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FNAC of right cervical lymph node shows granulomatous lymphadentis. Meaning of report?

Today I got the below report kindly let me know about the report SITE : FNAC FROM RIGHT CERVICAL LYMPH NODE. Yielded blood admixed aspirate MICROSCOPIC : Smears show epithelioid cell granulomas and occasional giant cell against lymphoid and haemorrhagic background. ZN stain for AFB non-contributory. IMPRESSION : GRANULOMATOUS LYMPHADENITIS (LIKELY TUBERCULAR)
Asked On : Fri, 2 Nov 2012
Answers:  3 Views:  2422
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General & Family Physician 's  Response
thanks for asking the question. F.N.A.C stands as fine needle aspiration cytology. By doing, F.N.A.C you can have an idea about the underlying disease. You did not mention about your age and description of the lymph node. A matted nontender lymph node with discharge coming out from it will go in favour of tuberculosis. Although, pathologist did not mention in detail about the necrosis, but I suspect it was present because in the impression possibility of tuberculosis was written. Sarcoidosis, fungal infection, histoplasmosis, crohn's disease may also lead to development of granulomatous lymphadenopathy. For confirmation of diagnosis, lymph node biopsy along with detailed histopathological examination has to be undertaken. A mantoux test and serum angiotensin converting enzyme estimation will also help in differentiation of tuberculosis and sarcoidosis. But as you are an Indian, I will advocate you to start antitubercular drug Isoniazid , Rifampicin ,Pyrazinamide, ethambutol for two months followed by isoniazid, rifampicin for four months. Depending on the response, duration of treatment has to be prolonged. I cannot tell you dose of the individual drugs as you did not mention about your body weight. If the size of lymph nodes do not regress, then a biopsy may be required. also please do a sputum for acid fast bacilli followed by chest Xray PA view .If it shows bilateral hilar prominence, then Contrast enhanced CT thorax has to be done keeping possibility of sarcoidosis in mind. Don't think too far . Start antitubercular drugs.
Hope, i satisfied your queries.
Answered: Sat, 3 Nov 2012
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General & Family Physician Dr. Stephen Christensen's  Response
Hello! The physician who performed your biopsy (or the one who ordered it done) would be best qualified to answer this question, since he/she/they are more familiar with your case. However, I'll try to translate it into more meaningful language for you.
As you probably know, FNAC stands for "fine needle aspirate cytology," which simply means this is the pathologist's interpretation of what the cells in your lymph node look like. First, the cells in the biopsy were mixed with a little blood, which is normal. When viewed under a microscope, the biopsy contained granulomas (knots of specialized immune cells called macrophages) that had assumed the appearance of skin cells. (A granuloma is your body's way of walling off a microorganism or substance that it cannot otherwise eliminate. Epithelioid granulomas are typical of several conditions that are associated with granuloma formation, such as Crohn's disease, sarcoidosis and tuberculosis, so that terminology, per se, doesn't help much.) These granulomas were mixed with normal-appearing lymph node tissue. Giant cells are an indication that some of the macrophages in the granuloma have been activated, or stimulated, to deal with the irritant that triggered the granuloma -- again, not a particularly helpful clue. Ziehl-Neelson (ZN) stain is a specific cellular stain used by pathologists to detect acid fast bacteria (AFB), such as tuberculosis. In your case, the ZN stain didn't reveal any acid fast bacteria, but the pathologist still thought your biopsy was most consistent with tuberculosis.
I hope that helps. Your doctor will let you know if any further investigation is warranted or if any specific treatment is needed.
Good luck!
Answered: Fri, 2 Nov 2012
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General & Family Physician Dr. Das Arindam's  Response
Sep 2012
Hello, Welcome to HCM, I am Dr. Das
The report indicates granulomatous lymphadenitis likely tubercular. It means probably you are suffering from tuberculosis.
But before considering it as a confirmed diagnosis, you have to be examined thoroughly and other tests like Mantoux, Bactec, and lastly DNA PCR.
But, antitubercular drug may be started on the basis of this report.
Answered: Fri, 2 Nov 2012
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