Introduction: Superficial lymphadenopathy is a frequent reason for consultation in Internal Medicine. The diagnosis approach even done by a meticulous clinical examination has to be completed with investigations such as medical imagery and pathologic study. In low-income countries like Democratic Republic of Congo, means for proper diagnosis remain hardly accessible for some classes of the society. Thus, our study aims to describe socio-economic, clinical and biologic parameter that can give diagnosis orientation in patients with superficial lymphadenopathy as observed in the department of internal medicine at the University of Lubumbashi Clinics (DR Congo). Patients, Material and Method: This is a descriptive, transversal study on superficial lymphadenopathy observed for a period of 24 months from November 2013 to October 2015 at the University of Lubumbashi Clinics. Parameters studied included gender, age, localization and clinical characteristics of superficial lymphadenopathy; biologic parameters and pathologic diagnosis were determined by lymph nodes biopsy. Results: 36 patients data were captured and non-Hodgkin lymphoma is the most frequent pathologic diagnosis (47.20%) followed by reactive hyperplasia (27.80%) and infectious lymphadenitis (19.40%). Some of the variables studied presented a significant statistical association and included age ≥ 50 years old (p = 0.0247), inguinal location (p = 0.0053), multifocal location (p = 0.0063), sensible character (p = 0.0391) and leukocytosis (p = 0.0022) for non-Hodgkin lymphoma and variables like age below 50 years (p = 0.0345), inguinal location (p = 0.0299) and sensible character (p = 0.394) for reactive hyperplasia. Conclusion: The most frequent aetiology seen in this very is non-Hodgkin lymphoma (47.2%) followed by ly mph node reactive hyperplasia (27.8%) and infectious lymphadenitis. The emergence of non-communicable diseases in both developed countries as low income is growing and special emphasis should be given to this growing scourge. Cancer is one of the most frequent pathologies and non-Hodgkin lymphoma is one of the deadliest cancer types. And having epidemioclinic and biological parameters in the absence of appropriate diagnosis means could contribute to improving the prognosis of lymphadenopathy patients in low-income countries like the Democratic Republic of Congo.
The generic word for any lymph node pathology is lymphadenopathy. This abnormality can be defined by dimension, consistency and/or number of abnormal lymph nodes [
Superficial lymphadenopathy is a frequent reason for consultation in Internal Medicine in both North American countries and Sub Saharan Africa [
Causes of superficial lymphadenopathy are multiple and prognosis is usually unknown [
The confirmation of the aetiology of lymphadenopathy, from a clinical examination even meticulous, remains as a challenge because its presentation differentiates a little from infectious to non-transmissible lymphadenopathy [
Thus, the objective of our study is to describe socio-demographic, clinical and biological parameters that can provide diagnosis orientation to superficial lymphadenopathy patients in the department of internal medicine at the University of Lubumbashi Clinics.
This is a descriptive and transversal study on patient with superficial lymphadenopathy who had consulted in the department of internal medicine at the University of Lubumbashi Clinics (DR Congo) from 1st November 2013 to 31 October 2015.
We have proceeded by a convenience sampling including all patients with superficial lymphadenopathy seen at the internal medicine outpatient department or those admitted in the department of internal medicine at the University of Lubumbashi Clinics where 36 patients were listed.
Were admitted, any patients with hypertrophy affecting one or more palpable superficial lymph nodes in the cervical, axillary or inguinal area, measuring more than one centimeter in diameter, irrespective of the gender. We have retained the age above 15 for our series. Were excluded, all patients on TB treatment and/or on anti- mitotic treatment.
The study was done using and analyzing patients medical records including sociodemographic parameters (age, gender), clinical description of lymphadenopathy (localization, consistency, mobility, sensibility), biologic (hemoglobin, red cells, white cells, platelets, HIV serology) and pathologic parameters.
1) HIV infection diagnosis: HIV serology was determined by a screening rapid test: DetermineTM HIV-1/2 (Alere) and positive cases were confirmed by ELISA: Vironostika and Enzygnost done on IMMUNOWASH type WELLWASH 4 MK 2N˚SERIE 006-9-7943.
2) Bacteriologic analysis of infectious lymphadenopathy: Secretions culture was done on an ordinary microbial culture medium: Sabouraud and Loweisten.
3) Full Blood Count: Blood analysis was done using hematology automate ABX MICROS 60 № SERIE 8050S85648.
Values of full blood count were categorized as follow [
1) hemoglobin (Hb):
・ <11.8 g/L: values considered as anaemia
・ ≥11.8 g/L: values considered as normal
2) white cells count (WCC):
・ <3.8 × 103/mm3: values considered as leucopenia
・ 3.8 - 11.1 × 103/mm3: values considered normal
・ >11.1 × 103/mm3: values considered leukocytosis
3) red cells count (RCC):
・ <3.8 × 106/mm3: values considered as erythropenia
・ ≥3.8 × 106/mm3: values considered normal
4) platelets count:
・ <140 × 103/mm3: value considered as thrombocytopenia
・ ≥140 × 103/mm3: values considered normal
4) Pathology analysis: Tissue sampling was done by excision biopsy where the all lymph node tissue is entirely removed under local anesthesia. Once excised the tissue is fixed in formalin 10% sealed and sent to the pathologist and deposited in plastic cassettes. Tissues contained in plastic cassettes are then dehydrated passed through alcohol (ethanol, isopropanol), alcohol is eliminated by solvents (xylene), and then liquid paraffin at 56˚C impregnates the tissue which is then cooled. These steps are automated by inclusive devices. The solid block of paraffin containing the tissue is cut with a microtome, 3 to 5 microns thin slices are then spread on slides. After paraffin dissolution, then rehydration, the tissue is colored. The coloration associate a basic nuclear colorant (hematoxylin) and an acid colorant (eosin). The colored slice is protected with a glued glass or a transparent plastic film and is ready for histological analysis. The reading on the optic microscope brand Leica Microsystems CMS Gmbh Ernest-Leitz-straBe 17 - 37 allowed the diagnosis.
5) Ethics considerations: The study was approved by the Ethical Committees of Lubumbashi’s University. For Ethics and code of practice reasons and trying to avoid stigma, data were collected in such a manner that patients remained anonymous after obtaining their consent.
Different data collected were coded then captured on a computer and statistical analysis were performed on Microsoft Excel 2010 for encoding of data and Epi Info7® for determining frequencies. Statistical comparisons between diagnoses and socio-demographic, clinical and biological parameters have been made and the Fischer exact test was used for comparison of frequencies with a significant level of p < 0.05.
In this study, pathologic diagnosis of superficial lymphadenopathy was made on 36 patients and
During this study, data of 36 patients with superficial lymphadenopathy were captured and 47.2% presented with non-Hodgkin lymphoma as most frequent pathologic diagnosis followed by reactive hyperplasia (27.8%) and infectious lymphadenitis (19.4%). Several studies have been done on the subject but different observations have been made around the world. For some the most frequent aetiology was infectious with TB as main cause
Variables | NHL | Others1 | Total | p | RH | Others2 | Total | p | IL | Others3 | Total | p |
---|---|---|---|---|---|---|---|---|---|---|---|---|
n = 17 | n = 19 | n = 36 | n = 10 | n = 26 | n = 36 | n = 7 | n = 29 | n = 36 | ||||
n(%) | n(%) | N | n(%) | n(%) | N | n(%) | n(%) | N | ||||
Socio-demographics characteristics | ||||||||||||
Age ≥ 50 years | 8(80) | 2(20) | 10 | 0.0247 | 10(38.5) | 16(61.5) | 26 | 0.0345 | 6(23.1) | 20(76.9) | 26 | 0.6453 |
Male gender | 13(56.5) | 10(43.5) | 23 | 0.177 | 7(30.4) | 16(69.6) | 23 | 0.716 | 5(38.5) | 8(61.5) | 13 | 0.716 |
Topography | ||||||||||||
Cervical | 17(53.1) | 15(46.9) | 32 | 0.1062 | 8(25) | 24(75) | 32 | 0.1062 | 5(15.6) | 27(84.4) | 32 | 0.1625 |
Inguinal | 11(78.6) | 3(21.4) | 14 | 0.0053 | 1(7.1) | 13(92.9) | 14 | 0.0299 | 1(7.1) | 13(92.9) | 14 | 0.2092 |
