Fine Needle Aspiration Cytology in Effective Management of Patients with Granulomatous Inflammation in Neoplastic and NonNeoplastic Lesions

Abstract

Background and Aim: Fine Needle Aspiration Cytology (FNAC) plays an important role in the diagnosis of
tuberculous inflammation and prevents unnecessary surgery. Cytodiagnosis of tuberculosis depends on the
demonstration of epithelioid cell granuloma and caseous necrosis with or without Langhans type of giant cells.
Present study was done to assess the usefulness of the cytological study in the diagnosis of granulomatous lesions.
Material and Methods: The present study was carried at the department of Pathology at tertiary care hospital over
12 months. Patients fulfilling inclusion criteria will be selected from fine needle aspiration cytology specimens
after written consent. A routine stain like Hematoxylin and eosin (H&E), Papanicolaou (PAP) and Giemsa stain
will be done. Two extra unstained slides will be smeared from aspiration material.
Results: Total 200 patients with granulomatous inflammation diagnosed on FNAC were taken. Among 200 cases,
single swelling was present in 160 cases and multiple swellings were present in 40 cases. Out of which cervical
was the commonest site. On FNAC, the nature of aspirate was blood mixed in 123 cases followed by aspiration
of pus and cheesy material in 52 and 25 cases respectively. In the present study of 200 cases of granulomatous
inflammation on FNAC, tuberculosis was the most common finding in 140 cases (70%). There was an association
between AFB positivity and caseation necrosis.
Conclusion: FNAC is still a good diagnostic tool in the evaluation of granulomatous lesions. Patients who are not
responding to empirical AKT should be considered for other causes of granulomatous inflammation other than
TB, and proper workup should be done.