious disease in the developing countries. Inspite of newer modalities for diagnosis and treatment million of people are still suffering and dying from this disease. Many diagnostic tests are devised for its detection including FNAC. This study was designed to discuss the role of Fine Needle Aspiration Cytology using special stains in classifying and diagnosing the cause of granulomatous inflammation in patients diagnosed to have granulomatous inflammation on FNAC.
Materials and Methods: A descriptive cross-sectional survey was done on 200 cases of granulomatous inflammation consistent with tuberculosis diagnosed on fine needle aspiration cytology at the Department of Pathology, of Cure Surgical Hospital & Research Center, Solan, H.P, India.
All FNAC aspirates showing granulomatous inflammation on light microscopy with Hematoxylin & Eosin staining were subjected to special stains, like ZN, GMS, and PAS. Cases positive for AFB on ZN stain and fungus on GMS/PAS were noted down along with their frequency and percentages.
Results: One hundred and four cases (52%) of AFB positive smears were reported in granulomatous inflammation while only 4% cases of fungus were reported down. Cervical lymph nodes were the most commonly involved site (81%), and females were affected more (55%) than males. Most cases of AFB-positive smears were associated with caseation necrosis (96%).
Conclusion: Special stains should be done on all granulomatous inflammation cases seen on FNAC for confirmation of TB and ruling out other infectious causes.
References
1. Hirsh AE,Tsolaki AG,De Riemer,Feldman MW, Small PM. “Stable Association between strains of Mycobacterium TB and their human host populations.” Proc Natl Acad Sci USA, 2004;101:4871-6
2. Christopher Dye et al, “ Global Burden of TB”, JAMA, Aug 18, 1999, V-282:677-686.
3. Geneva: WHO;2010. Fact Sheet No. 104: TUBERCULOSIS.
4. Chakraborty AK “ Epidemiology of TB: Current status in India”.Indian J Med Res. 2004 Oct;120(4):248-76
5. R. Agarwal, R. Srinivas, and A. N. Aggarwal, “Parenchymal pseudotumoral tuberculosis: case series and systematic review of literature,” Respiratory Medi-cine, vol. 102, no. 3, pp. 382–389, 2008.
6. P. Nuwal, R. Dixit, S. Jain, and V. Porwal, “Isolated appendicular tuberculosis-a case report,” The Indian Journal of Tubercu-losis, vol. 47, no. 4, pp. 241–242, 2000.
7. S. Rasheed, R. Zinicola, D. Watson, A. Bajwa, and P. J. Mcdonald, “Intra-abdominal and gastrointestinal tubercu-losis, ”Colorectal Disease, vol. 9, no. 9, pp. 773–783, 2007.
8. G. Akoglu, A. Karaduman, G. Boztepe et al., “A case of lupus vulgaris successfully treated with antituberculous therapy despite negative PCR and culture,” Dermatology, vol. 211, no.3, pp. 290–292, 2007.
9. A. Sarwar, S. Aftab, M.Mustafa, A.Moatasim, S. Siddique, and A. Sani, “Spectrum of morphological changes in tuberculous lymphadenitis,” Internation journal of Pathology, vol. 2, no. 2,pp. 85–89, 2004.
10. S. Nayak and R. Satish, “Genitourinary tuberculosis after renal transplantation—a report of three cases with a good clinical outcome,” American Journal of Transplantation, vol. 7, no. 7,pp. 1862–1864, 2007.
11. R. B. Rock, M. Olin, C. A. Baker, T. W. Molitor, and P. K. Peterson, “Central nervous system tuberculosis: pathogenesis and clinical aspects,” Clinical Microbiology Reviews, vol. 21, no. 2, pp. 243–261, 2008.
12. S. K. Sinha, M. Chatterjee, S. Bhattacharya et al., “Diagnostic evaluation of extrapulmonary tuberculosis by fine needle aspiraton (FNA) supplemented with AFB smear and culture,”Journal of the Indian Medical Association, vol. 101, no. 10, pp.590–591, 2003.
