J Pathol Transl Med.  2021 Jan;55(1):60-67. 10.4132/jptm.2020.09.28.

Causes of necrotic features in fine-needle aspirates from cervical lymph nodes

• Seo YJ
• Shin H
• Lee HW
• Jung HR

• KMID: 2511514
• DOI: http://doi.org/10.4132/jptm.2020.09.28

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.

Keyword

Fine-needle aspiration; Lymph node; Necrosis; Tuberculosis; Kikuchi disease

Figure

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  Fig. 1 Smear and biopsy findings of the neck lesion diagnosed as necrosis on aspiration but changed diagnosis by biopsy (A, B). (A) Fine needle aspiration (FNA) shows colloid material. (B) Lymph node (LN) excision specimen was diagnosed as metastatic papillary carcinoma. (C, D) Case 2. (C) FNA shows pinkish amorphous material. (D) LN excision specimen was diagnosed as Warthin tumor. (E, F) Case 3. (E) FNA shows cystic fluid material. (F) LN excision specimen was diagnosed as salivary duct cyst. (G, H) Case 4. (G) FNA shows myxoid stroma. (H) LN excision specimen was diagnosed as schwannoma. (I, J) Case 5. (I) FNA shows red blood cells and fibrin material. (J) LN excision specimen was diagnosed as reactive hyperplasia.

Reference

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