title: Tularemia: potential role of cytopathology in differential diagnosis of cervical lymphadenitis: multicenter experience in 53 cases and literature review.
abstract: Tularemia is a zoonosis caused by Francisella tularensis. Tularemia outbreaks occurred in Central Anatolia during 2009 and 2011. We evaluated the clinical characteristics and cytomorphologies of fine needle aspirations (FNAs) from cervical lymph nodes in serologically confirmed tularemia cases. To our knowledge, this is the first large series concerning FNA morphology of Tularemia. FNA smears of 53 patients of the 290, diagnosed by microagglutination tests and PCR, were evaluated at three Pathology centers. FNAs were performed by cytopathologists or ear-nose-throat surgeons. Of all patients, 17 had also lymph node resections. FNAs showed the presence of suppuration and abscess. Rare epithelioid histiocytes and granulomas, seldom phagocytosed bacilli-like microorganisms were observed. On histopathology; granulomas, necrosis, and suppurative inflammation extending extracapsular areas were seen. Tularemia is endemic in certain areas of the Northern Hemisphere. The benefit from cytopathology is limited and cytological suspicion should be confirmed by serology. However FNA cytology is helpful in differential diagnosis of tularemia and other diseases presented with suppurative, granulomatous cervical lymphadenitis. It is also useful in providing the material for PCR and culture in early phase when the serology is negative and the treatment is more effective.
authors.affiliation: Pathology Department, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
authors.forename: Ersin
authors.initials: E
authors.lastname: Tuncer
authors.forename: Binnur
authors.initials: B
authors.lastname: Onal
authors.forename: Gulcin
authors.initials: G
authors.lastname: Simsek
authors.forename: Sahande
authors.initials: S
authors.lastname: Elagoz
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sahpaz
authors.forename: Selcuk
authors.initials: S
authors.lastname: Kilic
authors.forename: Emine Elif
authors.initials: EE
authors.lastname: Altuntas
authors.forename: Aysegul
authors.initials: A
authors.lastname: Ulu Kilic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002648:Child; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D005260:Female; D005604:Francisella tularensis / Q000254:growth & development / Q000302:isolation & purification; D006801:Humans; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008199:Lymphadenitis / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014406:Tularemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D055815:Young Adult
keywords: Tularemia; cervical lymph node; fine needle aspiration cytology; histopathology; suppurative infection