Lymphadenopathy: Incidence, Nature and Pattern in Goa

 

 

Article By:

Mohanray  V.  Mallya 

Suzette  Menezes

Nisha Nadkarni  

 

This article has been reproduced from the August 1988, Vol. 52, No. 8 of “The Clinician”. Permission has been obtained from Dr. Mohanray  V.  Mallya, one of the authors of the article.

 

Abstract 

A total number of 556 lymph node biopsies were studied between 1982 and 1984 by Department of Pathology, Goa Medical College. The commonest cause of lymphadenopathy was tuberculous lymphadenitis (42.1%) followed by reactive hyperplasia (33.8%) and secondaries in lymph nodes (15.1%) and lymphomas (5 .7%).

 

Introduction :

Lymphadenopathy is a frequent finding in medical practice and poses a diagnostic problem to the clinician as well as to the type and nature of the lesion.

The lymph nodes stand as sentinels on the path of lymph stream. They play the part of a filter holding up foreign particles and bacteria. Tumor cells carried by lymph from primary site to regional lymph nodes may implant and cause lymph node enlargement. Thus lymph nodes may enlarge in various diseases like tuberculosis (Figure 1), filariasis (Figure 2), non-specific infections, metastatic carcinomas, lymphomas (Figure 3) etc. having different therapeutic approach and prognosis. Lymph node biopsy therefore is the only definite aid to arrive at an accurate diagnosis.

TC- Jan 2017 - 018 - Figure 1. Photograph of Tuberculous lymphadenitis TC- Jan 2017 - 019 - Figure 2. Photograph of Filarial lymphadenitis TC- Jan 2017 - 020 - Figure 3. Photograph of Hodgkin’s lymphoma

Lymphadenopathy is fairly common in Goa, forming an incidence of 5.25% as seen from the medical records of Goa Medical College, Hospital. The present study was therefore undertaken with the aim :-

a) To obtain data regarding the prevalence of various types of lymphadenopathies in Goa.

b) To find out the incidence of each variety of lymphadenopathy according to age, sex, and site of lymph node enlargement.

c) To compare the above findings with the statistics of similar studies done elsewhere in India, as well as those of the west.

 

Materials and Methods :

This work comprises a study of a lymph nodes obtained from patients who presented with lymphadenopathy in the out patient departments (OPD’s) and various wards of hospitals associated with Goa Medical College from the year 1982 to 1984.

A total number of 10,591 surgical specimens were received at the Department of Pathology, Goa Medical College during the above period. Out of these 556 lymph node biopsies were received.

The cases were investigated as follows:

1) A detailed case history was elicited from the patient. This included the age, sex, religion etc.  Special emphasis was laid in recording the duration of complaints and site of lymph node enlargement.

2) General examination for any associated systemic disease and local examination was done.

3) Blood examination was done in all cases of lymphadenopathy.

4)  Biopsy from the enlarged glands was taken in call cases for histopathological examination.

 

Results :

A total number of 10,591 surgical specimens were received during the 3 years period from 1982 to 1984 out of these 556 lymph node biopsies were recorded giving an incidence of 5.25% and an average of 185 lymph node biopsies per year.

The youngest case in the present series was a child of 6 months and the oldest case was an 80 year old male.

The largest number of lymph node enlargement was   seen  in  2nd and 3rd decades (255 cases) accounting for 45.9% followed by 15.8% (88 cases) in the 4th decade and 11.3% (63 cases) in the 5th decade.

The commonest cause of lymphadenopathy was tuberculous lymphadenitis (42.1%) followed by reactive hyperplasia (33.8%) and metastasis in lymph node (15.1%). The commonest type of metastasis was Adenocarcinoma, Squamous Cell Carcinoma, Infiltrating duct Carcinoma, and Carcinoma of thyroid in that order. (Table 1).

 

TC- Jan 2017 - 021 - Table1. Distribution of cases

 The male to female ratio of incidence of lymphadenopathy was 1.08:1.

The commonest site of involvements was the cervical group of lymph node 54.5% (305 cases), Axillary group 21.3% (119 cases) and inguinal lymph node 5.7% (32 cases).

 

Discussion :

Lymph nodes are among the organs most commonly biopsied for diagnostic purpose. Their frequent involvement in regional and systemic diseases and their easy accessibility make the morphologic study of lymph nodes a permanent activity for the pathologists.

The incidence of lymphadenopathy per year was almost similar to that of Anthony et al (1983) but higher compared to that of Prabhakar et al. The Age variation in out study coincides with the observation of Reddy et al (1962) Trivedi and Basu Mallick (1953), Prabhakar et al (1971) Kher  et al (1983) and M. Shafique et al (1985). These were in contrast with the findings of Anthony et al (1983) in their study in Exeter health authority area in Great Britain. The gradual increase of lymphadenopathy with age reported in their study was due to increase of malignant conditions with age. The high incidence of lymphadenopathy in younger age in our study is probably due to predominance of non-neoplastic conditions the commonest being tuberculosis which is rare in the West (Table 2).

The age curve of lymphadenopathy showed that the peak curve for tuberculous lymphadenitis and reactive hyperplasia of lymph nodes was in the  2nd and 3rd decade (Table 3).

The histologic findings showed that the tuberculous lymphadenitis constituted the largest group (42.1%). Next in frequency were reactive hyperplasia (33.8%) and metastasis in lymph nodes (15.1%).  A  Comparison of the incidence of nature of lymphadenopathy with various studies conducted at different places and at different times is shown in Table 2. It is seen that although the pattern of distribution of lymphadenopathy in each study is same, the incidence of the histological type of lymphadenopathy varies. In contrast to our studies and other studies conducted in India. Anthony et al (1983) in his study in Exeter health authority area in Great Britain reported metastatic  lymphadenopathy  to form 41% of all cases, followed by reactive hyperplasia 30%, malignant lymphomas 19% and specific non-neoplastic conditions 10%. Tuberculous lymphadenitis was seen in only 6 cases.

TC- Jan 2017 - 022 - Table 2 Comparative statistics TC- Jan 2017 - 023 - Table 3 Age Curve of Lymphadenopathy

 

The above findings show that tuberculosis has declined in the West and it still continues to be rampant in India.

 

Acknowledgements :

We thank the Dean of Goa Medical College for allowing us to publish this paper.

 

TC- Jan 2017 - 024 - Writers Art pg 38

 

References:

  1. Ackerman L. V.: Surgical Pathology 5th edition page 947 – 992.
  2. Anthony, P. P.; Knowles S.A.S.: Lymphadenopathy as a primary resenting sigh: a clinicopathological study of 228 cases, British Journal of Surgery Vol: 70, No. 7 July 1983 Pg. 412 – 415.
  3. Kher, K.S.; Sharma, R.S.: Cervical lymphanopathy a clinicopathological study : In Medical Gazette 1983. Vol XXVII No. 6 Pg.
  4. Prabhakar, B.R et al Lymphadenopathy, Incidence nature and pattern of various types, In Journal of Surgery, 1974 36 : 269.
  5. Trivedi, B.P. Basu Mallick, K.C.: Indian Journal of Surgery 15:74 – 77.