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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.
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.
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
was performed for amplification of
123 bp fragment of the IS6110 insertion element.
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.
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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