Lymp node cytology

2. Approach to Lymph node Cytology
Fereshteh Ameli

3. Approach to Lymph node Cytology
Spectrum of conditions:
- Benign
- Malignant
- Metastatic
- Lymphoma
- Not a lymph node

4. • Clinical Information
• Microscopy
• Ancillary tests
Approach to Lymph node Cytology

5. Clinical Information
• Age, symptoms, site, size, time of onset,
imaging (US)
• Past and current medical history
• Basic serology (ESR, LDH, ToRCH complex,
ANA, others)

6. Key cytomorphologic features used to
examine lymph node FNA

7. Microscopy
• Low power:
– Tissue architecture
• Tissue fragments /cohesive cell groups
• Dispersed cells
– Background material (cyst fluid/necrosis)
• High power:
• Lymphoid or not?
• Monotonous or polymorphous?
• Cell size: small/ large/ intermediate?

8. Residents of a Normal Lymph node

9. Lymph node cytologic pattern

10. Small Large
Intermediate

12. Ancillary tests
• Infections: Microbiology culture
• Malignancy
– Metastatic: Cell block
– Suspect lymphoma: Cell block/ Flow cytometry

13. Case 1
Cervical LN FNA: A 5 y/o boy with a
history of chronic otitis media

22. FNA Diagnosis:
• Negative for malignant cells, features of
benign reactive LN
• Further investigation is warranted if
unexplained lymphadenopathy persists or
progresses.

23. Lymphoid tissue fragments vs
Metastatic ca

24. Tissue Fragments: DDX

25. Granulomatous LN

26. Granulomatous LN

28. Case 2
A 65 y/o woman with intraparotid LN

36. Age 65

37. Dx:
Atypical lymphoid population,
suspicious for non-hodgkin lymphoma,
recommend excision
Follow up- histo: Low grade follicular lymphoma

38. Polymorphous pattern
• Reactive lymph node
• Low grade lymphoma
– Marginal zone lymphoma
– Low grade follicular lymphoma
– NLPHL
– T cell lymphoma
False Negatives

39. Polymorphous pattern

42. Polymorphous pattern

45. A 55 y/o woman with cervical
lymphadenopathy
Case 3

51. Dx:
Positive for malignancy, suspicious for
high grade non-hodgkin lymphoma,
recommend tissue evaluation
Follow up- histo: Diffuse large B cell lymphoma

52. Predominant large cell pattern

53. Burkitt's lymphoma

54. A 75 y/o man with extensive
lymphadenopathy
Case 4

60. Dx:
Suspicious for malignancy, suggestive of
a low grade non-hodgkin lymphoma,
recommend tissue evaluation
Follow up- histo: CLL/SLL

61. Predominant small cell pattern

62. A 25 y/o man with cervical LN
Case 5

67. Dx:
Suspicious for Hodgkin lymphoma,
recommend tissue evaluation
Follow up- histo: Classic Hodgkin lymphoma

68. Pleomorphic cell pattern

70. DISPERSED CELLS: DDx

73. Small cell carcinoma

75. Pattern based approach
• Pattern 1: Cohesive tissue fragments
– Lymphoid aggregates
• Benign-germinal centers
• Malignant: FL, Anaplastic large cell lymphoma
– Non-lymphoid
• Metastasis
• Granulomatous LN
– Not a Lymph node

76. Pattern based approach
• Pattern 2: Predominantly single cells
– Lymphoid:
• Mixed population: Reactive LN, MZL, NLPHL, low grade FL
• Monotonous: Lymphoma
• Scattered large cells: HL,ALCL, TCRBCL
– Non-Lymphoid:
• Metastases: (NPC, small cell ca, melanoma)

77. False positive:
-EBV LN
- Kikuchi

78. :
Acknowledgement