Spectrum of morphological changes in lymph nodes of HIV infected patients with lymphadenopathy (original) (raw)
Related papers
Histological Features of Tubercular Lymphadenitis in HIV Positive Patients
Advances in Cytology & Pathology, 2017
Tuberculosis is one of the most common causes of lymphadenopathy in HIV positive patients. Though the presenting complaint is same as non HIV patient, the histologic features of lymph node biopsy varies depending on the immune status. The present study is conducted to find out these differences and its relevance in diagnosis. Material and methods: The histological features seen on lymph node biopsies, done on HIV positive patients who presented with lymphadenopathy, with or without other systemic manifestations over a period of three years were analysed. Seventy four lymph node biopsies were found adequate and provided the material for the present study. The lymph nodes biopsies were fixed in 10% formalin and were stained using Haematoxylin and eosin (H&E) stain. Sections were stained for AFB by using Ziehl-Neelson method if H & E stained slides showed features suggestive of tuberculosis on light microscopy. Results: In the current study, 33 cases (44%) were diagnosed as tuberculous lymphadenitis and was the second most common cause of lymphadenopathy. The CD4 counts of all these patients ranged from 10-258/µl with the CD4 count being<200 in 84.8% of cases. In the present study, granulomas were detected in 90.9% of the cases and were the most common and conspicuous feature. Confluent granulomas were more commonly seen than discrete ones. Most of the cases of caseating (75%) had more than 1 AFB/hpf whereas in the remaining cases (25%), number was less than 1/100hpf. Granulomatous lymphadenitis without caseous necrosis was seen in 2 cases (6.7%). Microabscess with granular debris without coexisting granuloma was found in 11 cases (33.3%) and all showed acid fast bacilli on Ziehl-Neelsen stain. Other features noted in present study were plasmacytosis (57.6%), paracortical expansion (12.1%) and periadenitis(30.3%). In the present study, AFB was positive in all the 33 cases. Two cases were diagnosed as tuberculosis on biopsies and confirmed as atypical mycobacterium. Conclusion: Lymph node biopsy is a valuable tool in the evaluation of HIV positive patient to identify the causes of lymphadenopathy.
Cytological evaluation of lymphadenopathy in HIV seropositive patients
IP innovative publication pvt ltd , 2020
Introduction: The most common lesions encountered in HIV positive patients is Lymphadenopathy. The cytopathology of these masses encompass a variety of changes that provide insight into the underlying condition associated with HIV. The present study analyzed the cytological patterns of lymph node lesions in HIV/AIDS patients by FNAC (Fine Needle Aspiration Cytology) and correlate its findings with serum CD4 counts. Materials and Methods: A total 75 cases of all genders and age, already diagnosed as seropositive by ELISA and presented with lymphadenopathy of 1 cm were studied in pathology department by FNAC during the period of 1 and half year. Smears were fixed in ethanol (95%) for PAP (Papanicolaou Stain) staining. Air dried smears were kept for MGG (May Grunwald Giemsa) and AFB (acid fast bacilli). The serum CD4 count was assessed by BD FACS Count System. Results: Male predominance observed with male to female ratio of 1.3: 1. Maximum cases (80%) had involvement of cervical lymph nodes followed by axillary 6 (8%). The commonest cytological diagnosis was chronic granulomatous lymphadenitis 30 cases (40%), followed by tuberculous lymphadenitis 27 (36%). The Most common cytomorphological pattern in tuberculous lymphadenitis cases was caseous necrosis along with epithelioid cells (55.5%). Most of the chronic granulomatous cases (20) had a serum CD4 count between 200-499 cells/ mL with an average of 330.2 cells/ mL. The minimum average value of serum CD4 count was observed in tuberculous lymphadenitis was 118.29 cells/ mL. Conclusion: For HIV lymphadenopathy patients, FNAC is the simple and effective diagnostic modality which helps in identification of majority of the granulomatous, reactive and opportunistic infections. It therefore, helps in guiding subsequent management of these patients.
