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Cervical tuberculous lymphadenitis in the elderly: comparative diagnostic findings

Published online by Cambridge University Press:  18 September 2009

T Kato ,
Y Kimura ,
M Sawabe ,
Y Masuda  and
K Kitamura
T Kato*
Affiliation:
Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Japan
Y Kimura
Affiliation:
Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Japan
M Sawabe
Affiliation:
Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Japan
Y Masuda
Affiliation:
Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital, Japan
K Kitamura
Affiliation:
Department of Otolaryngology, Tokyo Medical and Dental University, Japan
*
Address for correspondence: Dr Tomofumi Kato, Department of Otolaryngology, Tokyo Metropolitan Geriatric Hospital, Sakae-Cho 35-2, Itabashi-ku, Tokyo 173-0015, Japan. Fax: +81 3 3964 1982 E-mail: tomofumi_katou@tmgh.metro.tokyo.jp; kato.oto@tmd.ac.jp
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Abstract

Background:

Patients suspected of having cervical tuberculous lymphadenitis are diagnosed using investigations such as fine needle aspiration cytology and the polymerase chain reaction for Mycobacterium tuberculosis. However, these investigations are intended for primary tuberculosis infection. The majority of cervical tuberculous lymphadenitis cases in the elderly are thought to be caused by reactivation.

Objective:

The aims of this study were (1) to examine the efficacy of fine needle aspiration cytology, polymerase chain reaction and blood tests in the diagnosis of cervical tuberculous lymphadenitis caused by reactivation, and (2) to clarify any differences when compared with primarily infected cervical tuberculous lymphadenitis cases.

Materials and methods:

Thirty-three elderly patients with neck lumps underwent excisional biopsy from 2003 to 2008. The efficacy of fine needle aspiration cytology was examined by comparing the results of excisional biopsy with those of fine needle aspiration cytology performed at the initial medical examination for cases of suspected tuberculous disease. Furthermore, the leucocyte count and C-reactive protein concentration were compared for cases of cervical tuberculous lymphadenitis versus cases of malignant lymphoma.

Results:

Although nine cases were diagnosed with cervical tuberculous lymphadenitis using excisional biopsy, only one of these had been suspected based on fine needle aspiration cytology results. Three cases with tuberculous lymphadenitis were suspected of having malignant lymphoma on initial examination. There was no significant difference in the leucocyte count and C-reactive protein concentration, comparing cases of tuberculous lymphadenitis versus malignant lymphoma.

Conclusion:

Unlike the primary infection often seen in endemic areas, the diagnosis of early stage tuberculous lymphadenitis of the swelling type caused by reactivation in elderly people is difficult to confirm unless excisional biopsy is performed. In elderly patients with neck lumps, cervical tuberculous lymphadenitis should be included in the differential diagnosis.

Keywords

NeckTuberculosisDiagnosisAged
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 12 , December 2009 , pp. 1343 - 1347
Copyright
Copyright © JLO (1984) Limited 2009

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