TUBERCULOUS

LYMPHADENOPATHY
Causative agent

• Mycobacterium tuberculosis

Most common extra pulmonary manifestation

Tuberculous lymphadenopathy
• Scrofuloderma is a mycobacterial infection of the skin
• caused by direct extension of tuberculosis into the skin
from
• underlying structures or by contact exposure to
tuberculosis.
Site

• Cervical
• Axillary
• Inguinal
• Mesenteric
• Mediastinal and Hillar
• Para aortic
Mode of Infection

• Inhalation
• Ingestion
• Innocultion
• Trans placental rout rare
 PATHOLOGICAL STAGES

By Jones and campbell

Stage 1
• Reactive lymphadenopathy
• Enlarged, firm mobile discrete nodes showing non
specific reactive hyperplasia
Stage 2
Periadenitis
• Large rubbery node fixed to surrounding tissue
(matting takes place)

Stage 3
Cold abscess
• Central softening due to abscess formation
• Caseating necrosis in lymph nodes takes place
Stage 4
• Collar stud abscess
• Abscess is in deep fascia, it ruptures and comes in
superficial fascia but remains inside the skin

Stage 5
• Sinus
• Blind tract lined by granulation tissue
LN on section
• In early stage: opaque and yellowish ( as a result of
necrosis and caseation)

Microscopically
• In early stage:
• Tubercles are seen which consists of epitheloid cells
with peripherally arranged nuclei
After one week:
• Lymphhocytes with directly stained nuclei and
scanty cytoplasm

After 2nd week

• Caseation appears in the centre of tubercle follicle
• The centre of the tubercle follicle consist of caseous
necrosis surrounded by giant cells and zone of
chronic inflamatory cells like lymphocytes, plasma
cells fibroblasts
 CLINICO PATHOLOGICAL CO-
RELATIONS
• Reactive lymphadenitis
a) Inflamed
b) Enlarged
c) palpable
d) tender
• Periadenitis

a) Mated LN
b) Slight tender
• Cold abscess : deep to deep fascia, soft, smooth,
fluctuant, due to caseation necrosis
a) No rise in temperature
b) No pain
c) No tenderness
d) no redness
e) no involvement of skin
• Collar stud abscess: ruptures out of deep fascia

a) signs of inflammation on skin

b) fluctuation
c) swelling
d) adherent to the overlying skin
Sinus

a) Opening in the neck or ulcer ( undermined edge)

b) non mobile
c) Bluish discolouration of skin
d) Pus discharge: Caseating material comes out
Clinical types

• Acute type

• Hyperplastic

• Caseating

• Atrophic
• Different between Hyperplastic and Caseating
Cervical

• Commonly through Tonsils

• anterior triangle: Jugulodigastric nodes

• Adenoid: posterior triangle lymph node through

retropharyngeal lymphatics
• Axilarry node: retrograde lymphatic spread or
blood spread

• Inguinal Lymph nodes : usually through blood

 MESENTERIC LYMPHADENOPATHY

• Demonstrated radiologically

• As acasue of general symptoms

• As cause of abdominal pain

• Symptoms indistinguishable from those of

appendicitis
• As a cause of intestinal obstruction

• As cause of pseudomesenteric cyst

• As a Ileocaecal Lymph nodes
Differential Diagnosis

• Nonspecific lymphadenitis
• Lymphomas
• Secondaries
• Branchial cyst in neck
• Lymph Cyst
• HIV with node involement
 INVETIGATION OF TUBERCULAR
LYMPHADENITIS

• FNAC :

• Open Biopsy: atleast two nodes taken intact for

pathology and microbiology
• Z-N staining
• Lowenstein Jensen for culture
Other tests:

Tuberculin Test (Mantoux test):mycobacterial

antigen,in which the reagent is mostly protein purified
derivative (PPD).
The test becomes positive 2–10 weeks after the
mycobacterial. Infection Positive reactions (>10-mm
induration)
• Chest X ray
• PCR
 TREATMENT:

• According to the DOTS guidelines TB

• lymphadenitis is categorised under treatment
category III.
• Those with smear positive TB lymphadenitis with
pulmonary involvement or severely ill are
categorised under treatment category I. While the
six months treatment may be sufficient for many
patients, each patient has to be individually
assessed and, where relevant, treatment duration
may have to be extended.
Surgical management

Aspiration: if Cold abscess ,Widebore needle In Zig

zag Path ways to prevent Sinus

Incision and drainage: If recurs , nondependent area,

closed without drain
 • Surgical removal:
If an abscess fails to resolve despite appropriate
chemotherapy and general measures occasionally
excision of abscess and it’s surrounding fibrous
capsule is necessary together with relevant lymph
node
• Excision of the sinus track
Thank U!!!!