RAJIV GANDHI OF HEALTH SCIENCES, KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
Name of the candidates and
address
(in block letters)
Permanent Address
Dr. RENUKA V KHUBA
DEPARTMENT OF ENT
MAHADEVAPPA RAMPURE MEDICAL
COLLEGE, GULBARGA – 585105
Dr. RENUKA V KHUBA
D/O VISHWANATH KHUBA
H.NO.34/B, NEAR HEAD POST OFFICE
SUPER MARKET , GULBARGA 585105
2.
Name of Institution
H.K.E. SOCIETY’S
MAHADEVAPPA RAMPURE MEDICAL
COLLEGE, GULBARGA – 585105
3.
Course of study and subjects
M.S (ENT)
4.
Date of admission to the
course
Title of topic
31st MAY 2011
5.
6.
A CLINICOPATHOLOGICAL STUDY OF
CERVICAL LYMPHADENOPATHY IN
HYDERABAD KARNATKA REGION.
Brief Resume of the intended work
6.1 Need for the study
Cervical lymphadenitis is one of the common and important presentations of
the underlying pathology of the head and neck region which has large number
of differential diagnosis like neoplasms, infections (specific and non-specific )
and in immune deficiency disorders and also the rare disorders like
Inflammatory pseudotumour (Plasma cell granuloma)and Kikuchi-Fujimoto
diseases . Hence for the proper and effective treatment of the underlying
pathology it requires a definitive clinicopathological study of the patients
presenting with cervical lymphadenitis. Although other investigations like
Computerized tomographic scan of neck, Magnetic resonance imaging,
Ultrasonography are present, but this study will try to give a better insight for
the overall quantum of the problem.
Hyderabad Karnataka region is a backward area where the socio economic
condition and literacy status of the patients are low and the people are not
much aware about the diseases leading to cervical lymphadenitis. Hence the
patients presenting to the ENT O.P.D with cervical lymphadenitis should be
thoroughly evaluated clinically along with a pathological study to confirm our
diagnosis so that the patient should get an appropriate treatment.
6.2
Review of Literature
1. Annam V et.al conducted a study to emphasize the role of fine needle aspiration
cytology (FNAC) in etiologic workup in significant cervical lymphadenopathy in
children. A total of 336 consecutive children, aged 1 month to 12 years, with
significant cervical lymphadenopathy were subjected to FNAC. Children on
empirical/specific therapy for lymphadenopathy for >2 months and children with
lymphadenopathy other than cervical region were excluded from this study. Of
324 cases, the cytomorphologic features observed were reactive lymphadenitis
in 58.02% of cases, granulomatous lymphadenitis in 30.55%, and suppurative
lymphadenitis in 7.10% and malignancies in 5.62%. The remaining 3. 57% of
cases were excluded because of inadequate aspiration. The most common
cause diagnosed was tuberculosis in 29.01% of cases followed by chronic
tonsillopharyngitis in 28.39%, suppurative lymphadenitis in 7.10%, human
immune deficiency infection in 5.55% and malignancies in FNAC is an important
diagnostic modality for the etiologic workup in significant cervical
lymphadenopathy in children. It is almost as sensitive and specific as excision
lymph node biopsy when an adequate aspirate is examined by expert eyes.
2. Jagdeep S. Thakur et.al: conducted a study. Cervical lymphadenopathy due to
metastasis carry poor prognosis. The status of cervical nodes is of critical
interest to surgical, radiation and medical oncologists who manage patients with
head and neck cancers. We conducted a prospective randomized study to
assess the role of palpation, ultrasound and CT in detection of cervical
metastasis in 25 patients presented to us with head and neck malignancy
irrespective of cervical nodal status. It was observed that clinical examination
was least sensitive (73.33%) when compared with computerized tomography
(80%) and ultrasound (93.93%). The computerized tomography was found to be
most specific (90%) when compared to clinical examination or ultrasonography
(70% each).