13. M. Bezabih, D. W. Mariam, and S. G. Selassie, “Fine needle aspiration cytology of suspected tuberculous lymphadenitis, ”Cytopathology, vol. 13, no. 5, pp. 284–290, 2002.
14. S. M. Lam, A. C. W. Lau, M. W. Ma, and L. Y. C. Yam, “Pseudallescheria boydii or Aspergillus fumigatus in a lady with an unresolving lung infiltrate, and a literature review,” Respirology, vol. 13, no. 3, pp. 478–480, 2008.
15. S. Mamishi, N. Parvaneh, A. Salavati, S. Abdollahzadeh, and M. Yeganeh, “Invasive aspergillosis in chronic granulomatous disease: report of 7 cases,” European Journal of Pediatrics, vol.166, no. 1, pp. 83–84, 2007.
16. M. S. Cohen, R. E. Isturiz, H. L. Malech et al., “Fungal infection in chronic granulomatous disease. The importance of the phagocyte in defense against fungi,” American Journal of Medicine, vol. 71, no. 1, pp. 59–66, 1981.
17. J. S. Klein, A. Johnson, E. Watson, and S. Mount, “CT-guided transthoracic needle biopsy in the diagnosis of sarcoidosis,” Journal of Thoracic Imaging, vol. 24, no. 1, pp. 23–30, 2009.
18. A. Mueller, K. Holl-Ulrich, P. Lamprecht, and W. L. Gross, “Germinal centre-like structures in Wegener’s granuloma: the morphological basis for autoimmunity?” Rheumatology, vol. 47, no. 8, pp. 1111–1113, 2008.
19. V. Mehta and C. Balachandran, “Primary cutaneous actinomycosis on the chest wall,” Dermatology Online Journal, vol.14, no. 8, article no. 13, 2008.
20. Y. Al-Gindan, M. Satti, A. Al-Quorain, and A. Al-Hamdan, “Crohn’s disease in Saudi Arabia: A clinicopathological study of 12 cases,” Saudi Journal of Gastroent-erology, vol. 2, no. 3, p150, 2010.
21. H. V. K. Naina, C. F. Thomas, and S. Harris, “Histoplasmosis and asplenia,” Thorax, vol. 65, no. 4, p. 372, 2010.
22. H. W. Tan, K. L. Chuah, S. G. N. Goh, W. M. Yap, and P. H. Tan, “An unusual cause of granulomatous inflammation: eosinophilic abscess in Langerhans cell histiocytosis,” Journal of Clinical Pathology, vol. 59, no. 5, pp. 548–549, 2006.
23. S. S. Ahmad, S. Akhtar, K. Akhtar, S. Naseem, and T.Mansoor, “Study of fine needle aspiration cytology in lymphade-nopathy with special reference to acid-fast staining in cases of tuberculosis,” JK Science, vol. 7, no. 1, pp. 1–4, 2005.
24. S. Chakravorty, M. K. Sen, and J. S. Tyagi, “Diagnosis of extrapulmonary tuberculosis by smear, culture, and PCR using universal sample processing technology,” Journal of Clinical Microb-iology, vol. 43, no. 9, pp. 4357–4362, 2005.
25. K. E. Volmar, H. K. Singh, and J. Z. Gong, “Fine-needle aspiration biopsy of lymph nodes in the modern era: reactive lymphadenopathies,” Pathology Case Reviews, vol. 12, no. 1, pp. 27–35, 2007.
26. S. Mirza, B. I. Restrepo, J. B. McCormick, and S. P. Fisher- Hoch, “Diagnosis of tuberculosis lymphadenitis using a polymerase chain reaction on peripheral blood mononuclear cells,” American Journal of Tropical Medicine and Hyg-iene, vol. 69, no. 5, pp. 461–465, 2003.
