الفهرس | Only 14 pages are availabe for public view |
Abstract The problem of lymphadenopathy is frequently encountered in surgical and medical outpatient clinics. Meanwhile, it is not uncommon to find enlarged lymph nodes in patients who are admitted for other clinical issue. Fine needle aspiration cytology (FNAC) is considered a rapid screening method in patients presenting with lymph node enlargement. Cell blocks and subsequent application of immunostaining are of promising benefits. The aim of the present work was to determine the reliability and accuracy of FNAC, cell blocks and immunostaining in rapid diagnosis of lymph node enlargement. Materials and methods: After taking brief history and performing physical examination, fine needle aspirates were taken directly or under ultrasound guidance and examined from 50 patients presenting with lymphadenopathy in the outpatient clinic of the Medical Research Institute, Alexandria University. Cell blocks and immunostaining have been performed whenever possible. Results: In 46% of cases the lymphadenopathy was due to benign etiology, while 54% of cases were malignant. Benign cases were affecting females mainly (78.3%) and the malignant cases had nearly equal distribution, with only slight male predominance. Roughly, 30% of malignancies were lymphomatous and the remaining 70% were metastatic deposits. The most common benign etiology was reactive lymphadenitis (82.6%). The most common lymph node group involved was the axillary group for both benign and malignant groups. The most common malignant etiology in males was the large B cell non-Hodgkin lymphoma (29%), while in females it was metastatic ductal carcinoma of the breast (85% of cases). Cell blocks were available in 31 cases in the other 19 cases the aspirate was inadequate or hemorrhagic devoid of cells. The available cell blocks allowed immunocytochemistry to be done where they were used to confirm suspicious diagnosis, determine the origin of a metastatic tumour, classify lymphoma, determine the histopathologic type of a tumour or determine immune markers of relevance in prognosis and treatment. In 2 cases immunostaining was done on FNAC slides to confirm the diagnosis of Hodgkin’s lymphoma. Diagnostic accuracy of cytology (FNAC & Cell block) was found to be 82%. Conclusion: Cell block method allows the recovery and processing of minute amounts of cellular material and facilitates the better classification of tumors especially if accompanied with immunostaning FNAC, cell block and immuno-staining are very helpful methods in rapid diagnosis of lymphadenopathy. These methods have yielded the diagnosis in all cases without the need of excision biopsy with a fairly high diagnostic accuracy. |