Histological examination in obtaining a diagnosis in patients with lymphadenopathy in Lima, Peru
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26–52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis.
Date Issued
2017-08-21
Date Acceptance
2017-06-30
Citation
American Journal of Tropical Medicine and Hygiene, 2017, 97 (4), pp.1271-1276
ISSN
1476-1645
Publisher
American Society of Tropical Medicine and Hygiene
Start Page
1271
End Page
1276
Journal / Book Title
American Journal of Tropical Medicine and Hygiene
Volume
97
Issue
4
Copyright Statement
© The American Society of Tropical Medicine and Hygiene. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited (https://creativecommons.org/licenses/by/4.0/)
License URL
Sponsor
Sir Halley Stewart Trust
Medical Research Council (MRC)
Wellcome Trust
Wellcome Trust
Wellcome Trust
Medical Research Council (MRC)
Grant Number
N/A
MR/K007467/1
097816/Z/11/A
105788/Z/14/Z
201251/Z/16/Z
MR/P019978/1
Subjects
11 Medical And Health Sciences
Tropical Medicine
Publication Status
Published