Histological examination in obtaining a diagnosis in patients with lymphadenopathy in Lima, Peru

Daniela E. Kirwan, Cesar Ugarte-Gil, Robert H. Gilman, Syed M. Hasan Rizvi, Gustavo Cerrillo, Jaime Cok, Eduardo Ticona, Jose Luis Cabrera, Eduardo D. Matos, Carlton A. Evans, David A.J. Moore, Jon S. Friedland

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1271-1276
Number of pages6
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume97
Issue number4
DOIs
StatePublished - 2017

Bibliographical note

Funding Information:
Financial support: This work was supported by the Sir Halley Stewart Foundation (DK) and with an ISID Small Grant from the International Society for Infectious Diseases (CUG). JSF and CAE thank the Imperial College NIHR Biomedical Research Centre and The Wellcome Trust (awards 057434/Z/99/Z, 070005/Z/02/Z, 078340/Z/05/Z, 105788/Z/ 14/Z and 201251/Z/16/Z) for financial support. CAE thanks the Joint Global Health Trials consortium (MRC, DFID, and Wellcome Trust award MR/K007467/1), IFHAD, and The Bill & Melinda Gates Foundation (award OPP1118545) for funding. The views expressed within this report are those of the authors and not necessarily of the funders. The funders had no role in study design, data collection and analysis, or preparation of the manuscript.

Publisher Copyright:
© Copyright 2017 by The American Society of Tropical Medicine and Hygiene.

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