Patel Bhavik N, Shil Suman, Pandey Arvind S


Background & Objectives:

Since an ancient time tuberculosis is a widely distributed in all over world more particularly in a country like India. Extra-pulmonary involvement is also common in which Peripheral lymphnode involvement is the commonest form of extra-pulmonary mycobacterial disease and cervical region is the most frequent site nowadays, there is increased incidence of Tuberculous lymphadenitis due to increased prevalence of HIV. Even with the best treatment available, tuberculosis of lymphnode still remains a problem for the clinician, because of late diagnosis,

poverty and ignorance of symptoms.

                        Hence this study has been undertaken to evaluate tuberculosis cervical lymphadenitis with special emphasis based on FNAC. Surgical excision biopsy followed by histopathological examination is time consuming, costly, required hospitalization, pre and post procedure complications hence patients compliance is poor. While fine needle aspiration cytology is simple, rapid, cheaper and outpatient department procedure. The success rate of diagnosis from FNAC is around 75-90% in various studies.



A prospective, observational study was conducted among the patients who attended Tuberculosis & Respiratory Diseases Department from June 2011 to March 2013 in a tertiary care hospital with features of Peripheral Extra pulmonary Tubercular Lymphadenopathy. A total of 124 cases of peripheral extra pulmonary tubercular Lymphadenopathy were studied  from June 2011 to March 2013. A detailed history, complete physical examination, various laboratory work and radiological studies carried out. Diagnosis of TB made by histopathological & Tuberculin test was done with 10 TU PPD (0.1 ml) on left forearm and reading was taken after 48 hours. Majority patients were sent to pathology department for fine needle aspiration cytology of affected gland. Patients were having private FNAC report suggestive of tuberculous lymphadenitis were also considerd in study.



In the present study of 124 patients having Tuberculous Lymphadenopathy, the commonest age group affected is below 40 years (85% patients).Females are affected more than males (M:F ratio 1:1.03). With most of the patients coming from lower socioeconomic status. Majority of patients (72%) were presented with painless swelling in neck and 91% patients had attended health facility within 3 months.Family history positive in 04 (03%) of patients. Most of the time in tuberculous lymphadenopathy patients present with swelling only i.e 106 (86%) and 18 (14%) patients with either cold abscess or pus discharge so simple lymph node enlargement is common. 67 % patients show raised ESR. It may help in supportive diagnosis of tuberculous aetiology.67% patients show tuberculin test positive which also may help in diagnosis of tubercular aetiology. 10(08%) patients of lymphadenopathy had abnormal chest radiogram. Majority of the patients have normal leukocyte count with normal lymphocyte.Only 03 patients are found sputum positive in 124 tubercular lymphadenitis patients.It might be due to direct spread of infection from tonsil to regional lymphnode.Primary infection may occur in lymphoid tissue of tonsil.Only 1 patient is found HIV reactive in this study.This might be due to less HIV prevalence in rural population.


It was observed that cervical region lymph node was more commonly involved and fine needle aspiration cytology (FNAC) was found to be a safe, useful, reliable, effective method for early diagnosis of tubercular lymphadenitis and early institution of definitive therapy. It is a comparatively cheap and less time consuming method. Adults are more affected than old people and females are affected more than males. ESR help in supportive diagnosis of Tuberculous etiology and tuberculin test positive also may help in diagnosis of tubercular etiology.


Full Text:



K.N. Rao : Textbook of Tuberculosis 2nd Edition, 1981 - 5

Nccp textbook of respiratory medicine 1st edition 2010

Sharma and Mohan : Tuberculosis 1st edition 2001

Satyasri S. Textbook of pulmonary and extra pulmonary tuberculosis. 4th

Edition, 2001.

RNTCP TB India 2011

RNTCP: A training course modules 1-4.

K. Toman: Tuberculosis: Care detection, treatment and monitoring, 2nd

ed. 2004, 233.

Crofton and Douglas: Respiratory Diseases 5th Edition, 2003, Vol. I, 531

Samar Mitra: Anatomy - Triangle of Neck. 5th Edition, 2000: 5.53.

. S. K. Bhattacharya : Short cases in surgery 4th Edition,

. Romones Cunningham’s: Manual of practical anatomy 15th Edition,

Vol. III, 39.

B. D. Chaurasia: General Anatomy: 3rd edition, 1996, 97.

Gray’s Anatomy : Anatomy of Lymphnode and Lymphatic drainage, 38th

Edition, 1611-1612

Harold Ellis: Clinical Anatomy, Facial Compartment of Neck. 9th Edition,

Snell: gross Anatomy: 245-258.

Inderbir Singh: Textbook of Human Histology, 1994, 173.

Rosai J. Lymphnodes: An Ackerman’s Surgical Pathology, 7th Edition,

: Vol.2, 1269.