Cytomorphological profile of lymphadenopathy in HIV-infected persons
IP innovative publication pvt. ltd, 2019
Objective: To assess the role of fine needle aspiration cytology (FNAC) and to determine the cytomorphological profile in persons infected with human immunodeficiency virus presenting with lymphadenopathy. Materials and Methods: This was a five year (2010-2015) analysis of 54 HIV positive cases who presented with lymphadenopathy. Archival FNAC smears stained with Papanicolaou, Giemsa and Ziehl-Neelsen stains were reviewed for their cytological features. Results: Lymph nodes from 54 HIV-positive patients in the age range of 11-61 years were reviewed. The most common FNA diagnosis was tubercular lymphadenitis (n=24). The other diagnoses were: reactive lymphadenitis (n=11), suppurative lymphadenitis (n=6), lymphoma (n=9), metastases (n=3) and cryptococcal lymphadenitis (n=1). Of the 24 cases of tubercular lymphadenitis, seven showed epithelioid granulomas with Langhan’s giant cells and caseous necrosis. Numerous clusters of epithelioid cells in reactive background were noted in one case which was AFB positive. There were five cases which showed mostly caseous necrotic material with few epithelioid cells. Our study found that three cases showed only presence of acellular caseous necrosis. Caseous necrotic material with few lymphocytes and histiocytes and no epithelioid cells were reported in four cases. The remaining four cases showed tubercular abscess showing predominantly neutrophils along with epithelioid cells and semi fluid necrosis. These cases were AFB positive. Conclusion: FNAC is a cost-effective technique in patients of HIV lymphadenopathy to segregate lymph nodes that need to be biopsied from infective lymphadenopathy.
Spectrum of Morphologic Changes of Lymph Nodes in HIV Infection
Memórias do Instituto Oswaldo Cruz, 1996
Cervical lymph nodes biopsies from 31 HIV positive patients (with or without AIDS) were studied by histologic methods and immunohistochemistry (StreptABC staining of paraffin sections) to identify cellular and extracellular matrix components. The results were the following: (1) the biopsies were included in the stages of follicular hyperplasia without fragmentation FH-FF (4 cases); follicular hyperplasia with follicular fragmentation FH+FF (16 cases); follicular involution FI (6 cases) and diffuse pattern DP (5 cases); (2) the most important alteration was the germinal centers disruption due to follicle lysis, which began in the light zone; (3) there was coincidence between intrafollicular hemorrhages and segmental hyaline mycroangiopathy; (4) during the progression of the disease occurred: (a) an increase in the number of mast cells, CD68 + and Mac387 + macrophages; (b) a diffuse augment of collagen III, elastic fibers, laminin, fibronectin and proteoglycans; (c) maintenance of Factor VIIIrelated antigens in the vascular endothelial cells, with decrease in the expression of Ulex-Europeus I lectin. Follicular hyperplasia (FH-FF or FH+FF) was the most common histologic pattern recognized in the lymph nodes of patients without AIDS and follicular involution and difuse pattern were seen in those who had AIDS. The results indicate that the lymph node biopsies may provide important information about the evolutive stage of the disease and its prognosis.
Fine needle aspiration cytology study of HIV lymphadenopathy and its correlation with CD4 count
HIV-AIDS is considered as a worldwide pandemic with an epicentre in Asia. Lymphadenopathy is the commonest manifestation observed in HIV-AIDS. Although multiple studies have been conducted in western countries, there is need for further studies to evaluate the causes of lymphadenopathy in Indian setting. So the FNAC study of HIV lymphadenopathy and its correlation with CD4 counts was carried out. Methods: Two yrs. observational study was carried out at the Tertiary care centre from Jan 2013 to Dec 2014. All the patients of HIV lymphadenopathy during this period were included in the study. History and clinical details were obtained from medical records. Thorough clinical examination was done in all cases. Thereafter Fine needle aspiration cytology (FNAC), both guided and unguided was performed, as needed. Smears were fixed and stained with H & E stain & special stains, as required. CD4 counts were carried out at the antiretroviral treatment (ART) centre. Results: Out of 64 cases, Tuberculosis (TB) lymphadenitis was the most common lesion with 47.05% cases & its mean CD4 count was 329/ul. There were 4 cases of malignancy; two were that of primary malignancy -lymphoma and other two were metastasis from epithelial malignancies. Conclusions: FNAC is a simple and rapid investigative technique to differentiate and diagnose various causes of lymphadenopathy. TB lymphadenitis is the most common lesion associated with HIV positive patients. CD4 counts correlate well with underlying lymph node pathology, TB lymphadenitis being common in CD4 range of 200-500/ul and HIV associated malignancies seen in CD4 count less than 100/ul.
