Causes of necrotic features in fine-needle aspirates from cervical lymph nodes
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Background: Lymph node fine-needle aspiration (LN FNA) cytology indicates necrosis in various diseases. Dominant necrotic features make the diagnosis of underlying conditions very difficult. Methods: We retrospectively reviewed 460 patients who underwent cervical LN aspiration cytology that revealed necrotic findings at Keimyung University Dongsan Hospital in Daegu, Korea, from 2003–2017. Each specimen was evaluated and analyzed in association with the clinical findings, biopsy findings, and/or other ancillary tests, including acid-fast bacilli staining and molecular testing for Mycobacterium tuberculosis. Results: When necrotic features were noted upon cervical LN FNA cytology, the most common pathologic LN FNA category was necrosis alone (31.5%). The second most common category was granulomatous inflammation (31.3%), followed by Kikuchi disease (20.0%) and malignant neoplasm (8.7%). In cases where the cervical LN FNA revealed necrosis alone, the most common final diagnosis was tuberculosis. In young patients, Kikuchi disease should be considered as one cervical LN FNA category, while metastatic carcinoma should be suspected in older patients. Conclusions: Even when necrosis alone is observed in LN FNA cytology, it is important to determine the cause through further evaluation.
Abstract
Background: Lymph node fine-needle aspiration (LN FNA) cytology indicates necrosis in various diseases. Dominant necrotic features make the diagnosis of underlying conditions very difficult. Methods: We retrospectively reviewed 460 patients who underwent cervical LN aspiration cytology that revealed necrotic findings at Keimyung University Dongsan Hospital in Daegu, Korea, from 2003–2017. Each specimen was evaluated and analyzed in association with the clinical findings, biopsy findings, and/or other ancillary tests, including acid-fast bacilli staining and molecular testing for Mycobacterium tuberculosis. Results: When necrotic features were noted upon cervical LN FNA cytology, the most common pathologic LN FNA category was necrosis alone (31.5%). The second most common category was granulomatous inflammation (31.3%), followed by Kikuchi disease (20.0%) and malignant neoplasm (8.7%). In cases where the cervical LN FNA revealed necrosis alone, the most common final diagnosis was tuberculosis. In young patients, Kikuchi disease should be considered as one cervical LN FNA category, while metastatic carcinoma should be suspected in older patients. Conclusions: Even when necrosis alone is observed in LN FNA cytology, it is important to determine the cause through further evaluation.
참고문헌 (39)
- van Schaik JE, "Squamous cell carcinoma antigen concentration in fine needle aspiration samples : a new method to detect cervical lymph node metastases of head and neck squamous cell carcinoma", Head Neck, 41, pp.2561~2565 (2019)
- Aljafari AS, "Diagnosis of tuberculous lymphadenitis by FNAC, microbiological methods and PCR : a comparative study", Cytopathology, 15, pp.44~48 (2004)
- Das DK, "Superficial and deep-seated tuberculous lesions : fine-needle aspiration cytology diagnosis of 574 cases", Diagn Cytopathol, 8, pp.211~215 (1992)
- Ersoz C, "Fine needle aspiration(FNA)cytology in tuberculous lymphadenitis", Cytopathology, 9, pp.201~207 (1998)
- Kumar N, "AFB staining in cytodiagnosis of tuberculosis without classical features : a comparison of Ziehl-Neelsen and fluorescent methods", Cytopathology, 9, pp.208~214 (1998)
- Chantranuwat C, "Polymerase chain reaction for detection of Mycobacterium tuberculosis in papanicolaou-stained fine needle aspirated smears for diagnosis of cervical tuberculous lymphadenitis", Southeast Asian J Trop Med Public Health, 37, pp.940~947 (2006)
- Xia F, "Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients : experience from China", World J Gastroenterol, 9, pp.1361~1364 (2003)
- Berzosa M, "Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of extra-pulmonary tuberculosis", Int J Tuberc Lung Dis, 14, pp.578~584 (2010)
- Itaba S, "Endoscopic ultrasoundguided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis", J Gastroenterol, 42, pp.83~86 (2007)
- Mittal P, "Comparative evaluation of fine needle aspiration cytology, culture, and PCR in diagnosis of tuberculous lymphadenitis", Diagn Cytopathol, 39, pp.822~826 (2011)