3. Khan RA et al: conducted a study of 89 children in the age group of 10 months
to 12 years, during their time gap of April 2004 to March 2005. All the patients
underwent thorough clinical and investigational assessment vis-Ã -vis cervical
lymphadenopathy. Reactive hyperplasia was the most common type of
lymphadenitis, followed by granulomatous involvement. Unilateral posterior
triangle lymph nodes were the most commonly affected in the tubercular
cervical lymphadenopathy group. Fine-needle aspiration followed by ZiehlNeelsen staining, histopathology and culture in combination were able to
perform the diagnosis in 85.7% of cases affected with tubercular aetiology.
Fine-needle aspiration is a valuable diagnostic tool in the management of
children with the clinical presentation of enlarged cervical lymph nodes. The
technique reduces the need for more invasive and costly procedures, especially
in a Third World country. Culture and histopathology, however, should be
considered in cases where repeated fine-needle aspiration cytology is nondiagnostic.
4. The exclusion or confirmation of malignant lymphoma and other malignant
processes by FNB is of great practical importance in these patients, since it may
oblivate the need for surgical excision. FNAC is also used as a triage to
distinguish between causes of lymphadenopathy with a high or a low level of
suspicion of significant diseases by the most simple and least invasive and least
costly method.
5. FNAC is an acceptable and helpful diagnostic tool for the critical distinction
between metastatic squamous carcinoma and other masses. FNAC techniques
are especially helpful in analyzing a neck mass that does not have an obvious
source. In such cases the general distinctions between squamous cell
carcinoma and lymphoma when made saves the patient unnecessary
endoscopic and biopsy procedures in the arodigestive tract. FNAC techniques
are inadequate for definitive diagnosis and subcategorizing of lymphomas but
they do demonstrate a lymphomas rather than a squamous cytologic pattern. In
such circumstances, the next diagnostic step can be an excisional nodal biopsy
rather than endoscopic procedures that are designed to find a squamous cell
primary neoplasm that does not exist.
6. Mohan et al in a study of 1724 lymph node biopsy has reported that 35.6% had
nonspecific lymphadenitis, 31.3% had tubercular lymphadenitis, 25.9% had
malignancy and less than 1% were diagnosed with Kikuchi-Fujimoto diseases.
7. Showkat .A. Showkat et al conducted a study of 400 pediatric patients (0—12
yrs) who presented with cervico facial masses, were evaluated clinically and
pathologically of which inflammatory lesions were 48%, congenital and
developmental malformations 26%, cystic lesions19%, benign neoplastic lesions
7% and malignant neoplastic lesions 2%.Fine Needle Aspiration Biopsy( FNAB)
was performed in 93% of cases and HPE(histopathological examination) was
available in 51.5% of cases. Sensitivity of FNAB was 87.5% in this study.
8. The diagnostic evaluation of a neck mass requires a planned approach that
does not compromise the effectiveness of the treatment options. The differential
diagnosis is dependent on its location and patient’s age. FNA with or without
USG or CT guided can provide valuable information for early treatment
planning. If a variety of diagnoses are still being entertained after FNA an open
biopsy may be necessary. For the patients with potential diagnosis of
Lymphoma, a biopsy sacrificing normal anatomical structures is not necessary.
Ensuring appropriate processing of biopsy materials, sent in saline or in
formalin, and sparing undue trauma to tissues can decrease the need for
rebiopsy.
5
Objectives of the study
1. To know the confirmatory diagnosis of the underlying pathological variants.
2. To know the prognosis of the disease.
3. To know the incidence of the malignancies of aero digestive tract, presenting
with cervical lymphadenitis.
4. To diagnose various etiologies of cervical lymphadenitis in all age groups.
8.
Materials and methods
8.1 Source of Data
Patients presenting to the ENT OPD with cervical lymphadenopathy at Basaveshwar
Teaching and General Hospital, Gulbarga.
8.2 Methods of collection of data(including sampling)
Inclusion Criteria
1. Patients of all age group and both genders presenting to ENT O.P.D with neck
swelling for more than 3 weeks.
