Author(s): Ruchi Khajuria BACKGROUND Lymphadenopathy is one of the commonest clinical presentations among the paediatric age group. Evaluation of a child with lymphadenopathy is a common clinical scenario for the paediatricians and poses a diagnostic challenge. Fine needle aspiration cytology (FNAC) is the first line of investigation for any individual with significant lymphadenopathy. To evaluate the role of FNAC in establishing the aetiology of lymphadenopathy in children. To study the different cytomorphological patterns associated with various lymphadenopathies. MATERIALS AND METHODS This study was carried out on paediatric patients (infants and children aged 1 year to 18 years) presented with significant peripheral lymphadenopathy referred for FNAC to the Department of Pathology, at Government Medical College, Jammu, for a period of three years. This includes a retrospective study conducted from November 1, 2014 to October 31, 2016 and prospective study from November 1, 2016 to October 31, 2017. FNAC was carried out in all cases on significant lymph nodes and aspirated materials was smeared and sent to laboratory, various stains were used for staining cytological smears. RESULTS Fine needle aspiration cytology results, in 465 cases of lymphadenopathies, have been collected over a period of three years. The spectrum of cytomorphological diagnosis consisted of reactive hyperplasia (69.46%), tuberculosis lymphadenitis (24.73%), acute suppurative lymphadenitis (2.58%), non-Hodgkin???s lymphoma (2.37%), Hodgkin???s lymphoma (0.22%), Rosai-Dorfman Disease (0.43%), and Langerhans cell histiocytosis (0.22%). Reactive lymphadenitis was found to be the most common cause of lymphadenopathy in 6 to 10 years of age group and tuberculous lymphadenitis was most common in 11 to 18 years of age group. Males show preponderance of reactive hyperplasia (78.65%), while tuberculosis lymphadenitis showed a female preponderance (39.67%). Males and females were equally involved in Rosai-Dorfman disease. CONCLUSION FNAC is a very useful diagnostic tool in diagnosis of enlarged lymph nodes. Tuberculous lymphadenitis can be easily diagnosed by FNAC based on cytomorphology and ZN stain. However, limitations of FNAC should be kept in mind and histopathologic examination should be used in doubtful cases.