Aims and Objective-This study has been undertaken to evaluate the role of Fine Needle Aspiration Cytology (FNAC) in Human Immunodeficiency Virus (HIV) positive lymphadenopathy patients. Materials And Method-Forty HIV positive Patients with lymphadenopathy were subjected to FNAC over a period of eight months i.e. from January, 2011 to August, 2011 in pathology department in our tertiary care hospital. Aspiration was done as a routine procedure using 22 gauge needle with standard precautions after taking detailed clinical history and physical examination of the patients. Smears obtained were stained with May-Grunwald-Giemsa (MGG), Papanicolaou (PAP) and Hematoxylin & Eosin (H&E) stains. Special stain used was Ziehl-Neelsen (ZN) stain for Acid Fast Bacilli (AFB). Result-Age distribution was noted between 5 years to 67 years during the present study. The peak incidence was noted in fourth decade of life (32.5 %). In HIV positive patients, lymphadenopathy showed male predominance, with the male: female ratio of 3.44:1. Cervical lymph nodes were the most common site encountered (62.5 %) as an initial affected site. FNAC results were classified as an inadequate material, non-neoplastic lesions and neoplastic lesions. The most common etiology associated with HIV was Tuberculous lymphadenitis (40.54 %) followed by acute suppurative lymphadenitis (27.03 %). Conclusion-FNAC is simple and safe investigative procedure for diagnosis of lymphadenopathy in HIV positive patients. It obviates surgical excision and guides subsequent therapy and management. Many opportunistic infections can also be found out with the help of this procedure.
Lymphadenopathy An Important Guiding Tool for Detecting Hidden HIV-Positive Cases: A 6-Year Study
Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002), 2007
Lymphadenopathy is one of the leading and persistent signs during the progression of human immunodeficiency virus (HIV) infection. Lymphadenopathy, as a clinical sign, can become one of the important guiding tools for detecting hidden HIV-positive cases. The present study was conducted to assess the incidence of HIV positivity in previously undiagnosed patients of HIV presenting with lymphadenopathy, comparing it with the current trends of HIV infection in the community, and to ascertain the etiology of lymphadenopathy in HIV-positive and HIV-negative cases. Over a period of 6 years, a total of 1082 cases of extra-inguinal lymphadenopathy were screened for HIV infection. Simultaneously, fine needle aspiration cytology of the enlarged lymph nodes was performed to know the etiology. The incidence of HIV positivity was found to be 2.3% among the patients presenting with lymphadenopathy. Among the HIV-positive cases, tuberculous lymphadenopathy was found in 60% of cases as compared to 2...
Histopathology, 1986
The morphological and immunohistochemical findings in lymph nodes of nine patients with the acquired immunodeficiency syndrome (AIDS) and 81 patients with the AIDSrelated complex (ARC) are presented. Three basic histological patterns were observed: follicular hyperplasia (20 cases), mixed hyperplasia (49 cases) and lymphocyte depletion (12 cases). While the first two variants were detected in typical A R C patients, lymphocyte depletion was always associated with AIDS. lrnmunohistochemistry on frozen sections showed that the number of B-cells varied throughout the series, being higher in the follicular type and significantly lower in the lymphocyte depletion nodes. The content of T-lymphocytes of the helperlinducer (T4) phenotype was reduced in all instances; this reduction was more pronounced in the germinal centres in follicular hyperplasia, while it involved all compartments of the node in the mixed and lymphocyte depletion types. In contrast the cytotoxiclsuppressor (T8) subset was increased in the follicular and mixed hyperplasias only. Partial disintegration of the dendritic network in at least some of the follicles could be demonstrated in all lymph nodes. In the follicular and mixed hyperplasias there was a high number of proliferating B-cells in the germinal centres. Our data indicate the usefulness of grading the changes occurring in lymph nodes of patients with ARC and AIDS, and allow speculation as to the pathophysiology of these conditions.
Biopsy of sonologically detected peripheral lymph nodes: diagnostic value in HIV positive patients
International Surgery Journal, 2019
Background: One of the most common manifestations in human immunodeficiency virus (HIV) is generalized lymphadenopathy. Biopsy of these nodes can help in diagnosing associated conditions. Biopsy of clinically non-palpable lymph nodes can help physician to obtain an early diagnosis of associated diseases in people living with HIV (PLHIV). Present research was undertaken to study diagnostic yield of sonologically detected peripheral lymph node biopsy in symptomatic PLHIV.Methods: One hundred ten PLHIV above age of 18 years referred to surgery department for excision biopsy of sonologically detected peripheral lymph nodes were included. Specimen was sent in normal saline to laboratory for testing and part of the specimen was fixed in formalin for further evaluation. Gram stain, Zeil Nelson stain, histopathological examination and genotype MTBDR plus test were conducted. Comparison of quantitative variables and qualitative variables was done by using Kruskal wallis test and Chi-square t...
British Journal of Surgery, 1996
The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing superficial lymph node biopsy during 1989–1990 in Lusaka, Zambia, were examined in a prospective cohort study of HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989–1990, 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63 of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa.