A research report submitted to the Faculty of Health Sciences, University of
Witwatersrand, in fulfillment of the requirements for the degree of Master of Medicine in
the branch of Internal Medicine
Johannesburg, 2015 / Lymphadenopathy is a common clinical presentation of disease in South Africa (SA),
particularly in the era of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) coinfection.
Methods
Data from 560 lymph node biopsy reports of specimens from patients older than 12
years at Chris Hani Baragwanath Academic Hospital (CHBAH) between 1 January 2010
and 31 December 2012 was extracted from the National Health Laboratory Service
(NHLS), division of Anatomical Pathology. Cytology reports of lymph node fine needle
aspirates (FNAs) performed prior to lymph node biopsy in 203 patients were also
extracted from the NHLS. Consent was not obtained from participants for their records
to be used as patient information was anonymized and de-identified prior to analysis.
Results
The majority of patients were female (55%) and of the African/black racial group (90%).
The median age of patients was 40 years (range12-94). The most common indication
for biopsy was an uncertain diagnosis (more than two differential diagnoses entertained),
followed by a suspicion for lymphoma, carcinoma and TB. Overall, malignancy
constituted the largest biopsy pathology group (39%), with 36% of this group being
carcinoma and 27% non-Hodgkin lymphoma. 22% of the total sampled nodes displayed
necrotizing granulomatous inflammation (including histopathology and cytology
demonstrating definite, and suspicious for mycobacterial infection), 8% comprised HIV
reactive nodes; in the remainder no specific pathology was identified (nonspecific
reactive lymphoid hyperplasia). Kaposi sarcoma (KS) accounted for 3% of lymph node
pathology in this sample. Concomitant lymph node pathology was diagnosed in four
cases of nodal KS (29% of the subset). The co-existing pathologies were TB and
Castleman disease. HIV-positive patients constituted 49% of this study sample and the
majority (64%) of this subset had CD4 counts less than 350 cells/ul. 27% were HIVnegative
and in the remaining nodes, the HIV status of patients was unknown. The most
common lymph node pathologies in HIV-positive patients were Mycobacterial infection
(31%), HIV reactive nodes (15%), non-Hodgkin lymphoma (15%) and nonspecific
reactive lymphoid hyperplasia (15%). Only 9% were of Hodgkin lymphoma. In contrast,
the most common lymph node pathologies in HIV-negative patients were nonspecific
reactive lymphoid hyperplasia (45%), carcinoma (25%) and Mycobacterial infection
(11%). In this group, non-Hodgkin lymphoma and Hodgkin lymphoma constituted 9%
and 8%, respectively. There were more cases of high-grade non-Hodgkin lymphoma in
the HIV-positive group compared to the HIV-negative group. FNA and lymph node
biopsy had excellent agreement with regard to Hodgkin lymphoma (K 0.774, SE 0.07,
95% CI 0.606-0.882, p=0.001), and good agreement with regard to non-Hodgkin
lymphoma (K 0.640, SE 0.07, 95% CI 0.472-0.807, p=0.001), carcinoma (K 0.723, SE
0.069, 95% CI 0.528-0.918, p=0.001), and mycobacterial infection (K 0.726, SE 0.07,
95% CI 0.618-0.833, p=0.001).
Conclusions
The most common lymph node pathologies in CHBAH are malignancies, nonspecific
reactive lymphoid hyperplasia, necrotizing granulomatous inflammation and HIV reactive
nodes. The distribution of disease differed in HIV-positive patients. Overall, adequate
FNA samples of lymph nodes have been found to have good correlation with lymph
node biopsy findings in our setting.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/19474 |
| Date | January 2015 |
| Creators | Reddy, Denasha Lavanya |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf, application/pdf |
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