RAJIV GANDHI OF HEALTH SCIENCES,KARNATAKA,BANGALORE



RAJIV GANDHI OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |Name of the candidates and address |Dr. RENUKA V KHUBA |

| |(in block letters) |DEPARTMENT OF ENT |

| | |MAHADEVAPPA RAMPURE MEDICAL COLLEGE, GULBARGA – 585105 |

| |Permanent Address |Dr. RENUKA V KHUBA |

| | |D/O VISHWANATH KHUBA |

| | |H.NO.34/B, NEAR HEAD POST OFFICE |

| | |SUPER MARKET , GULBARGA 585105 |

|2. |Name of Institution |H.K.E. SOCIETY’S |

| | |MAHADEVAPPA RAMPURE MEDICAL COLLEGE, GULBARGA – 585 105. |

|3. |Course of study and subjects |M.S (ENT) |

|4. |Date of admission to the course |31st MAY 2011 |

|5. |Title of topic |a CLINICOPATHOLOGICAL STUDY OF CERVICAL LYMPHADENOPATHY IN HYDERABAD KARNATKA |

| | |REGION. |

|6. |Brief Resume of the intended work |

| |6.1 |Need for the study |

| | |Cervical lymphadenitis is one of the common and important presentations of the underlying pathology of the head and neck region |

| | |which has large number of differential diagnosis like neoplasms, infections (specific and non-specific ) and in immune |

| | |deficiency disorders and also the rare disorders like Inflammatory pseudotumour (Plasma cell granuloma)and Kikuchi-Fujimoto |

| | |diseases . Hence for the proper and effective treatment of the underlying pathology it requires a definitive clinicopathological|

| | |study of the patients presenting with cervical lymphadenitis. Although other investigations like Computerized tomographic scan |

| | |of neck, Magnetic resonance imaging, Ultrasonography are present, but this study will try to give a better insight for the |

| | |overall quantum of the problem. |

| | |Hyderabad Karnataka region is a backward area where the socio economic condition and literacy status of the patients are low and|

| | |the people are not much aware about the diseases leading to cervical lymphadenitis. Hence the patients presenting to the ENT|

| | |O.P.D with cervical lymphadenitis should be thoroughly evaluated clinically along with a pathological study to confirm our |

| | |diagnosis so that the patient should get an appropriate treatment. |

|6.2 |Review of Literature |

| |Annam V et.al conducted a study to emphasize the role of fine needle aspiration cytology (FNAC) in etiologic workup in significant |

| |cervical lymphadenopathy in children. A total of 336 consecutive children, aged 1 month to 12 years, with significant cervical |

| |lymphadenopathy were subjected to FNAC. Children on empirical/specific therapy for lymphadenopathy for >2 months and children with |

| |lymphadenopathy other than cervical region were excluded from this study. Of 324 cases, the cytomorphologic features observed were |

| |reactive lymphadenitis in 58.02% of cases, granulomatous lymphadenitis in 30.55%, and suppurative lymphadenitis in 7.10% and |

| |malignancies in 5.62%. The remaining 3. 57% of cases were excluded because of inadequate aspiration. The most common cause diagnosed |

| |was tuberculosis in 29.01% of cases followed by chronic tonsillopharyngitis in 28.39%, suppurative lymphadenitis in 7.10%, human immune|

| |deficiency infection in 5.55% and malignancies in FNAC is an important diagnostic modality for the etiologic workup in significant |

| |cervical lymphadenopathy in children. It is almost as sensitive and specific as excision lymph node biopsy when an adequate aspirate is|

| |examined by expert eyes. |

| | |

| |Jagdeep S. Thakur et.al: conducted a study. Cervical lymphadenopathy due to metastasis carry poor prognosis. The status of cervical |

| |nodes is of critical interest to surgical, radiation and medical oncologists who manage patients with head and neck cancers. We |

| |conducted a prospective randomized study to assess the role of palpation, ultrasound and CT in detection of cervical metastasis in 25 |

| |patients presented to us with head and neck malignancy irrespective of cervical nodal status. It was observed that clinical examination|

| |was least sensitive (73.33%) when compared with computerized tomography (80%) and ultrasound (93.93%). The computerized tomography was |

| |found to be most specific (90%) when compared to clinical examination or ultrasonography (70% each). |

| | |

| |Khan RA et al: conducted a study of 89 children in the age group of 10 months to 12 years, during their time gap of April 2004 to March|

