ABSTRACT
Background: Tuberculosis is a great problem throughout the world, especially in developing countries like India. Beside pulmonary tuberculosis, extra pulmonary tuberculosis is relatively more common among the Asian population. Aims & Objective: (1) To establishing the utility of performing Acid Fast Bacilli (AFB) on aspirated material; (2) To study the distribution of cytomorphological patterns of tuberculous lymphadenitis; (3) To study the role of repeat aspiration in diagnosing tuberculous lymphadenitis. Material and Methods: The present study was conducted on 1022 patients of lymphadenopathy during the period of 36 months. Fine needle aspiration was performed in all the patients and 3 smears are made. One is kept unfixed for Ziehl Neelsen staining and other two are alcohol fixed and stained with Papanicolaou (Pap) stain and May Grunwald Giemsa (MGG) stain. Results: Out of 1022 aspirations from lymph nodes 402 cases were diagnosed as tuberculous (TB) lymphadenitis. Three cytomorphological patterns were observed: group-1: Granulomas without necrosis (33.83%); group-2: Caseating epithelioid granulomas (43.03%); and group-3: Necrotizing lymphadenitis (23.13%). AFB positivity was seen in 44.02% cases. 125 cases were diagnosed as reactive lymphadenitis with activated histiocyte clusters were advised a repeat aspiration, out of these 55 cases showed subsequent development of epithelioid granulomas. Conclusion: FNAC is a useful tool in the study of tuberculous lymphadenitis and repeat aspiration, after 2 – 3 weeks helps in providing the correct diagnosis of early tubercular lesions.
ABSTRACT
Syphilitic granulomatous pancreatitis is an extremely rare condition,and can occur in the generalized acquired syphilitic patient in tertiary or secondary phase. The most serious problem with granulomatous pancreatic lesion is clinical or radiological misdiagnosis as cancer. We experienced a case of syphilitic granulomatous pancreatitis arising in 54 year old female patient. She was treated for syphilis 20years ago. But she and her husband are still strong positive to VDRL and TPHA. On abdominal computed tomography and endoscopic pancreatico- duodenography, there was an obstructive mass of low density in the distal common bile duct or pancreatic head. Under the preoperative diagnosis of pancreatic head carcinoma, Whipple's operation was done. On gross examination, the pancreas was fibrotic, and the common bile duct was well preserved without tumor mass. Microscopically, numerous intralobular noncaseating epithelioid cell granulomas with multinucleated giant cells are identified. They surround thick-walled, small to medium sized arteries and involve vascular wall with luminal narrowing or obliteration, which are characteristic findings of the syphilitic granuloma. The remaining parenchyme shows fibrosis, acinar atrophy or destruction with dense infiltration of lymphohistiocytes, plasma cells with granuloma formation. Although the Warthin-Starry stain reveals no spirochetes, the serologic result and pathologic findings are compatible with syphilitic granulomatous pancreatitis.