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Category: Volume 06 Issue 04 April 2018
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Title: Study of Multifactorial Origin and Clinical Presentation of Peripheral   Lymphadenopathy and Recent Trends of Management

Authors: Dr Shailendra Singh, Dr Amit Kumar Verma, Om Prakash Dwivedi

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.120

Abstract

Background: Lymphadenopathy is a very common clinical manifestation of many diseases, defined as an abnormality in the size or character of the lymph nodes, caused by the invasion or propagation of either inflammatory cells or neoplastic cells. There are about 800-1000 lymph nodes in the body out of which 300 are present in the neck in about 25 nodal basins. Peripheral lymphadenopathy is quite common in our country and forms a quite big group of patients attending the surgery outdoors. Tuberculous lymphadenitis constitute a major health problem in our country. Also the metastatic lymphadenopathy is quite a common cause. A lymph node appears to be the most accessible and appropriate organ which could easily lend to cytology by needle aspiration and exicisional biopsy and imprint smears.

Aims and Objective

Study the multifactorial origin of peripheral lymphadenopathy.

And detailed clinical study the distribution of secondary involvement of peripheral lymph nodes in relation to various malignancy. And to assess the role of aspiration biopsy/ cytology in diagnosing peripheral lymphadenopathy. along with  recent trends of management in peripheral lymphadenopathy.

Material and Methods: The study is comprised of 150 cases suffering from peripheral lymphadenopathy due to various causes who attended surgery OPD/ Cancer OPD or were admitted in surgery/cancer wards during the period of Sep. 2011 to Feb. 2018. 100 cases were screened retrospectively from records (Sep. 2011 to Sep 2016). 50 cases from (Oct. 2016 to Feb. 2018) were screened by the author.

Patients included in this study had clinically detectable cervical, axillary and inguinal lymphadenopathy. From each patient a thorough history was taken and underwent a thorough clinical examination and relevant investigations. Every patient was subjected to FNAC or Biopsy of the node or biopsy of primary site in cases of cancer of head and neck or breast or penile carcinoma.

Result: The study comprised of 150cases of various peripheral lymphadenopathies Patients were broadly classified into five groups. 1.Acute lymphadenitis (25) 2. Chronic Non specific lymphadenitis (10) 3.Tubercular lymphadenitis (95) 4. Lymphomas (8) 5. Secondaries (12)

There were 82  male(54.66%)and 68 female(45.33 %) patients .most of patients of age  group of 25-40 year (56.6%).Majority were from rural area(57.33%). All patient has common complain of Swelling. Cervical lymphadenopathy is most commonly seen in peripheral lymphadenopathy. Most of the patients were case of Tuberculous lymphadenitis 95 (63.33%) 9% patients has HIV infection. In 50% cases montoux test was positive. most of patients were managed conservatively 99(66%) .

Conclusion: Any lymph node enlargement exceeding 1.5 cm should be taken as presumptive evidence of abnormality. Aspiration biopsy provides a reliable, safe, rapid and economical method of investigating lymph node enlargements, The diagnosis of lymphomas was invariably suggested, but classification could not consistently be made. Primary lymph nodes disease is best diagnosed by incisional or excisional biopsy in which details such as capsular invasion, architectural pattern and reaction of perinodal tissues can be studied carefully. In lymph nodes the presence of other than lymphoid tissue is evidence of a secondary or metastatic disease. FNAC is very reliable procedure to diagnose tubercular lymphadenitis. Epitheloid cells, multinucleated giant cells and caseation necrosis was confidentally diagnosed. Proper history, careful clinical examination and FNAC of lymph nodes should reliably diagnose tubercular lymphadenitis. Montouxreaction might be used as an adjunct but it is not very specific, its role is diminished.         

Keywords: Lymphadenopathy, FNAC, Biopsy.

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Corresponding Author

Dr Amit Kumar Verma

Demonstrator, Department of Biochemistry

S.S. Medical College S.G.M.H &G.M. Hospital Rewa M.P.

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