C. C. Chatterjee: Human Physiology: 10th Edition, Vol. I, 196.

Guyton and Hall : Textbook of Medical Physiology, 10th Edition, 171

Fishman's Pulmonary Disease and Disorders 3rd Edition, Vol. II, 1998,

Harrison’s Principles of Internal Medicine – 16th Edition, 343

Davidson textbook of medicine.

Koneman: Textbook of Diagnostic Microbiology: 15th Edition, 918.

R. Ananthanarayan : Textbook of Microbiology, 5th Edition, 1996

Gabriel Virella: NMS Microbiology and Infectious disease. 3rd edition,

, 167.

Harsh Mohan : Textbook of Pathology, 3rd Edition, 1998, 486

Anderson’s Pathology: 10th Edition, 1990, Vol. I, 853.

Robbin’s: Basic Pathology, 5th Edition, 1992, 42, 130.

Khanna B. K.: Tuberculous Lymphadenitis, Mediwave, Vol. I, 1991.

Patra A.K., Banda B.K. Mohapatra B

Dandapat M.C. et al.: Peripheral lymphnode tuberculosis: a review of 80

cases Br. J. Surg. 1990, Aug. 77(8), 911-912.

Chaudhary N.R.: Cervical lymphadenopathy. Dissertation Gujarat Uni.

Ahmadabad, 1986.

Shafi Ullah et al.: Tuberculous lymphadenitis Afghan Refugees. J. Ayub

Med. Coll. Abbottabad 2002 14(2), 223.

Dodiya study of Tuberculosis lymphadenitis. Rajkot. 2003.

Bailey and Love: Short Practice of Surgery. 17th Edition, 1985

Reddy LB et al.: Peripheral Glandular tuberculous CM Med. Prac. 1962,

, 1095.

Lau S. K.: Efficacy of fine needle aspiration cytology in diagnosis of

tuberculous cervical lymphadenopathy J. Laryngootology, Jan. 1990,

(1), 24-27.

Jhaa et al. Cervical tuberculous lymphadenopathy: Changing clinical

pattern and concepts in management. Post. Grad. Med. J. 2001, 77: 185-

Btsill, Jr. W. L. Hajdu S.I.: Percutaneous aspiration biopsy of lymphnode.

Am. Jour. Clin

Lucas P.E.: Lymphnode smear in the diagnosis of lymphadenopathy and

review blood. Am. J. Clinical Path. 1952, 22, 255-262.

Kline T.S., Neal H.S.: Needle Biopsy, A Pilot Study J. Am. Med. Ass.

, 224, 1143-1146.

Parma S. P., Mathur G.D.: A co-operative study of tuberculous cervical

lymphadenitis Ind. J. Med. Res. 1974, 62(11), 1631-1646.

Singh J. P., Chaturvedi N. K., Das A.: Role of FNAC in the diagnosis of

tuberculous lymphadenitis. Ind. J. Patho. 1989, 32(2), 101-104. . C.

Steel B. L., Schwartz Mary, Ranzy Ibrahim: Fine Needle Aspiration

Biopsy in the diagnosis of lymphadenopathy in 1103 patients, Acta, Cyto.

, 39, 76-81.

Fain. : Diagnosis of Lymphadenopathy by FNAC. Ind. J Patho. 1983, 26,


Thompson M. Cervical lymphadenopathy in Bhagulpas area. Ind. J. Med.

Ass. 1985, 83, 229.

Facu et al: Correlation of fine needle aspiration cytology, smear and

culture in tuberculous lymphadenitis. A prospective study. Journal of

Postgraduate Med. 2002, 48(2), 113-116.

Patel RV and Mehta RT.: Short term chemotherapy in tuberculous

lymphadenitis. Ind. J. Surg. 1987, 33, 20-23.

Reddy LB et al.: Peripheral Glandular tuberculous CM Med. Prac. 1962,

, 1095

Shah Dipen: Tuberculosis cervical lymphadenitis Dissertation Gujarat

Uni. Ahmadabad. Oct. 1988.

SK. P. Hathi: Role of FNAC in diagnosis of tuberculous lymphadenitis.

Dissertation Saurashtra University, 1996.

Subrahmanyam: Role of surgery and chemotherapy for peripheral

lymphnode tuberculosis. Br. J. Surg. 1993, Dec. 80 (12), 1547-1548.

Mc Carthy and Radd RM: Six months chemotherapy for lymphnode

tuberculosis: Respi. Med. 1984, 83, 425-427.

Yuen AP et al.: Prospective randomized study of thrice weekly six

months and nine month chemotherapy for cervical tuberculous

lymphadenopathy. Otolaryngeal Head Neck Surg. Feb. 1947, 116(2),



  • There are currently no refbacks.