| |2005. All the patients underwent thorough clinical and investigational assessment vis-Ã -vis cervical lymphadenopathy. Reactive |

| |hyperplasia was the most common type of lymphadenitis, followed by granulomatous involvement. Unilateral posterior triangle lymph nodes|

| |were the most commonly affected in the tubercular cervical lymphadenopathy group. Fine-needle aspiration followed by Ziehl-Neelsen |

| |staining, histopathology and culture in combination were able to perform the diagnosis in 85.7% of cases affected with tubercular |

| |aetiology. Fine-needle aspiration is a valuable diagnostic tool in the management of children with the clinical presentation of |

| |enlarged cervical lymph nodes. The technique reduces the need for more invasive and costly procedures, especially in a Third World |

| |country. Culture and histopathology, however, should be considered in cases where repeated fine-needle aspiration cytology is |

| |non-diagnostic. |

| | |

| |The exclusion or confirmation of malignant lymphoma and other malignant processes by FNB is of great practical importance in these |

| |patients, since it may oblivate the need for surgical excision. FNAC is also used as a triage to distinguish between causes of |

| |lymphadenopathy with a high or a low level of suspicion of significant diseases by the most simple and least invasive and least costly |

| |method. |

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| | |

| | |

| |FNAC is an acceptable and helpful diagnostic tool for the critical distinction between metastatic squamous carcinoma and other masses. |

| |FNAC techniques are especially helpful in analyzing a neck mass that does not have an obvious source. In such cases the general |

| |distinctions between squamous cell carcinoma and lymphoma when made saves the patient unnecessary endoscopic and biopsy procedures in |

| |the arodigestive tract. FNAC techniques are inadequate for definitive diagnosis and subcategorizing of lymphomas but they do |

| |demonstrate a lymphomas rather than a squamous cytologic pattern. In such circumstances, the next diagnostic step can be an excisional |

| |nodal biopsy rather than endoscopic procedures that are designed to find a squamous cell primary neoplasm that does not exist. |

| | |

| |Mohan et al in a study of 1724 lymph node biopsy has reported that 35.6% had nonspecific lymphadenitis, 31.3% had tubercular |

| |lymphadenitis, 25.9% had malignancy and less than 1% were diagnosed with Kikuchi-Fujimoto diseases. |

| | |

| |Showkat .A. Showkat et al conducted a study of 400 pediatric patients (0—12 yrs) who presented with cervico facial masses, were |

| |evaluated clinically and pathologically of which inflammatory lesions were 48%, congenital and developmental malformations 26%, cystic |

| |lesions19%, benign neoplastic lesions 7% and malignant neoplastic lesions 2%.Fine Needle Aspiration Biopsy( FNAB) was performed in 93% |

| |of cases and HPE(histopathological examination) was available in 51.5% of cases. Sensitivity of FNAB was 87.5% in this study. |

| | |

| |The diagnostic evaluation of a neck mass requires a planned approach that does not compromise the effectiveness of the treatment |

| |options. The differential diagnosis is dependent on its location and patient’s age. FNA with or without USG or CT guided can provide |

| |valuable information for early treatment planning. If a variety of diagnoses are still being entertained after FNA an open biopsy may |

| |be necessary. For the patients with potential diagnosis of Lymphoma, a biopsy sacrificing normal anatomical structures is not |

| |necessary. Ensuring appropriate processing of biopsy materials, sent in saline or in formalin, and sparing undue trauma to tissues can |

| |decrease the need for rebiopsy. |

|6.3 |Objectives of the study |

| |To know the confirmatory diagnosis of the underlying pathological variants. |

| |To know the prognosis of the disease. |

| |To know the incidence of the malignancies of aero digestive tract, presenting with cervical lymphadenitis. |

| |To diagnose various etiologies of cervical lymphadenitis in all age groups. |

|7. |Materials and methods |

| |7.1 Source of Data |

| |Patients presenting to the ENT OPD with cervical lymphadenopathy at Basaveshwar Teaching and General Hospital, Gulbarga. |

