Cervical tuberculous lymphadenitis : Clinicopathological reatures and AFB positivity / 결핵

ABSTRACT

BACKGROUND: Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulmatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. METHODS: We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics (lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). RESULTS: 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1 45. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB Positivity and histological features or clinical characteristics. CONCLUSION: Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.