Lymph node is one of the major anatomic components of the immune system. Because normal immune response leads to proliferation and expansion of one or more of the cellular components of lymph nodes, it leads to significant lymph node enlargement.

1. These lymph nodes have the potential to become infected or malignant.
2. Lymphadenopathy is usually classified as generalized lymphadenopathy or localized lymphadenopathy, where more than half of the patients will present with localized lymphadenopathy and the rest will present with general lymphadenopathy.3

In India, lymphadenopathy cases are very common and hence lymph node biopsy is an imperative measure to check for infections or malignancies. One of the most common causes of lymphadenopathy observed is reactive lymphadenitis followed by granulomatous lymphadenitis. 1 In cases of lymphadenopathy, lymph node biopsy is very useful to identify if there is any malignancy involved. 4 Out of all the infections caused by lymphadenopathy, Tuberculosis is the most common cause of lymphadenopathy. 5 The high prevalence of TB can be due to poor living conditions in underdeveloped and developing countries. 6 For diagnosis of lymph node biopsies, excisional biopsy and histopathological analysis are considered as the ‘gold standard’.7

Prospective  an study done in the department of Pathology at Mamata academy of medical sciences , Bachupally ,Hyderabad, Telangana for duration of 6 months  i.e. from  ie from July 2024 to Dec 2024.

Inclusion criteria

Age distribution, Excision biopsies of lymph nodes were included in the study

Exclusion criteria

Cases with inconclusive diagnosis due to lack of adequate material.

Methodology

Ethical approval from the Institutional Ethics Committee was obtained for this study.

The excisional lymph node biopsy specimen is fixed in 10% neutral buffered formalin (NBF).  The sample is processed in multiple steps. Firstly, sample acceptance and numbering are done in the lab after which grossing of the sample is done. Tissue processing and embedding is then carried out after which block cutting of the samples is done. The samples then undergo hematoxylin and eosin staining. The sample then be mounted, labelled and arranged in trays. And reporting done.

Statistical tests be applied to analyze the histopathological data

Age distribution:  The age range was 1 year to more than 70 years and maximum cases were seen in the 41-50 years age group accounting 44.4%(20/45) , followed by 61-70 years 15.5% (7/45), 11.1% (5/45) in 31040 years and 51-60 years.one case noted of 9 years age .2 cases in 17 years and  19 years and  2 cases 74 years and 71 years age . 3 cases among 31-40 years,

Gender distribution: There was slight female preponderance (52%) and male to female ratio was 1:1.1.

According to site : The common site was cervical lymphadenopathy seen in 71.1% (32/45)  of cases followed by inguinal 6.6%( 3/45) , axillary 4.4%(2/45) , submandibular  6.6%(3/45) , and parotid  11.1%(5/45)

According to clinical history : In our study  all 45  cases presented with lymphadenopathy   .44.4% ( 20/45)  with fever , cough and pain in 2,2% (10/45) ,loss of weight in 44.4% (20/45) , Loss of appetite 33.3% (15/45).

Table 1: Diagnosis on FNAC

In the present study    Reactive  lymphadenitis  was most commonly reported accounting 53.3%  followed by Abscess and Chronic nonspecific lymphadenitis 11.1% and Chronic Granulomatous lymphadenitis  6.6%,Hodgkins lymphoma and NHL in 4.4%  and  Metastases  in 6.6%

Table 2: Diagnosis on Histopathology

Table 3: Correlation between FNAC and Histopathology

Comparative studies based on Age distribution

In our study the age range was  1 year to more than 70 years and maximum cases were seen in the  41-50 years age group accounting  44.4%(20/45) , followed by 61-70 years 15.5% (7/45), 11.1% (5/45) in 31040 years and 51-60 years.one case note of 9 years age .2 cases in 17 years and  19 years and  2 cases 74 years and 71 years age . 3 cases among 31-40 years, In Ashwini  et al⁸ study mmajority of the patients were from 41 to 60 years of age group 36 (34.6%), followed by 29 (27.9%) from 21-40 years of age groups .In Ramya et al ⁹study the age range was 3-85 years and maximum cases were seen in the 21-30 years age group.In Pradhan et al ¹⁰ study maximum cases were observed in the age group of 41–50 years, whereas least was above 70 years. In Smaina et al ¹¹ study mean age of males was 35.248 + 19.9451 years, and that of females 36.470 + 19.7346 years, (P value = 0.668).

