Histopathologic Spectrum of Lymph Node Lesions in a Teaching Hospital in East Nigeria. A Nine-Year Review

Abstract

Background: The lymph node is a very important structure in the haemopoietic and lymphatic systems. The lesions are wide-ranging and  include non-neoplastic conditions, benign and malignant neoplastic diseases, to metastatic deposits. Histopathology is considered  the gold standard in its diagnosis.

Objectives: To determine the spectrum of lesions in both peripheral and visceral lymphadenopathies  in a tertiary hospital in Nnewi and compare it with other studies.

Methodology: This is a retrospective study involving 207 cases of histologically diagnosed lymph node biopsies in the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital  (NAUTH), Nnewi, Nigeria, over a 9-year period. Cases with incomplete biographic data such as age, sex, nature of tissue, and  unrepresentative or inadequate tissue were excluded from the study. Few fine needle aspiration cytology of lymph nodes done within  this study period were excluded because of inconclusive results in the majority of the cases, however, biopsies requested in those cases  were used.

Results: Two hundred and seven lymph node biopsies were studied. The age of these patients ranged from 0.9 to 89 years,  with a mean age of 41.4 years (SD±20.9) and median age of 41.0 years. Females slightly outnumbered males with a ratio of 1.1:1.  Neoplastic lesions were more common: comprising of 58.4% (121/207) and including metastatic deposits to the lymph nodes 31.9%  (66/207), non-Hodgkin lymphoma 23.7.1% (49/207), Hodgkin lymphoma 2.4% (5/207) and one case of Kaposi sarcoma: 0.5%(1/207). Non- neoplastic lesions were the second commonest and included: majorly inflammatory lesions 41.5% (85/207) such as non-specific reactive  hyperplasia accounting for 24.6% (52/207), other specific reactive hyperplasia 2.8% (6/207), 9.7% (20/207) of Tuberculous lymphadenitis,  3.4% (7/207) of other chronic necrotizing granulomatous lymphadenitis, and one case of ectopic thyroid inclusion accounting for 0.5%(1/207).

Conclusion: Histopathology plays an important role in establishing the cause of lymphadenopathy. Among the lymph nodes  examined, neoplastic lesions were the most prevalent cases in our environment, which is contrary to the popular belief, that  infectious diseases of lymph nodes are more common in developing countries. This study also concluded that the cervical group of lymph nodes was the most frequently encountered palpable nodal swelling, followed by the axillary group. Further studies are also required,  where extensive immunohistochemical stains and molecular studies would be applied for further classifications of lymphomas.