- Sun J, "Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis", Ann Thorac Surg, 96, pp.2021~2027 (2013)
- Florentine BD, "Nodular sclerosing classical Hodgkin lymphoma masquerading as acute suppurative-necrotizing lymphadenitis", Diagn Cytopathol, 42, pp.238~241 (2014)
- Okuni M, "A case of classical Hodgkin lymphoma with total lymph node infarction", J Clin Exp Hematop, 58, pp.24~26 (2018)
- Phulware RH, "Cytological diagnosis of Langerhans cell histiocytosis : a series of 47 cases", Cytopathology, 30, pp.413~418 (2019)
- Sneige N, "Morphologic and immunocytochemical evaluation of 220 fine needle aspirates of malignant lymphoma and lymphoid hyperplasia", Acta Cytol, 34, pp.311~322 (1990)
- Tani E, "Cytomorphology and immunocytochemistry of fine needle aspirates from blastic non-Hodgkin’s lymphomas", Acta Cytol, 33, pp.363~371 (1989)
- Dao TH, "Percutaneous fine needle aspiration cytology and biopsy in the diagnosis and classification of lymphoma : clinical evaluation", Leuk Lymphoma, 5, pp.237~242 (1991)
- Dunphy CH, "Combining fine-needle aspiration and flow cytometric immunophenotyping in evaluation of nodal and extranodal sites for possible lymphoma : a retrospective review", Diagn Cytopathol, 16, pp.200~206 (1997)
- Handa U, "FNAC in a case of NHL presenting initially as nodal infarction", Indian J Pathol Microbiol, 48, pp.510~512 (2005)
- Banet N, "Metastatic HPV-related head and neck squamous cell carcinoma to the lung and mediastinal lymph nodes in aspirated cytology material : a diagnostic pitfall", Diagn Cytopathol, 44, pp.206~214 (2016)
- Lastra RR, "Adequacy of fine needle aspiration specimens for human papillomavirus infection molecular testing in head and neck squamous cell carcinoma", Cytojournal, 10, pp.21~ (2013)
- Allison DB, "Cytopathologic characteristics of SMARCB1(INI-1)deficient sinonasal carcinoma : a potential diagnostic pitfall", Diagn Cytopathol, 44, pp.700~703 (2016)
- Rollo F, "Cytology and direct human papillomavirus testing on fine needle aspirates from cervical lymph node metastases of patients with oropharyngeal squamous cell carcinoma or occult primary", Cytopathology, 29, pp.449~454 (2018)
- Mac DeMay R, "The art and science of cytopathology" (2012), American Society for Clinical Pathology
- Kumar N, "Utility of repeat fine needle aspiration in acute suppurative lesions : follow-up of 263 cases", Acta Cytol, 48, pp.337~340 (2004)
- Tong TR, "Diagnosing Kikuchi disease on fine needle aspiration biopsy : a retrospective study of 44 cases diagnosed by cytology and 8 by histopathology", Acta Cytol, 45, pp.953~957 (2001)
- Mokhtari S, "Mechanisms of cyst formation in metastatic lymph nodes of head and neck squamous cell carcinoma", Diagn Pathol, 7, pp.6~ (2012)
- Choi AH, "Clinicocytopathologic correlation in an atypical presentation of lymphadenopathy with review of literature", Am J Clin Pathol, 143, pp.749~754 (2015)
- Gailey MP, "Fine-needle aspiration of histoplasmosis in the era of endoscopic ultrasound and endobronchial ultrasound : cytomorphologic features and correlation with clinical laboratory testing", Cancer Cytopathol, 121, pp.508~517 (2013)
- Aerts JG, "EUS-FNA of enlarged necrotic lymph nodes may cause infectious mediastinitis", J Thorac Oncol, 3, pp.1191~1193 (2008)
- Lapuerta P, "Fine-needle aspiration of peripheral lymph nodes in patients with tuberculosis and HIV", Am J Clin Pathol, 107, pp.317~320 (1997)
- Ulu-Kilic A, "Tularemia in central Anatolia", Infection, 41, pp.391~399 (2013)
- Tuncer E, "Tularemia : potential role of cytopathology in differential diagnosis of cervical lymphadenitis : multicenter experience in 53 cases and literature review", APMIS, 122, pp.236~242 (2014)
- Markoc F, "Tularemia in differential diagnosis of cervical lymphadenopathy : cytologic features of tularemia lymphadenitis", Acta Cytol, 58, pp.23~28 (2014)
- Hsueh EJ, "Fine-needle aspiration of histiocytic necrotizing lymphadenitis(Kikuchi’s disease)", Diagn Cytopathol, 9, pp.448~452 (1993)
- Viguer JM, "Fine-needle aspiration cytology of Kikuchi’s lymphadenitis : a report of ten cases", Diagn Cytopathol, 25, pp.220~224 (2001)
- Fite JJ, "Paraganglioma : cytomorphologic features, radiologic and clinical findings in 12 cases", Diagn Cytopathol, 46, pp.473~481 (2018)
- Annema JT, "Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis", Eur Respir J, 25, pp.405~409 (2005)
- Vrbica Z, "Necrotising sarcoid granulomatosis of the spinal cord : case report", Coll Antropol, 34, pp.713~717 (2010)