The chronic cervical lymphadenopathy is common neck swelling among this tuberculous lymphadenopathy is most common in India. Secondary metastasis is common in elderly patients. Mainly because of prevalence of tuberculous in our country, a majority of patients empirically put on anti-tubercular therapy without FNAC or histopathological diagnosis and in the absence of proper treatment hazards. While considering the differential diagnosis our main aim to find out if swelling is inflammatory or malignant and if inflammatory whether it is tuberculous or not. In young adults, common causes are tuberculosis and lymphoma.

AIMS AND OBJECTIVES

1. To analyze the etiological factors of chronic cervical lymphadenopathy.
2. To analyze the age and sex distribution of chronic cervical lymphadenopathy.
3. To correlate clinical diagnosis with FNAC and histopathological diagnosis.
4. To authenticate the importance of clinical diagnosis.

Study type: Randomized prospective study

Study site: Department of General Surgery, Guru Gobind Singh Hospital Jamnagar

Study Duration: January 2002 to November 2003

INCLUSION CRITERIA-

Age of patient more than 12 years.

Study includes patients presenting with discrete cervical lymphadenopathy of greater than 4-week duration.

Consent to participate in study.

EXCLUSION CRITERIA-

Age less than 12 years (in this group chronic cervical lymphadenopathy is mostly due to scalp lesions, lice etc.)

Lymph nodes less than 10 mm in size (clinically insignificant)

Non-compliant patient.

A clinical study of 100 cases of chronic cervical lymphadenopathy admitted in various department or outpatient department of Guru Gobind Singh Hospital Jamnagar from January 2002 to November 2003 was done.

TABLE 1- ETIOLOGICAL DISTRIBUTION

TABLE 2- AGE DISTRIBUTION

TB - Tuberculosis; NS - Nonspecific; NHL - Non Hodgkins lymphoma

TABLE 3- SEX DISTRIBUTION

TABLE 4- PERCENTAGE DISTRIBUTION OF TB / NON TB CASES

TABLE 5- CORRELATION BETWEEN CLINICAL DIAGNOSIS AND HISTOPATHOLOGICAL DIAGNOSIS

TABLE 6- CORRELATION BETWEEN FNAC AND INCISIONAL EXCISIONAL

A total of 100 patients were included in this study. The various causes for cervical lymphadenopathy as found are shown in Table-1. Out of 100 cases 47% cases found to have tuberculous cervical lymphadenopathy. It is evident from Table-1 that tuberculosis is the most common cause of cervical lymphadenopathy.

Their sex distribution is shown in Table-3. There were 62 males and females. The male to female (M:F) ratio was found to be 1:1.09. The maximum number of cases was found to be in the age group of 12 to 20 (63%)

During study correlation was made between clinical diagnosis and histopathological diagnosis. In 73% cases clinical diagnosis was true and correlated with histopathological diagnosis. In 27 cases there was fallacies in clinical diagnosis. FNAC was able to diagnosis (truly) in 68% cases.

From above discussion it is evident that in all chronic cervical lymphadenopathy patients histopathological diagnosis should be done and patient should not be put on empirical anti-Koch’s treatment without histopathological diagnosis. Role of FNAC is limited in our setup due to lack of expert cytopathologist. Anti-Koch’s treatment should not be started without HP examination.

1. Most common etiological factor was tuberculous lymphadenitis.
2. Age group involved suggests between 21-40 years maximum affected.
3. Sex distribution suggest male predominance.
4. Clinical diagnosis was true in 73% cases.
5. Fallacies in clinical diagnosis was in 27% cases.
6. FNAC is not reliable in our set up due to lack of expert cytologist and all patients requires histopathological HP examination.
7. Most common form of management was anti-Koch’s treatment.

Patients with chronic lymphadenopathy should not be put empirically on anti Koch’s treatment without histopathological diagnosis.

1. History : short practice of surgery. 28^th Bailey and Love’s
2. Surgical anatomy : Lee McGregor’s
3. Short cases in surgery. S. K. Bhattacharya
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