Tubercular Lymphadenitis in Industrial workers: Cytological Diagnosis

  • Ranbeer Singh Associate Professor. Department of Pathology Glocal College & Hospital, Mirzapur, saharanpur, UP
  • Pravin Pawane Assistant Professor Pathology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India.
Keywords: Tubercular lymphadenitis, Industrial workers, Cytology, Lymph Node, Occupational health problem


Background: Exposure to dust in the workplace is associated with a variety of pulmonary and systemic illnesses. Mycobacterial disease is known to occur with increased frequency in persons with silicosis. Persons with chronic silicosis have an incidence of mycobacterial tuberculosis that is three times greater than that of age-matched controls. Others exposed to silica but without silicosis might have an excess risk of developing tuberculosis. We have included the sixty five patients and who are industrial workers, presented with lymphadenopathy at one or more sites with or without associated  clinical symptoms. Tubercular lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) and cases were classified into six cytomorphologic patterns correlated with AFB positivity and bacillary load.Methods: In this study we included 65 cases of lymphadenitis and FNAC were done in a period 3-4 months. Tuberculous lymphadenitis diagnosed on the bases of Cytomorphologic features of smears in lymph node aspirate. Complete clinical details were obtained in all cases. FNA was performed with 23G as well as 26G needles and a 10- ml disposable syringe. After lymph node aspiration, smears were made on clean glass slides. One or two smears were wet fixed in 95% alcohol and stained with Papanicolaou stain. Air dried smears were stained with Giemsa stain and 1-2 smears stained with ZN methos for Acid Fast Bacilli.Result: Females are slightly more affected than males with a female to male ratio of 1.03:1. The most common site of involvement is cervical group of lymph nodes in both male and female patients. Out of total 65 cases 43 cases (66.15%) showed involvement of cervical lymph nodes. Out of the 65 cases, 31 (47.69%) had lymphadenopathy along with fever, 21 (32.39%) cases had lymphadenopathy alone without any clinical symptoms.  On microscopic examination of the smears various cytomorphological patterns are observed. Maximum number 27 cases (41.54%) showed the pattern I i.e. the well formed granulomas , scattered lymphoid cells and caseous necrosis. We detected 29 AFB positive cases (44.62%) on ZN staining.Conclusion: Given the high incidence of tuberculosis in industrial workers, it is recommended that persons with silicosis or long-term exposure to crystalline silica should receive a tuberculin skin test. If symptoms or radiographic changes suggest the possibility of mycobacterial disease, routine or induced sputum should be obtained and bronchoscopy considered. Once these patients get pulmonary TB subsequently there is increased chances to have extrapulmonary disease commonly lymph node tuberculosis. So it is mandatory that patients with lymph node tuberculosis should be investigated for pulmonary TB and should be treated accordingly, as the treatment regime for pulmonary and extrapulmonary tuberculosis is different.


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Original Article