The lymph nodes are major components of the lymphatic system clustered in small groups or chains at strategic locations, where they drain the lymphatic vessels of various anatomic regions. The lymph nodes exhibit a complex architecture in which a variety of cell populations are arranged in distinct interfacing compartments. This provides a favourable environment in which the various cellular components can process antigens, interact and generate the immune response. Normally, lymph nodes are not palpable. They become detactable as a result of intense immune reactions or tumor metastasis. Sero positive disease caused by the retrovirus HIV, characterized by profound immune suppression that leads to opportunistic infection, secondary neoplasm and neurological manifestation. Lymphadenopathy is one of the earliest manifestations of sero positive infection. Transmission occurs under conditions that facilitate exchange of blood and body fluids containing the virus or virus-infected cells like by sexual contact, parenteral inoculation or by passage of the virus from infected mother to their newborns. To control the spread of the virus, the Indian government set up the National AIDS Control Programme (NACO) in 1987 to co-ordinate national responses such as blood screening and health education.

OBJECTIVE:

- To study cytopathological distribution of various lesions in lymph nodes and their relation to different age groups, gender and site of lymph node involvement in sero positive patients.

- To demonstrate the utility of Ziehl Neelsen staining for demonstration of acid fast bacilli in aspirates of all cases of tuberculous lymphadenitis by analysing the cytomorphological features of tuberculous lymphadenitis cases as observed on FNAC of lymph node.

- To compare our study findings with other relevant similar studies.

FNAC Study of sero positive lymphadenopathy was carried out in Cytopathology laboratory of Department of Pathology, PDU Government Medical College and Hospital, Rajkot between the January 2024 to April 2025 time period. When patient is referred by clinician for cytopathological evaluation, a brief history and consent was taken and clinical examination was done.

FNAC will be performed using 22 to 24 gauge needle and 10 ml syringe. The needle is pierced into the swelling, needle is moved to and fro several times, negative pressure is applied and material is aspirated. The material obtained in the syringe is spread on many slides. Some of them are fixed immediately in methanol for Hematoxylin and Eosin stain while some are kept air dried and then fixed in methanol for May Grunewald Geimsa stain.  

INCLUSION CRITERIA:

All seropositive patients presented with lymphadenopathy, irrespective of age and gender, will be included in cytopathological examination.

EXCLUSION CRITERIA:

Patients not willing to give informed written consent for fine needle aspiration cytology will not be included in the study.

Patient Demographics:

A total of 60 patients with lymph node FNAC study of sero positive patients were included in the study. In our study, age of the patient ranged from 0-80 years.(TABLE- 1) Maximum number of cases 27(45%) were seen in the age group 41-60 years followed by 23(38.33%) in 21-40 years.

TABLE 1: Distribution of FNAC study of Lymphnode according to Age group:

TABLE 2: Distribution of FNAC study of Lymphnode according to gender

TABLE 3: Distribution of FNAC study of Lymph nodes according to Age and Sex:

TABLE 4: Distribution of enlarged lymph nodes according to site:

In our study the maximum number of patient presented with cervical lymph node enlargement 30(50%) followed by Inguinal 13(21.67%), Axillary 06(10%), Submandibular 06(10%), Supraclavicular 05(8.33%) (TABLE- 4).

TABLE 5: Incidence of various pathological conditions of lymph nodes in sero positive patients

Out of 60 cases of lymph node aspiration majority were Tuberculous lymphadenitis 20(33.33%) followed by Reactive lymphadenitis 13(21.67%), Chronic nonspecific lymphadenitis 11(18.33%), Metastatic malignancy 02(3.33%), Lymphoproliferative lesions like Non Hodgkin lymphoma 03(5.0%), Hodgkin lymphoma 02(3.33%). In 09(15%) cases no any cellular details seen (TABLE 5).

TABLE 6: Incidence of benign and malignant lesions of lymph node

TABLE 7: Result of Ziehl Neelsen stain in Tuberculous lymphadenitis

In total 20 cases of tuberculous lymphadenitis, Ziehl Neelsen stain was done. Out of that 14(70%) cases were positive for acid fast bacilli and 06(30%) were negative.

TABLE 8: Correlation of major cytological features in Tuberculous Lymphadenitis

In total 20 cases of tuberculous lymphadenitis 14(70%) cases show epithelioid granuloma with necrosis, 04(20%) cases show only necrosis without epithelioid granuloma and 02(10%) cases show only epithelioid granuloma without necrosis.

