Spectrum of Morphological Changes in Tuberculous Lymphadenitis

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Spectrum of Morphological Changes in Tuberculous Lymphadenitis

Ayesha Sarwar, Anwar Ul Haque, *Sara Aftab, Mahera Mustafa,
Ambreen Moatasim, Saadia Siddique and Aaliya Sani
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
* Medical Student at the Aga Khan University Hospital, Karachi.

Introduction: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. Fine needle aspiration
cytology is the most economical, quick and easy way of its diagnosis. Familiarity with cytological features of
lymphadenopathy is essential in order to arrive at a correct diagnosis.
Objective: The objective of the study is to describe the spectrum of morphological features seen on cytological smears of
tuberculous lymphadenitis.
Material and Methods: One hundred consecutive cases of tuberculous lymphadenitis, performed in Pakistan Institute of
Medical Sciences, Islamabad, from July 2003 to August 2004, diagnosed on fine needle aspiration, were reviewed.
Results: The results of our study showed that in early lesions there is suppuration and caseation necrosis. As immunity
increases first ill defined (in exuadative lesions) and then well defined granulomas are formed. Neutrophils as nuclear dust
are present in early lesion and they are absent in late lesion when granulomas are well defined. Lymphocytes are maximum
in late granulomas phase and in intense caseous phases they are absent. Plasma cells are present with well defined
Conclusions: Tuberculous infection of a lymphnode follow a spectrum from early exudative to caseous to late
fibrocalcification phases. Presence of neutrophils does not rule out tuberculosis and one most look for other features like
epitheloid cells and caseation necrosis.


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