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Human Immunodeficiency Virus Lymphadenitis Patterns on Fine-Needle Aspiration Cytology
Mona Agnihotri1, Leena Naik, Sachin Chaudhari
1Department of Pathology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
Insights
Microscopic patterns of human immunodeficiency virus (HIV) lymphadenitis are identifiable on fine-needle aspiration cytology (FNAC). These patterns correlate with CD4 counts and can aid diagnosis, even without patient history.
Area of Science:
- Cytopathology
- Immunology
- Infectious Diseases
Background:
- Human immunodeficiency virus (HIV) infection can cause lymphadenopathy.
- Fine-needle aspiration cytology (FNAC) is a diagnostic tool for lymph node abnormalities.
- Correlation between HIV lymphadenitis morphology and immune status (CD4 count) is important for diagnosis.
Purpose of the Study:
- To investigate the microscopic patterns of HIV lymphadenitis using FNAC.
- To correlate these cytological patterns with CD4 cell counts in HIV-positive patients.
Main Methods:
- Retrospective analysis of lymph node FNAC cases from HIV-positive patients over five years.
- Classification of HIV lymphadenitis smears into patterns (A, B, C) based on cytomorphological features.
- Correlation of identified patterns with CD4 cell counts.
Main Results:
- Out of 317 cases, 38 were diagnosed with HIV lymphadenitis.
- Cytological patterns (A, B, C) were established based on cellularity, macrophages, mitosis, apoptosis, plasma cells, giant cells, and blood vessels.
- Pattern A was the most frequent and associated with higher CD4 cell counts.
Conclusions:
- Histological patterns of HIV lymphadenitis are recognizable on FNAC.
- FNAC findings can suggest HIV lymphadenitis and guide further investigation, even without clinical history.
- Cytomorphological awareness is crucial for differentiating HIV lymphadenitis from other conditions like Castleman disease or lymphoma.
Objective:
The aim of this work was to study the microscopic patterns of human immunodeficiency virus (HIV) lymphadenitis on fine-needle aspiration cytology (FNAC) and correlate them with cluster of differentiation 4 (CD4) counts.
Study Design:
A retrospective study of known HIV-positive patients who underwent lymph node FNAC over a period of 5 years (2009-2013) was undertaken. The cytology slides were retrieved and reviewed. Out of 317 cases, 38 (11.7%) were diagnosed as HIV lymphadenitis. We analysed the cytomorphological patterns of HIV lymphadenitis and correlated them with the CD4 cell counts.
Results:
Smears of HIV lymphadenitis were classified akin to histology patterns (A, B, and C) depending on cellularity, number of tingible body macrophages, mitosis, apoptotic bodies, plasma cells, Warthin-Finkeldey giant cells, and proliferating blood vessels. Thirty-one cases showed pattern A, 3 showed pattern B, and 4 were of pattern C. Pattern A had the highest CD4 cell count.
Conclusion:
Histologic patterns of HIV lymphadenitis are recognisable on FNAC smears. These can offer a clue to the diagnosis and guide further workup, even in the absence of history. The changes can mimic those of the infective lymphadenitis, Castleman disease, and lymphoma. Hence, the clinical history, serological correlation, and awareness of cytomorphology can aid the correct diagnosis.
