Screening for tuberculosis and its histological pattern in patients with enlarged lymph node.

Settings. Tuberculosis is a major health problem in the Republic of Yemen. Tuberculous lymphadenitis is one of the most common forms of extrapulmonary tuberculosis. Therefore, this retrospective descriptive study was conducted in Yemen to investigate the morphological pattern of tuberculous lymphadenitis, as well as to assess the reliability measures of (ZN) Ziehl-Neelsen and fluorescent methods in identification of Mycobacterium tuberculosis. Methodology. One hundred lymph nodes tissue biopsies that were previously diagnosed by conventional histopathology as having tuberculous lymphadenitis were reinvestigated. Five micron in thickness sections were obtained from formalin-fixed paraffin wax processed tissues. The sections were stained using Haematoxylin and eosin (H & E), ZN, and fluorescent methods. Results. All of the 100 specimens were proved as having histopathological pattern of tuberculosis lymphadenitis. The most major histological features were giant cell (88%), caseation (84%), epithelioid cells (80%), granuloma and caseation (68%), lymphocytes (31%), and histiocytes (4%). After staining the specimens with ZN and fluorescent, of the 100 specimens only 3 (3%) and 9 (9%) specimens were found positive, by ZN and fluorescent methods, respectively. Conclusion. Conventional ZN and fluorescent methods have limitations in diagnosis of tuberculous lymphadenitis due to their lower sensitivity. Histopathology remains the most suitable method for the diagnosis of tuberculous lymphadenitis. In cases of suspected tuberculous lymphadenitis, it is advisable to confirm with more sensitive and specific method, such as polymerase chain reaction PCR or immunohistochemistry before reporting the negative results.

Cytological study of exfoliative buccal mucosal cells of Qat chewers in Yemen.

Prevalence of oral cancer is relatively increasing in Yemen in recent years, which is ascribed to Qat with other carcinogens. Since the establishment of a simple and reliable method for the detection of oral cancerous and precancerous lesions is essential, exfoliative cytology (EC) was applied to a case-control study to appraise the presence and severity of oral epithelial atypia in 300 subjects (150 were Qat chewers and 150 were non-Qat users) without prior knowledge of the subjects' Qat exposure. Ten patients with oral squamous-cell carcinoma (OSCC) were included as internal controls. Cytological atypia and hyperkeratosis were demonstrated in six and 24 subjects, respectively, and could not be ascertained in the remaining 294 and 276 correspondingly. All of the 30 (six atypia and 24 hyperkeratosis) were among the 150 Qat chewers. Cytological atypia was found in all the 10 control cases with OSCCs (eight with severe degree and two with mild atypia). For the Qat among those with atypia and hyperkeratosis, the adjusted OR and the 95% confidence level were found to be 1.6 (0.8-7.2) and 3 (10.1-21.9), respectively. In view of these findings, we suggest the use of EC for detection and assessment of oral cytological atypia. Qat use contributes to the occurrence of cytological atypia that might develop to oral precancerous or cancerous lesions.

Study of oral epithelial atypia among Sudanese tobacco users by exfoliative cytology.

BACKGROUND: Prevalence of oral cancer is high in Sudan and the disease is attributed to N-nitrosamine rich oral snuff consumption. MATERIALS AND METHODS: As part of the development of a screening procedure for oral cancer and precancer, exfoliative cytology (EFC) was applied to a retrospective cohort to assess the presence and severity of oral epithelial atypia (ET) in 300 subjects (100 toombak dippers; 100 cigarette smokers; 100 non-tobacco users) without prior knowledge of the subjects' tobacco exposure. Five patients with oral squamous cell carcinoma (OSCC) were included as internal controls. RESULTS: ET was ascertained in 29 subjects and could not be ascertained in the remaining 271. Among the 29 subjects with ET, there were 11 (38%) toombak dippers, 14 (48%) cigarette smokers and 4 (14%) non-tobacco users. Among the 271 subjects without ET, there were 89 (33%) toombak dippers, 86 (32%) cigarette smokers and 96 (35%) non-tobacco users. ET was found in all the 5 control cases with OSCC. For the ET among toombak dippers and cigarette smokers, adjusted OR and the 95% CI were found to be 3 (0.91-9.7) and 4 (1.2-12.3), respectively. CONCLUSION: In view of these findings, we propose the use of EFC for detection and assessment of oral ET.