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| | |

| |7.2 Methods of collection of data(including sampling) |

| | |

| |Inclusion Criteria |

| | |

| |Patients of all age group and both genders presenting to ENT O.P.D with neck swelling for more than 3 weeks. |

| |Patients whose diagnosis has been done by USG(ultrasonography)/C.T scan neck are also included for thorough clinical evaluation and |

| |FNAC/Biopsy of the neck node. |

| | |

| |Exclusion Criteria |

| | |

| |Patients of all age group and both genders presenting to ENT O.P.D with neck swelling for more than 3 weeks. |

| |Patients whose diagnosis has been done by USG(ultrasonography)/C.T scan neck are also included for thorough clinical evaluation and |

| |FNAC/Biopsy of the neck node. |

| | |

| | |

| |Mode of selection: By simple random method. |

| |Sample Size: 50 cases |

| | |

| |7.3 Does the study require any investigations or interventions to be conducted on Patients or other humans or animals? If so please |

| |describe briefly. |

| | Yes |

| |The Investigations are: |

| |CBC, ESR, PBS, B.T, C.T |

| |Chest X ray |

| |FNAC / Biopsy |

| |HbsAg, HIV |

| | |

| |7.4 Has ethical clearance been obtained from institution in case of 7.3? |

| | |

| |Yes, ethical clearance has been taken from our Institution for this study. |

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| | |

| |8. References |

| |Annam v, Kulkarni MH, Puranik RB. Clinicopathologic profile of significant cervical lymphadenopathy in children aged 1-12 years: Acta |

| |Cytol Mar-Apr 2009; 53(2) :174-8. |

| |Jagdeep S. Thakur, M. L. Sharma, C. Mohan, N. K. Mohindroo, N. K. Kaushik. Clinicopathological and radiological evaluation of cervical |

| |lymph node metastasis in head and neck malignancies. Indian Journal of Otolaryngology & Head & Neck Surgery. October-December 2007; |

| |59: 327-331 |

| |Khan RA, Wahab S, Chana RS, Naseem S, Siddique S. Children with significant cervical lymphadenopathy: clinicopathological analysis |

| |and role of fine-needle aspiration in Indian setup. journal de pediatria (Rio J). Sep-Oct 2008; 84(5):449-54 |

| |Andrew field. Lymph node . In: Peter Von Heerde, John Miliauskas , editors . Fine needle aspiration cytology. 4th edition. New Delhi |

| |: Churchill livingstone (Elsevier).reprint 2005 .p. 83. |

| |Roy B sessions, Catherine P Hudkins . Malignant Cervical Adenopathy. In: Charles W Cummings ,John M Fredrickson, Lee A Harker , Charles|

| |J Krause ,David E Schuller , editors . Otolaryngology- head and neck surgery .2nd edition. Missouri: Mosby-year book 1993.p.1610-11. |

| | |

| |Aravind Ramkumar. Kikuchi-Fujimoto diseases as a differential diagnosis for cervical lymphadenopathy in India :A case report and |

| |review. Indian Journal of Otolaryngology & Head & Neck Surgery. July-september 2011;63:110-112. |

| |Showkat .A. Showkat , Mohammad Lateef , Asif A Wani , Shafqat A Lone , Kanwaljeet Singh , Iffat Yousuf. Clinicopathological profile of|

| |cervico facial masses in pediatric patients. Indian Journal of Otolaryngology & Head & Neck Surgery. April –June 2009;61:114-116. |

| |Richard O Wein , Rakesh K Chandran , Randal S Weber. Disorders of head and neck In:F. Charles Brunicardi, Dana K Anderson, Timothy R |

| |Billiar ,David L Dunn, John G Hunder, Jeffrey B Mathews, Raphael E Pollock. Editors Schwartz’s Principles Of Surgery 9th edition .USA: |

| |Mc Graw Hill’s Company 2009 p 503 |

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|9. |Signature of Candidates | |

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|10. |Remarks of Guide | |

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| | |Good attempt to evaluate the cervical lymphadenopahty in hyderabad |

| | |karnataka region. |

| | | |

| | | |

| | |Name and designation of the | |

|11. |11.1 |(In block letters) | |

| | | | Dr R.B Chapperbandi |

| | | |M.S (ENT) |

| | |Guide |ASSOCIATE PROFESSOR, |

| | | |DEPARTMENT OF ENT, |

| | | |M.R. Medical COLLEGe, |

| | | |GULBARGA-585105. |

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| |11.2 |Signature | |

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| |11.3 |Co-guide | |

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| |11.4 |Signature | |

| | | |Dr.V.s.patil |

| |11.5 |Head of the Department |D.L.O, M.S(ENT) |

| | | |HEAD OF THE DEPARTMEN , |

| | | |DEPARTMENT OF ENT, |

| | | |M.R. Medical COLLEGE, |

| | | |GULBARGA – 585105 |

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| |11.6 |Signature | |

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|12 |12.1 |Remarks of the chairman and principal | |

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| |12.2 |Signature | |

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