Specimens Tuberculous (Tb) Lymphadenitis

Specimens Tuberculous (Tb) Lymphadenitis

1. What is this specimen?

• Specimen of lymph nodes that are matted. The cut surface shows caseation. Hence, it is tuberculous lymphadenitis.

“What is tuberculous lymphadenitis?”

2. What is the microscopic picture?

• Central caseation is surrounded by epithelioid cells, Langhans type of giant cells.

3. What are the stages of TB lymphadenitis?

• Stage of lymphadenitis
• Stage of matting
• Stage of cold abscess
• Stage of collar stud abscess
• Stage of sinus formation

4. Why is matting seen in TB lymphadenitis?

• It is because of periodontitis.

5. What is the treatment of cold abscess?

• Nondependent aspiration by using a wide bore needle, to avoid sinus formation.

“Understanding TB lymphadenitis: Causes and symptoms”

Lymphoma

1. What is the diagnosis?

• Multiple lymph nodes which are discrete and not matted. The Cut surface does not show caseation. It is homogenous. Hence, this is a specimen of Hodgkin’s lymphoma.

2. How do you confirm the diagnosis?

• Lymph node biopsy.

3. What is the microscopic picture?

• Cellular pleomorphism: Lymphocytes, histiocytes, eosinophils, monocytes with giant cells containing mirror image nuclei—Reed-Sternberg cell.

4. What are the common lymph nodes involved in Hodgkin’s lymphoma?

• Cervical, axillary, para-aortic, iliac, and inguinal lymph nodes,

5. Is Waldeyer’s ring involvement seen in Hodgkin’s lymphoma?

• No. It is usually seen in non-Hodgkin’s lymphoma.

“Importance of specimen collection in TB lymphadenitis”

Marjolin’s Ulcer

1. What is this specimen?

• Wide excision specimen, showing ulcerated growth arising from the scar. It has everted edges, and there is extensive scarring.

2. What is the diagnosis?

• Squamous cell carcinoma arising in scar tissue is called Marjolin’s ulcer

3. What are the common causes of Marjolin’s ulcer?

• Burns, snake bite, and varicose ulcer

“Complications of untreated TB lymphadenitis”

4. What are the peculiarities of Marjolin’s ulcer?

• It grows very slowly because of scar tissue.
• It is painless as nerves have been destroyed.
• It does not spread by lymphatics as they are also destroyed.

5. What is the treatment?

• Wide excision followed by split skin grafting.

“Common types of specimens used for TB lymphadenitis diagnosis”

Squamous Cell Carcinoma

1. What is this specimen?

• Specimen of wide excision showing ulcerated growth with everted edges arising from skin.

2. What is the diagnosis?

• Squamous cell carcinoma

3. What is the microscopic picture?

• Mitotic figures with keratin pearls or epithelial pearls.

4. What is the other treatment for squamous cell carcinoma?

• Radiotherapy

5. What are the common causes of squamous cell carcinoma?

• Leukoplakia
• Radiation dermatitis
• Bowen’s disease
• Congenital skin conditions like xeroderma pigmentosa and albinism
• Chronic scar

“Impact of culture tests on TB lymphadenitis diagnosis”

Specimen Of Hemiglossectomy With Hemimandibulectomy

1. What is this specimen?

• Specimen showing growth arising from the tongue and infiltrating the mandible

2. What is the diagnosis?

• Advanced carcinoma tongue

3. Is radiotherapy indicated in this situation?

• No, because the chances of radionecrosis of the mandible are high.

“Role of histopathology in analyzing TB lymphadenitis specimens”

4. What type of X-ray is taken to look for involvement of the mandible?

• Orthopantomogram

5. What is Commando’s operation?

• Hemiglossectomy with excision of the floor of the mouth, hemimandibulectomy, with radical block dissection of the neck done in a single stage, with en bloc removal.