Abstract
Introduction: Cervical lymphadenopathy (CL) is one of the most common causes of consultations in ENT Out Patient Department. The differential diagnosis of CL is broad and the most common cause of CL, particularly in pediatric age group, is due to benign and self-limiting diseases such as viralinfections. The other common causes of CL in children include pyogenic or tubercular lymphadenitis. In adults and elderly patients it may be due to more sinister pathologies suchas lymphomas, leukemia and nodal metastasis. Less common causes of CL include autoimmune disorders (SLE and Sjogrens), plasma cell granuloma and histiocytosis.
Materials and Methods: Present study is a prospective cohort study in which 80 patients, above 12 years of age, attending ENT OPD for cervical lymphadenopathy were included on the basis of a pre-defined inclusion and exclusion criteria. A detailed history was taken and clinical examination was done in all the cases. Imaging studies were done whenever needed. FNAC followed by histopathological examination was done in all the cases. Patients in whom lymphadenopathy subsided after 10 days of antibiotics therapy or 14 days of conservative management were excluded from the study. The data was analysed using SSPE 16 software. For statistical purposes P value less than 0.05 was taken as significant.
Results: After excluding the patients in whom cervical lymphadenopathy subsided within 2 weeks the most common cause was found to be tubercular lymphadenitis (52.50 %). The other causes of cervical lymphadenopathy included chronic non-specific lymphadenitis (27.50%) and reactive lymphadenitis (12.50%). Uncommon causes of cervical lymphadenopathy included metastatic spread from primary malignancies and lymphoma (7.50 %). FNAC was found to be fairy reliable in diagnosis of etiology of lymphadenopathy.
Conclusion: Tubercular, non-specific and reactive lymphadenitis were found to be the most common benign causes of cervical lymphadenopathy. In elderly metastatic spread from primary malignant lesions was common cause. FNAC is an excellent diagnostic tool for establishing the etiological diagnosis of cervical lymphadenopathy.
Keywords: Cervical Lymphadenopathy, Etiology, Fine needle Aspiration Cytology, Metastatic Nodes.
References
- Gosche JR, Vick L. Acute, subacute, and chronic cervical lymphadenitis in children. Semin Pediatr Surg. 2006 May;15(2):99-106.
- Leung AK, Davies HD. Cervical lymphadenitis: etiology, diagnosis, and management. Curr Infect Dis Rep. 2009 May;11(3):183-9.
- Lang S, Kansy B. Cervical lymph node diseases in children. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc08. Published 2014 Dec 1.
- Westbury G. Management of metastatic cervical lymph nodes. Proc R Soc Med. 1976;69(11):865-7.
- Schuller DE, McGuirt WF, McCabe BF, Young D. The prognostic significance of metastatic cervical lymph nodes. Laryngoscope. 1980 Apr;90(4):557-70.
- Sellers M, Beenken S, Blankenship A, Soong SJ, Turbat-Herrera E, Urist M, Maddox W. Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer. Am J Surg. 1992 Dec;164(6):578-81.
- Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A. Peripheral lymphadenopathy: approach and diagnostic tools. Iran J Med Sci. 2014;39(2 Suppl):158-70.
- Dasgupta A, Ghosh RN, Poddar AK, Mukherjee C, Mitra PK, Gupta G, Ganguly U. Fine needle aspiration cytology of cervical lymphadenopathy with special reference to tuberculosis. J Indian Med Assoc. 1994 Feb;92(2):44-6.
- Hegde S, Rithesh KB, Baroudi K, Umar D. Tuberculous lymphadenitis: early diagnosis and intervention. J Int Oral Health. 2014;6(6):96-8.
- Thompson MM, Underwood MJ, Sayers RD, Dookeran KA, Bell PR. Peripheral tuberculous lymphadenopathy: A review of 67 cases. Br J Surg. 1992;79(8):763–4.
- Karpf M. Lymphadenopathy. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 149.
- Kojima M, Nakamura S, Oyama T, Motoori T, Itoh H, Yoshida K, Suchi T, Masawa N. Autoimmune disease-associated lymphadenopathy with histological appearance of T-zone dysplasia with hyperplastic follicles. A clinicopathological analysis of nine cases. Pathol Res Pract. 2001;197(4):237-44.
- Yang L, Luo D, Li L, et al. Differentiation of malignant cervical lymphadenopathy by dual-energy CT: a preliminary analysis. Sci Rep. 2016;6:31020. Published 2016 Aug 8.
- Batni G, Gaur S, Sinha ON, Agrawal SP, Srivasatva A. A Clinico-Pathological Study of Cervical Lymph Nodes. Indian J Otolary-ngol Head Neck Surg. 2016;68(4):508-510
- Mili MK, Phookan J. A clinico-pathological study of cervical lymphadenopathy. Int J Dent Med Res. 2015;1(5):24–27.
- Shakya G, Malla S, Shakya KN, Shreshtha R. A study of FNAC of cervical lymph nodes. J Nepal Res Counc. 2009;7(14):1–5.
- Narender NR, Rao YJ. A prospective clinico-pathological study of cervical lymphadenopathy. Int Surg J 2017;4:3967-70.
- Shas A, Webber C, Marti J. Fine needle aspiration in the diagnosis of cervical lymphadenopathy. Am J Surg. 1986;12 (4):420–423.
- Chau I, Kelleher MT, Cunningham D, et al. Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients. Br J Cancer. 2003;88(3):354-61.
- Qadri SK, Hamdani NH, Shah P, Lone MI, Baba KM. Profile of lymphadenopathy in Kashmir valley: A cytological study. Asian Pac J Cancer Prev 2012;13:3621-5.
Corresponding Author
Dr Hemraj Satpute
Assistant Professor, Department of ENT, Bharati Vidyapeeth Deemed (To be) University
Medical College and Hospital Sangli- Maharashtra (India)
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.77