Comparative studies based on Sex distribution

In the present study there was slight female preponderance (52%) and male to female ratio was 1:1.1. whereas Bimal et al ¹², Aswini et al⁸, Ramya et al⁹ and Pradhan et al¹⁰, in their studies reported a male: female ratio of 0.57:1,, 1.3:1 and 1.7:1 respectively indicating male preponderance, whereas, Mbata GC et al¹³ reported a male: female ratio of 1:1.3 showing female preponderance. Our study findings in discordance with most of the above studies

Comparative studies based on Site

In our study the common site was cervical lymphadenopathy seen in 71.1% (32/45) of cases followed by inguinal 6.6%( 3/45) , axillary 4.4%(2/45) , submandibular  6.6%(3/45) , and parotid  11.1%(5/45) our findings were in concordance with  Aswini ⁸et al  study where  majority were from the cervical region comprising 58 (55.7%) cases followed by 35 (33.6%) cases in axillary region..In Smaina et al ¹¹ study the most common site of biopsy was cervical (60.2%) followed by axillary (18.9%) and inguinal nodes (7.1%). In Ramya  et al⁹ study the common site was cervical lymphadenopathy seen in 60% of cases followed by inguinal (15%), axillary (8%), supraclavicular (7%), mediastinal (3%), retroperitoneal (2%) and other sites (5%).Bimal  et al¹² study 316 (67.38%) cases were reported at the cervical location.

The preponderance of cervical lymphadenopathy may be related to its location near a Common primary site of infections and malignancy that are drained through this single channel (the cervical lymph nodes).

Table 4: Comparative studies based on Histopathology findings

In the present study, out of 45 patients, nonspecific cause (reactive hyperplasia) was found in 22 (60%) and similar findings noted in Ramya et al ^9.Ashwini et al^8,  , and Pradhan et al ¹⁰ study. Granulomatous lymphadenitis which is the most common etiologic factor in Bimal shah et al study¹² done within our environment was found to be the third etiologic factor in our study. The percentage of granulomatous lymphadenitis found in our study  was smaller than that found in some series including those by Roy A et al, ¹³Ali K Ageep et al, ¹⁴ O Ochicha et al, ¹⁵ and Mbata GC et al. ¹⁶ Higher prevalence has been quoted in Nigeria, India, Pakistan and Bangladesh. ¹³

Lymphomas were the most common cause of malignancies in our study accounting for 6.6 % of lymphadenopathy. This is lower than the findings in the studies by Ali K Ageep et al¹⁴ (16.6%), O Ochicha et al¹⁵ (24%), and Mbata GC et al¹⁶ (17.1%).

In our study non Hodgkin’s lymphoma is higher (32.2%) than Hodgkin’s (11.2%). Most other studies by Roy A et al¹³, Ali K Ageep et al, ¹⁴ O Ochicha et al¹⁵ and Mbata GC et al¹⁶ also gave a higher preponderance of non-Hodgkin’s lymphoma. Also in the western world non Hodgkin’s lymphoma is reported to be three to four times more common than Hodgkin’s disease. ^17,18

The present study highlights the importance of lymph node biopsy and in establishing the cause for lymphadenopathy. In this study maximum number of cases were seen in the age group of 41-50 years and there was a female preponderance. In non – neoplastic lesions, reactive lymphadenitis was common. In neoplastic lesions, metastatic diseases were common followed by Hodgkin lymphomas and Hodgkin lymphomas.