2. Patients whose diagnosis has been done by USG(ultrasonography)/C.T scan
neck are also included for thorough clinical evaluation and FNAC/Biopsy of the
neck node.
Exclusion Criteria
1. Patients coming with acute attack of lymphadenitis of more than 3 weeks.
2. Patients having underlying any bleeding disorders or patients with
cardiorespiratory failure.
Mode of selection: By simple random method.
Sample Size: 50
8.3
Does the study require any investigations or interventions to be
conducted on Patients or other humans or animals? If so please describe
briefly.
Yes
The Investigations are:

CBC, ESR, PBS, B.T, C.T

Chest X ray

FNAC / Biopsy

HbsAg,, HIV
8.4
Has ethical clearance been obtained from institution in case of 7.3?
Yes, ethical clearance has been taken from our Institution for this study.
8.5
References
1. Annam v, Kulkarni MH, Puranik RB.
Clinicopathologic profile of significant
cervical lymphadenopathy in children aged 1-12 years: Acta Cytol
Mar-Apr
2009; 53(2) :174-8.
2. Jagdeep S. Thakur, M. L. Sharma, C. Mohan, N. K. Mohindroo, N. K. Kaushik.
Clinicopathological and radiological evaluation of cervical lymph node
metastasis in head and neck malignancies. Indian Journal of Otolaryngology &
Head & Neck Surgery. October-December 2007; 59: 327-331
3. Khan RA, Wahab S, Chana RS, Naseem S, Siddique S.
Children with
significant cervical lymphadenopathy: clinicopathological analysis and role of
fine-needle aspiration in Indian setup. journal de pediatria (Rio J). Sep-Oct
2008; 84(5):449-54
4. Andrew field. Lymph node . In: Peter Von Heerde, John Miliauskas , editors .
Fine needle aspiration cytology. 4th edition. New Delhi : Churchill livingstone
(Elsevier).reprint 2005 .p. 83.
5. Roy B sessions, Catherine P Hudkins . Malignant Cervical Adenopathy. In:
Charles W Cummings ,John M Fredrickson, Lee A Harker , Charles J Krause
,David E Schuller , editors . Otolaryngology- head and neck surgery .2nd edition.
Missouri: Mosby-year book 1993.p.1610-11.
6. Aravind Ramkumar. Kikuchi-Fujimoto diseases as a differential diagnosis for
cervical lymphadenopathy in India :A case report and review. Indian Journal of
Otolaryngology & Head & Neck Surgery. July-september 2011;63:110-112.
7. Showkat .A. Showkat , Mohammad Lateef , Asif A Wani , Shafqat A Lone , Kanwaljeet
Singh , Iffat Yousuf. Clinicopathological profile of cervico facial masses in pediatric
patients. Indian Journal of Otolaryngology & Head & Neck Surgery. April –June
2009;61:114-116.
8. Richard O Wein , Rakesh K Chandran , Randal S Weber. Disorders of head and
neck In:F. Charles Brunicardi, Dana K Anderson, Timothy R Billiar ,David L
Dunn, John G Hunder, Jeffrey B Mathews, Raphael E Pollock. Editors
Schwartz’s Principles Of Surgery 9th edition .USA: Mc Graw Hill’s Company
2009 p 503
10. Signature of Candidates
11. Remarks of Guide
Good attempt to evaluate the cervical
lymphadenopahty
in
hyderabad
karnataka region.
Name and designation of the
12. 12.1 (In block letters)
Dr R.B CHAPPERBANDI
Guide
M.S (ENT)
ASSOCIATE PROFESSOR,
DEPARTMENT OF ENT,
M.R. MEDICAL COLLEGE,
GULBARGA-585105.
12.2 Signature
12.3 Co-guide
12.4 Signature
Dr. V.S PATIL
12.5 Head of the Department
12.6 Signature
13
13.1 Remarks of the chairman and
principal
13.2 Signature
D.L.O, M.S(ENT)
HEAD OF THE DEPARTMENT ,
DEPARTMENT OF ENT,
M.R. MEDICAL COLLEGE,
GULBARGA – 585105.