27. M. Saha,M. Bakar,M. Rahman, and S. Hossain, “Role of FNAcytology in the diagnosis of lymph node diseases,” Journal of Bangladesh College of Physicians and Surgeons, vol. 23, no. 1, p.30, 2005.
28. S. K. Lau,W. U.Wei, C. Hsu, and U. C. G. Engzell, “Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy,” Journal of Laryngology and Otology,vol. 104, no. 1, pp. 24–27, 1990.
29. R. Vignesh, P. Balakrishnan, E. M. Shankar et al., “Value of single acid-fast bacilli sputum smears in the diagnosis of tuberculosis in HIV-positive subjects,” Journal of Medical Microbiology, vol. 56, no. 12, pp. 1709–1710, 2007.
30. Sharma SK and A,Mohan A, “ Multi drug-resistant Tuberculosis”,Indian J Med Res 120, October 2004, pp 354-376.
31. V. Koo, T. F. Lioe, and R. A. J. Spence, “Fine needle aspiration cytology (FNAC) in the diagnosis of granulomatous lymphadenitis,” Ulster Medical Journal, vol. 75, no. 1, pp. 59–64, 2006.
32. A. Rajwanshi, S. Bhambhani, and D. K. Das, “Fine-needle aspiration cytology diagnosis of tuberculosis,” Diagnostic Cytopathology, vol. 3, no. 1, pp. 13–16, 1987.
33. G. Sethuraman, V. Ramesh, M. Ramam, and V. K. Sharma, “Skin tuberculosis in children: learning from India,” Dermat-ologic Clinics, vol. 26, no. 2, pp. 285–294, 2008.
34. T. Dua, P. Ahmad, S. Vasenwala, F. Beg, and A. Malik, “Correlation of cytomorphology with AFB positivity by smear and culture in tuberculous lymphadenitis,” The Indian Journal of Tuberculosis, vol. 43, pp. 81–84, 1996.
35. D. K. Das, C. S. Pant, J.N. Pant, and P. Sodhani, “Transthoracic (percutaneous) fine needle aspiration cytology diagnosis of pulmonary tuberculosis,” Tubercle and Lung Disease, vol 76, no 1, pp 84–89, 1995.
36. A Hemalatha, PS Shruti et al “Cytomorphological Patterns of Tubercular Lymphadenitis Revisited”, Ann Med Health Sci Res, V.4(3); May-Jun 2014.
37. S. Rajasekaran, M. Gunasekaran, D. Jayakumar, D. Jeyaganesh,and V. Bhanu-mati, “Tuberculous cervical lymphadenitis in HIV positive and negative patients,” The Indian Journal of Tuberculosis, vol. 48, no. 4, pp. 201–204, 2001.
38. S. Shukla, S. Singh, M. Jain, S. K. Singh, R. Chander, and N. Kawatra, “Paediatric cutaneous blastomycosis: a rare case diagnosed on FNAC,” Diagnostic Cytopathology, vol. 37, no. 2, pp. 119–121, 2009.
39. S. Suchitha, R. Sunila, and G. V. Manjunath, “Fine needle aspiration diagnosis of cryptococcal lymphadenitis: a window of opportunity,” Journal of Cytology, vol. 25, no. 4, pp. 147– 149, 2008.
40. B. R. J. Shravanakumar, K. R. Iyengar, Y. Parasappa, and R. Ramprakash, “Crypto-coccal lymphadenitis diagnosed by FNAC in a HIV positive individual,” Journal of Postgraduate Medicine, vol. 49, no. 4, p. 370, 2003.
41. Y. M. Al-Marzooq, R. Chopra, M. I. Al-Mommatten, M. Younis, A. S. Al-Mulhim, and H. Al-Hussini, “Fine-needle aspiration diagnosis of primary cutaneous cryptococcosis in an immunocompetent patient: a case report,” Diagnostic Cytopathology, vol. 32, no. 4, pp. 219–221, 2005.