1. Damle PR, Suryawanshi KH, Dravid NV, Newadkar DV, Prashant N, et al. Deor A Descriptive Study of Histopathological Patterns of Lymph Node Biopsies In A Tertiary Care Hospital. Ann Pathol Lab Med. 2017;4:131–136.
2. Bujoreanu I, Gupta V. Anatomy, Lymph Nodes. StatPearls Publishing. 2020.
3. Kamat G. A ten-year histopathological study of generalised lymphadenopathy in India. South Afr Fam Pract. 2011;53(3):267-70.
4. Lee Y, Terry R, Lukes RJ. Lymph node biopsy for diagnosis: a statistical study. J Surg Oncol. 1980;14(1):53-60.
5. Tiwari M, Aryal G, Shrestha R, Rauniyar SK, Shrestha HG. Histopathologic diagnosis of lymph node biopsies. Nepal Med Coll J. 2007;9(4):259-61.
6. Narang P, Narang R, Narang R, Mendiratta DK, Sharma SM, Tyagi NK. Prevalence of tuberculous lymphadenitis in children in Wardha district, Maharashtra State, India. Int J Tuberculosis Lung Dis. 2005;9(2):188-94.
7. Moore SW, Schneider JW, Schaaf HS. Diagnostic aspects of cervical lymphadenopathy in children in the developing world: a study of 1,877 surgical specimens. Pediatric Surg Int. 2003;19(4):240-4.
8. Ashwini Ashoksingh Shiledar, Amitkumar Bapuso Pandav, Santoshsing Shivramsingh Rajput, Ashish Ashoksingh Shiledar: Evaluation of Histopathological Findings in Lymph Node Lesions as frequency and percentages. Journal of Clinical and Diagnostic Research. 2022 Nov, Vol-16(11): EC37-EC41.
9. Ramya Potti, Venkata Renuka Inuganti, Chaitra B, Garima B, Durga Prasad:Histopathological and immunohistochemical study of lymphnodal biopsies: IP Archives of Cytology and Histopathology Research 2020;5(1):70–74
10. Pradhan M. Pagaro, Bedarshi Banerjee, Anushree Khandelwal, Aditi Pandey, Anushree Gambhir: Spectrum of Lymph Node Lesions as Determined by Histopathology: Medical Journal of Dr. D.Y. Patil University: 2017:Volume 10, Issue 4.
11. Samina Ali Khanday, Ruby Reshi, Majid Mushtaque: Histopathology and immunohistochemistry of lymph node biopsies: A prospective study from a tertiary care hospital in Kashmir . Indian Journal of Pathology and Oncology, July-September 2019;6(3):400-405.
12. Bimal Shah , Sarang Degloorkar, Sanjay Parab, Mita Shah, Ria Vijay: Analysis of the histopathological findings of lymph node biopsies at a tertiary care centre: International Surgery Journal | February 2023 | Vol 10 | Issue 2 Page 231.
13. Roy A, Kar R, Basu D, Badhe BA. Spectrum of histopathologic diagnosis of lymph node biopsies: A descriptive study from a tertiary care centre in south India over 5 ½ years. Ind J Path and Microbiol 2013;56(2):103-8.
14. Ali K Ageep. Assessment of Adult Peripheral Lymphadenopathy in Red Sea State, Sudan. Int J Tropical Disease Health 2012; 2(1):24-32.
15. Ochicha, S.T. Edino, A. Z. Mohammed, A. B. Umar, A. T. Atanda. Pathology of Peripheral Lymph Node Biopsies in Kano, Northern Nigeria: Ann Afr Med 2007;6(2):104-8.
16. Mbata GC, Nweke IG, Egejuru RO, Omejua EG, Nwako OF, Chima EI and Oparaocha D. South Eastern Histologic Pattern of Lymph Node Biopsies in a Tertiary Hospital in Nigeria. J AIDS Clin Res 2015;6:6.
17. Groves FD, Linet MS, Travis LB, Devessa SS. Cancer Surveillance Series: Non-Hodgkin's Lymphoma Incidence by Histologic Subtype in the United States From 1978 Through 1995. J Natl Cancer Inst 2000;92:1240-51.
18. Chee YC Tuberculous lymphadenitis in Singapore. Ann Acad Med Singapore 1982;11:587-92.