Universidad Peruana Cayetano Heredia

Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru

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dc.contributor.author Kirwan, Daniela E.
dc.contributor.author Ugarte Gil, Cesar Augusto
dc.contributor.author Gilman, Robert Hugh
dc.contributor.author Hasan Rizvi, Syed M.
dc.contributor.author Cerrillo, Gustavo
dc.contributor.author Cok, Jaime
dc.contributor.author Ticona, Eduardo
dc.contributor.author Cabrera, José Luis
dc.contributor.author Matos, Eduardo D.
dc.contributor.author Evans, Carlton Anthony William
dc.contributor.author Moore, David Alexander James
dc.contributor.author Friedland, Jon S.
dc.contributor.author Lymph Node Tuberculosis Working Group
dc.date.accessioned 2019-01-25T15:18:36Z
dc.date.available 2019-01-25T15:18:36Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4671
dc.description.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. en_US
dc.language.iso eng
dc.publisher American Society of Tropical Medicine and Hygiene
dc.relation.ispartofseries American Journal of Tropical Medicine and Hygiene (ASTMH Journal)
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adult en_US
dc.subject Biopsy en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Lymphadenopathy/diagnosis/pathology en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.subject Peru en_US
dc.title Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.4269/ajtmh.16-0961
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.06
dc.relation.issn 1476-1645


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