SCROFULA: ANALYZING THE ASPIRATE TO AID IN EARLY DIAGNOSIS

Background Tuberculosis is a commonly occurring mycobacterial pulmonary infection that can lead to chronic lymph node enlargement. Scrofula is cervical lymphadenopathy due to tuberculosis. Conventional methods are used to detect the active pulmonary component of the disease. However, tuberculous lymphadenopathy is often difficult to establish routinely; hence, fine-needle aspiration cytology (FNAC) can prove to be a useful aid in diagnosing tuberculous lymphadenopathy. Objective To analyze cytomorphological patterns of tuberculous lymphadenopathy by using FNAC and to analyze the presence of acid-fast bacilli (AFB) in different patterns of tuberculous lymphadenopathy by using Ziehl-Neelsen staining. Methods One hundred cases of cytologically proven cases of tuberculous lymphadenitis were analyzed, first using Giemsa staining to evaluate and categorize the cytomorphological patterns, then using Ziehl-Neelsen staining to screen of AFB in lymph node aspirate. Results Four cytomorphological patterns were seen, which were described as type 1 (primary), presence of neutrophils and suppuration (15%); type 2 (secondary), presence of necrosis, scattered lymphocytes, and degenerated cells (46%); type 3 (tertiary), presence of necrosis, epithelioid cells, and lymphocytes (30%); and type 4 (quaternary), presence of epithelioid granuloma, necrosis, with or without giant cells. AFB positivity was seen in 76% of cases: type 1 (10%), type 2 (39%), type 3 (25%), and type 4 (2%). Conclusions FNAC is a quick and economical aid in clinical diagnosis for lymphadenopathies. The cytomorphological pattern for tuberculous lymphadenopathy in the initial phases of the disease shows a reactive response; hence, in cases of suspicion, it is highly advisable for detecting AFB in order to diagnose the cervical lymphadenopathy as scrofula.