Axillary | 9(69.2) | 4(30.8) | 13 | 0.0819 | 3(23.1) | 10(76.9) | 13 | 0.716 | 1(7.7) | 12(92.3) | 13 | 0.3822 |
Multifocal location | 12(75) | 4(25) | 16 | 0.0063 | 2(12.5) | 14(87.5) | 16 | 0.1326 | 1(6.3) | 15(93.8) | 16 | 0.1041 |
Clinical characteristics | ||||||||||||
Sensibility | 4(26.7) | 11(73.3) | 15 | 0.0391 | 7(46.7) | 8(53.3) | 15 | 0.0394 | 3(20) | 12(80) | 15 | 1 |
Mobility | 16(50) | 16(50) | 32 | 0.6051 | 9(28.1) | 23(71.9) | 32 | 1 | 6(18.8) | 26(81.3) | 32 | 1 |
Hard | 11(45.8) | 13(54.2) | 24 | 0.906 | 6(25) | 18(75) | 24 | 0.7 | 5(20.8) | 19(79.2) | 24 | 1 |
Biological parameters | ||||||||||||
HIV serology | 3(30) | 7(70) | 10 | 0.2741 | 4(40) | 6(60) | 10 | 0.4128 | 2(20) | 8(80) | 10 | 1 |
Anaemia | 11(44) | 14(56) | 25 | 0.8247 | 6(24) | 19(76) | 25 | 0.4539 | 6(24) | 19(76) | 25 | 0.3999 |
Neutropenia | 1(1) | 4(80) | 5 | 0.3419 | 3(60) | 2(40) | 5 | 0.1186 | 1(20) | 4(80) | 5 | 1 |
Leukocytosis | 9(90) | 1(10) | 10 | 0.0022 | 0(0) | 10(100) | 10 | 0.0345 | 0(0) | 10(100) | 10 | 0.1546 |
Thrombopenia | 4(57.1) | 3(42.9) | 7 | 0.6842 | 1(14.3) | 6(85.7) | 7 | 0.6453 | 2(28.6) | 5(71.4) | 7 | 0.6016 |
Erythropenia | 10(45.5) | 12(54.5) | 22 | 0.9393 | 6(27.3) | 16(72.7) | 22 | 1 | 4(18.2) | 18(81.8) | 22 | 1 |
Others1: HL, IL, RH, UM; Others2: NHL, HL, IL, UM; Others3: NHL, RH, HL, UM.
[
Non-communicable diseases are the leading causes of death globally, killing more people each year than all other causes combined [
In our study some epidemiological and biological factors have shown a significant statistics correlation with non-Hodgkin lymphoma (age equal or above 50 years, inguinal location, multifocal location, painful character and leukocytosis) and lymph nodes reactive hyperplasia (age less than 50 years, inguinal location and painful character) as pathologic diagnosis. Looking at the epidemiological profile where change of life style and diet habits in urban African areas is expected in the future [
Befits, nevertheless, be noted that the invasive aspect of excision-biopsy didn’t allow an easy patient compliance and the financial and technical accessibility defect was also a difficulty encountered throughout our study.
36 patients were listed in our study and the most frequent aetiology in this series is non-Hodgkin lymphoma (47.2%) followed by lymph nodes reactive hyperplasia (27.8%) and infectious lymphadenitis. The emergence of non-communicable disease both in developed and low-income countries is on the rise and an emphasis should be made on this growing scourge. Cancer is one of these frequent pathologies and non-Hodgkin lymphoma is one of the most lethal malignant pathologies. Having epidemic-clinical and biological parameters in the absence of appropriate diagnosis means could contribute to the prognosis of lymphadenopathy patients in low-income countries like the DR Congo.
KC, MC conceived and designed the study. KC, KE, KM, KP, KV conducted and collected data. KC, MO, MM, ME, MC contribute to data analysis, interpretation and manuscript review. KC, MM, TB wrote manuscript.
The authors declare they have no competing interests.
Christian Kakisingi,Olivier Mukuku,Michel Manika,Placide Kakoma,Marc Kashal,Véronique Kyabu,Eric Kasamba,Beya Tshikuluila,Emmanuel Muyumba,Claude Mwamba, (2016) Clinical and Biological Approach to Peripheral Lymphadenopathy in Adults from a Tertiary Care Centre in Lubumbashi (D. R Congo). Open Access Library Journal,03,1-7. doi: 10.4236/oalib.1102852
DR Congo: Democratic Republic of Congo
HIV: Human Immunodeficiency Virus
ELISA: Enzyme-Linked Immunosorbent Assay
NHL: Non Hodgkin Lymphoma
HL: Hodgkin Lymphoma
IL: Infectious Lymphadenitis
RH: Reactive Hyperplasia
UM: Undifferentiated Malignancy
TB: Tuberculosis
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