Journal of Clinical & Experimental Pathology
Open Access

Abstract

FNAC is frequently performed for evaluation of space occupying lesions (SOL) of the liver. Tubercular involvement of the liver is uncommon, but is a serious consideration in differential diagnosis of granulomatous conditions especially in endemic regions like India. Objective: To assess the role of PCR done on archival cytological material in diagnosing tuberculosis (TB) in cases reported as granulomatous inflammation/TB in liver SOLs. Study Design: Total of 17 cases of liver SOLs reported as granulomatous inflammation [n=12] and TB [n=5] were retrieved from the departmental records from January 2005 to August 2011. Ultrasound-guided FNAC was performed and the smears were reviewed for the cytomorphological features. The air-dried smears stained with MGG from the archival material were assessed for the representative material in the form of epithelioid granulomas and giant cells. One/two MGG smears from each case were de-stained and the material was scraped to extract DNA. PCR for Mycobacterium tuberculosis was performed for amplification of 123 bp fragment of the IS6110 insertion element. Results: The age of the patients ranged from 3 to 61years (median age-41 years). There were 12 females and 5 males. The patients presented with solitary/ multiple liver SOLs. DNA could be extracted from 10/17 cases from archival MGG smears. PCR positivity was noted in 8/10 cases [including 4 AFB smear positive cases], confirming a diagnosis of tuberculosis. DNA could not be extracted from one smear positive case possibly due to predominance of necrosis. Conclusion: Cytomorphology alone may not be sufficient for differentiating various granulomatous lesions reported in Liver SOLs. DNA can be extracted from the archival cytological MGG stained smears. PCR should be carried out if ZN-staining is negative in granulomatous lesions, especially when material has not been submitted for culture.

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