The present study demonstrated the utility of lymph node cytology in the diagnosis and segregation. The study of total 60 cases of FNAC of lymph node in sero positive patients of January 2024 to April 2025(One year and four months) was carried out in the Department of Pathology, P.D.U. Government Medical College & Hospital, Rajkot. The age range of the patient varied from as young as 2 years to 80 years. Majority of the patients were in the age group 41-60 years (45%) closely followed by 21-40 years (38.33%). Similar findings were recorded by Parikh et al on 40 cases of lymphadenopathy in HIV positive patients and majority of the patients were in the age group 31-40 years (32.5%) closely followed by 21-30 years (22.5%). In similar study by Vanisri et al on 36 cases of lymphadenopathy in HIV positive patients 44.4% cases were recorded in age group of 21-30 years closely followed by 31-40 years (25%).

TABLE 1: Comparision of age wise distribution of lymph node lesions in present study with others

In the present study, males (60%) were affected more commonly than female (40%), male to female ratio was 2:1.Similar findings were reported by Guru et al in which male: female ratio was 2.3:1. Parikh et alt¹ reported male: female ratio 3.44:1 where as a female predominance was noted by Narang et al (male female ratio was 4:5) and Pandit et al recorded equal

occurrence in both genders.

Sites of Lymph nodes involved:

In the present study the maximum number of patient presented with cervical lymph node enlargement 30 (50%). Similar findings were recorded by Guru et al⁴⁴ (78.76%), Parikh et al⁴³ (62.5%), and many others like Vanisri et al⁴⁵, Shenoy et al⁴⁸.

Tuberculous lymphadenitis was predominant cytopathological diagnosis in the present study constituting 20 cases (33.33%). Studies conducted by Shenoy et al⁴⁸ (50%) in Mangalore, Saika et al¹ (32%) in Chandigarh and Jayaram et al³ (53.84%) in Malaysia also observed tuberculous lymphadenitis as a common lymph node lesion. However studies conducted in in Europe by Reid et al⁵¹ (15%) demonstrated lower number of cases in comparison with recent study.

The most common cytomorphological feature in tuberculous lymphadenitis was caseation with epithelioid granuloma (70%) followed by caseous necrosis only which correlates well with the study of Guru et al⁴⁴ (46.87%) Annam et al⁵² and Malakar et al⁵³ also found the same results.

In total 20 cases of tuberculous lymphadenitis on FNAC, Ziehl Neelson stain was done. Out of which 14(70%) cases were positive for acid fast bacilli and 06(30%) were negative. Similar rate of AFB positivity was reported by Ahmed et al⁵⁶ (46.4%) in 2005. Metre and Geeta Jayaram (1987) demonstrated acid fast bacilli in 56.4% of tuberculous lymphadenitis. Chronic nonspecific lymphadenitis was also common lesion affecting 18.33% cases. Similar findings were recorded by Prabhakaran et al⁵⁵ (28.9%) in 1974, Trivedi and Mallick⁵⁶ (28.8%) in 1953 and Longe et al⁵⁷ (22.2%) in 1972.

Reactive lesion (21.67%), was also common in a study conducted in India (Chandigarh) by Saika et al¹ (40%). Similar observations were reported in studies conducted in Europe by Reid et al (51%). Only five cases of lymphoma were reported in present study constituting 8.33%. Studies conducted by Guru et al (1.73%), Saika et al (4%) and Shenoy et al 6(10%) in India and Jayaram et al 3(2.56%) Malaysia also reported lower number of cases similar to present study. Studies conducted in Europe by Reid et al 8(11%) had higher incidence of lymphoma when compared to the present study. HIV related tuberculosis is becoming common in India. On the contrary, neoplastic diseases are seen in increased frequency in America and Europe.

Lymphadenopathy is one of the earliest manifestations of sero positive infection. Great advances have been made in the treatment of these patients. Sero positive related lymphadenopathy has definite patterns like florid reactive hyperplasia, folliculolysis, explosive follicular hyperplasia, advanced lymphocytic depletion. Though, FNAC cannot clearly demarcate all these lesions, it has definite identifiable reactive patterns and is useful in detecting specific infective aetiologies.

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