Cervical lymph node biopsy: Clinical and histological significance.

hronic cervical lymphadenopathy (enlarged lymph node for more than 3 weeks) may result from a variety of different underlying diseases. Metastatic carcinoma from the head and neck is the most important of these and must be borne in mind of the clinician before embarking on an open lymph node biopsy. Open cervical lymph node biopsy is a common procedure in surgical practice. Traditionally, it plays an important role in the diagnosis as well as in the treatment of cervical tuberculous lymphadenopathy, especially the atypical Mycobacterium tuberculosis (M.tuberculosis). Over the last 10 years, fine needle aspiration biopsy (FNAB) has played an important role in the diagnosis of cervical lymphadenopathy with high sensitivity and specificity for malignancy, especially squamous cell carcinoma, and for tuberculosis. 1,2 The aim of the present study was to find out the most common cause of cervical lymphadenopathy at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia and to know how many patients who had open biopsy underwent fine needle aspiration cytology (FNAC) prior to open biopsy. A total of 419 patients were studied retrospectively and who underwent an open cervical lymph node biopsy in KAUH over a 10 year period (1989-1998). There were 290 (69.2%) non-Saudi and 129 (30.7%) Saudi patients. Two hundred and seventy-nine patients (66.6%) were female and 140 patients (33.4%) were male. Most of these patients came from low socio-economic classes. There was no previous personal history of tuberculosis (TB). Three hundred and seventy-eight (90.2%) patients were adults with an average age of 40.5 years and 41 (9.8%) were considered children between 4 months and 14 years with an average age of 9.5 years. Deep cervical lymph nodes were affected in 316 (75.4%) patients and other cervical lymph nodes were less affected. Most of the patients (77%) had a multiple and bilateral lymph nodes enlargements. The size of the enlarged lymph nodes were 3 cm. The consistency of the enlarged lymph nodes varied; it was solid in 325 (79.6%) patients and cystic with sinus formation in 94 (22.4%) patients. Mycobacterium tuberculosis was present in 207 (49.5%) patients as it was suggested histologically by the presence of tuberculous granuloma, characterized by the presence caseating necrosis, epitheloid cells, and Langhans multinucleated giant cells. Acid-fast bacilli were seen by Ziehl-Neelsen (ZN) stain on 3 patients only. Tuberculosis cultures were not followed in this study. Of those 207 patients positive for TB, there were 68 (32.9%) Saudi patients and 139 (67.1%) non-Saudi patients from different nationalities. One hundred and thirty-five (65.2%) patients were female and 72 (34.8%) were male. The majority of these patients were young adults since there were only 5 (3.4%) children. Malignancy was diagnosed in 130 (31%) patients. Hodgkin’s lymphoma was the most common class of malignancy in 50 (11.2%) patients and immunohistochemically, 48 of them were B cell type and 2 were T cell type. This lesions was also classified in 4 histologic sub-types of the Rye classification system, which has been used almost exclusively in North America since its proposal in 1966, including nodular sclerosis Hodgkin's disease (NSHD), lymphocyte predominant Hodgkin's disease (LPHD), mixed cellularity Hodgkin's disease (MCHD), and lymphocyte depleted Hodgkin's disease (LDHD), these are based entirely on descriptions of the non-malignant background of the involved node rather than on the characteristics of the malignant cells themselves. 1 Nodular sclerosing Hodgkin's disease was the most common sub-type reported in 23 cases, MCHD was the 2nd most common histologic type with 8 cases. The histological type was not reported in the rest of the cases. Other major class of malignant lesions was metastatic carcinomas to cervical lymph nodes and this included squamous cell carcinoma from the head and neck, papillary thyroid carcinoma, metastatic breast carcinoma, malignant melanoma and metastasis from unknown primary site. Reactive lymphoid hyperplasia was found in 72 (17.2%) patients; 2 of them had human immunodeficiency virus (HIV) positive serology and 4 had toxoplasmosis positive serology. Surprisingly, FNAC was performed in 23 (5.4%) patients only. Thirteen of them were found to have inflammatory changes with caseation and epitheloid cells, 5 patients had malignancy, and the results of the 5 patients were not conclusive. All patients who had FNAC cytology, later had an open cervical lymph node biopsy where the FNAC findings were confirmed histologically. The significance of human M.tuberculosis infections has been recognized since the beginning of recorded history. Tuberculosis was the common cause of illness and death prior to the industrial revolution. Improved general public health and hygiene, as well as the introduction of anti-tuberculous treatment, had a dramatic effect on the reduction of TB in different