Aetiology of peripheral lymphadenopathy in adults: analysis of 1724 cases seen at a tertiary care teaching hospital in southern India.

ABSTRACT

BACKGROUND: In patients presenting with peripheral lymphadenopathy, excision biopsy of the most accessible lymph node provides material to establish an early diagnosis, and is important in the management of these patients. METHODS: A retrospective study was done of 1724 lymph node biopsy specimens obtained from adult patients and submitted for histopathological examination over a 12-year period. RESULTS: About one-third (n = 614; 35.6%) of these patients had non-specific lymphadenitis. This included a heterogeneous group of disorders comprising benign follicular hyperplasia, reactive hyperplasia, marked follicular hyperplasia and reactive sinus histiocytosis. Tuberculosis lymphadenitis (n = 540; 31.3%) and malignancy (n = 447; 25.9%) were the other common causes. Of the 540 patients with tuberculosis lymphadenitis, the human immunodeficiency virus (HIV) status was tested in 424 (78.5%) patients; of these, 34 patients (8%) were HIV-seropositive. Epithelioid granulomas with caseation necrosis were more frequently seen in HIV-seronegative patients compared with HIV-seropositive ones (chi2 = 54.66; p < 0.001 ). In HIV-seropositive patients, multiple sites of lymph node involvement (chi2 = 40.597; p < 0.001), suppurative type with adjacent necrosis and panniculitis (chi2 = 68.128; p < 0.001), and non-reactive histological types (chi2 = 109.234; p < 0.001) were more commonly seen compared with HIV-seronegative patients. Kikuchi-Fujimoto disease (n = 36), Kimura disease (n = 7), Rosai-Dorfman disease (n = 6), were rare aetiological causes that have been infrequently reported from India. CONCLUSION: Awareness of the characteristic histopathological findings and uncommon aetiological causes of peripheral lymphadenopathy may spare patients from unnecessary evaluation and treatment. In HIV-positive patients, lymph node tuberculosis may be histopathologically unusual and may be suppurative or non-reactive in nearly one-third of patients.