title: Lymph node tuberculosis - an attempt of clinico-morphological study and review of the literature.
abstract: OBJECTIVE
  The authors assessed the mycobacterial lesions in the lymph nodes discovered on tissue samples coming from the surgical stage in the Department of Pathology, Emergency County Hospital of Craiova, Romania, starting from 1990 until 2012.
  
  
  METHODS
  The studied material consisted of lymph node (LN) tissue samples obtained by biopsy or surgical excision from 362 patients histopathologically diagnosed with tuberculosis. For confirming the diagnosis, Ziehl-Neelsen staining was carried out and, in some cases, PCR technique was used.
  
  
  RESULTS
  Patients were mainly women, with a mean age of 35 years. The suspicion of diagnosis at admission was reduced, the most usual diagnosis being a very general and uncertain one of "adenopathy/polyadenopathy". In only few cases, other tissues/organs have been affected in the same time with the LN determination. Also, multiple LN group involvement was present in only five cases. The most affected LN groups were: the lateral cervical, submandibular, axillary, inguinal, supraclavicular and mesenteric. In paired LN groups, there was no predilection for any of the body sides. Epithelioid cells (ECs) and giant Langhans cells (GLCs) were present together in most of the granulomatous reactions. However, the presence of neutrophils in 10% of the cases should be noticed. Necrosis was present in almost all cases, displaying the whole range of morphological features, but usually the acidophilic, microgranular one. Fibrosis was rarely encountered. As a whole, well-differentiated granulomas were the most frequent but the presence of hyporeactive granulomas in more than a quarter of the cases and that of non-reactive granulomas in more than 10% of the cases should be noticed. The extension of TB process was not a rare event.
  
  
  CONCLUSIONS
  LNs seem to be the favorite location of TB besides the lung. The overall morphological picture revealed an active and destructive profile of the bacillary aggression in the LN parenchyma, which could mean either a higher sensitivity of the LN tissue or a more vulnerable background of the patients with TBLN lesions.
authors.affiliation: Department of Pathology, University of Medicine and Pharmacy of Craiova and Department of Pathology, Emergency County Hospital of Craiova, Romania; pie1956@yahoo.com.
authors.forename: Mihai Raul
authors.initials: MR
authors.lastname: Popescu
authors.forename: Gigi
authors.initials: G
authors.lastname: Călin
authors.forename: Irina
authors.initials: I
authors.lastname: Strâmbu
authors.forename: Marian
authors.initials: M
authors.lastname: Olaru
authors.forename: Maria
authors.initials: M
authors.lastname: Bălăşoiu
authors.forename: Veronica
authors.initials: V
authors.lastname: Huplea
authors.forename: Cătălina
authors.initials: C
authors.lastname: Zdrancotă
authors.forename: Răzvan Mihail
authors.initials: RM
authors.lastname: Pleşea
authors.forename: Stelian Dănuţ
authors.initials: SD
authors.lastname: Enache
authors.forename: Iancu Emil
authors.initials: IE
authors.lastname: Pleşea
mesh_terms: D000328:Adult; D044466:Asian People; D002454:Cell Differentiation; D005260:Female; D006101:Granuloma, Giant Cell / Q000150:complications / Q000473:pathology; D006801:Humans; D007194:India; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D009336:Necrosis; D013997:Time Factors; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology*