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Dr. Andrew Rynne

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What does this observations found on biopsy report regarding enlarged lymph nodes suggest?

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Dr. Rajkishori Godhi

ENT Specialist

Practicing since :2003

Answered : 709 Questions

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Posted on Mon, 4 Aug 2014 in Ear, Nose and Throat Problems
Question: Hi,

I have a swollen enlarged lymphnodes on the right side of the neck and this was there since 6 months. From the FNAC report doctors suggested to undergo a treatment for a TB.

* AKT3 followed by AKT4 after 2 months.

After 6 months, I'm still seeing the same size nodes on the right side where the position has changed.
So, they have asked me to go for biopsy. The following are the observations found on the reports:

1. Culture and sensitivity (Tissue)
Gram's Stain : No Bacteria, occasional pus cells, no epithelial cells and no fungal filaments seen

2. XPERT MTB/RIF - Extrapulmonary :

Specimen Type: TISSUE
MYCO. TB. - NOT DETECTED
Comments: Since this patient is not detected for mycobacterium tb, Rifampicin resistance detection is not possible.
Test Method: XPERT MTB/RIF - Extrapulmonary - Real Time PCR on GeneXpert platform
3. Histopathology:
A1- A2 : Sections studied show multiple lymphnodes and two nodes show discrete granulomas. The granulomas show central caseous necrosis with karyorrhectic debri, epitheliod cell aggregation surrondedd by lymphocytes and fibroblasts. Ocasional langhan's and foreign type of gaint cells seen. focal areass show dense fibrosis with collagen bundles with extension granulomas into perilymphondal fiborfatty tissue. Remaining lymphnodes show reactive changes. no evidence of malignancy in the sections studied.

AFB-TB(A1)- Negative
Impression : Necrotizing granulomatous lymphadenitis suggestive of tb.

Doctor prescribed few other medications for tb but there is no definite bacteria found on the reports. So, I would really want how should i proceed from there. In the sense, should I continue with TB prescriptions or anything has to be ruled out?
Note: AFB- Culture is pending.

Thanks,



doctor
Answered by Dr. Rajkishori Godhi 22 minutes later
Brief Answer:
continue with Tb medication

Detailed Answer:
Hello Mr XXXXXXX

The histopathology report clearly states that the picture is suggestive of tuberculosis. The histopathology picture is classical and cannot be mistaken for anything else. Histopathology is conclusive. It is more than enough evidence for tuberculosis.

The bacteria are not found many times, also since you have taken ATT it will not be possible to find bacteria.

Please continue with the treatment prescribed by your doctor. Resolution of nodes can take a while.

Regards,
Dr Rajkishori Godhi.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Rajkishori Godhi 14 minutes later
Hi Doctor,

Would like know if there is no mycobacteria, why should the swollen nodes is still having the same size?

Also, in all the reports, it was not having any evident of tb bacteria. As you said, it could have cured but why doctor prescribed other medicines which are powerful than AKT4. When there is no bacteria, how can we make sure I have tb.
The worry is why shouldn't be any other infection. Am I into the right treatment or any other diagnosis has to be done to confirm?


doctor
Answered by Dr. Rajkishori Godhi 4 hours later
Brief Answer:
If bacteria not found it does not mean it is cured

Detailed Answer:
Hello sir,
Many times Tb bacteria cannot be isolated. It does not mean that the infection is cured. Infection can still persist even when there can be no evidence of Tb bacteria.

Clinically since your nodes have not reduced in size your doctor has decided to continue treatment. Treatment for Tb lymphadenitis can sometimes go on for 18 months. Inspite of successive treatment the nodes may take a very long time to resolve.

As I said your histopathology report shows classical caseation necrosis and other features which are very highly suggestive of tuberculosis so your doctor will not wait to isolate the bacteria. But anyway culture report is awaited. May be it will isolate the mycobacteria.

I feel that you have been investigated quite thoroughly and are in the right treatment.

Regards,
Dr Rajkishori Godhi
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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