J Pathol Transl Med.  2023 Jul;57(4):196-207. 10.4132/jptm.2023.06.12.

A stepwise approach to fine needle aspiration cytology of lymph nodes

• Chong Y
• Park G
• Cha HJ
• Kim HJ
• Kang CS
• Abdul-Ghafar J
• Lee SS

• KMID: 2544327
• DOI: http://doi.org/10.4132/jptm.2023.06.12

Abstract

The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

Keyword

Cytology; Fine needle aspiration; Lymph node; Lymphoid neoplasms; Diagnosis

Figure

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  Fig. 1. Disease entity that can be found in lymph node fine needle aspiration cytology. DLBCL/ALCL, diffuse large B-cell lymphoma/anaplastic large cell lymphoma; FL, follicular lymphoma; MCL, mantle cell lymphoma; PTCL, peripheral T-cell lymphoma; HIV, human immunodeficiency virus; HL, Hodgkin’s lymphoma; PTC, papillary thyroid carcinoma; SqCC, squamous cell carcinoma; MSRCT, malignant solitary fibrous tumor of the pleura; NPUC, non-papillary urothelial carcinoma; PD, poorly differentiated; SmCC, small cell carcinoma.

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  Fig. 2. A stepwise approach to lymph node fine needle aspiration cytology (LN-FNAC) interpretation. US, ultrasonography; FDG, fluorodeoxyglucose; Hx, history; Dz, disease; MΦ, macrophage; R-S, Reed-Sternberg; HEV, high endothelial venule.

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  Fig. 3. Low-power smear patterns of lymph node fine needle aspiration cytology interpretation. TB, tuberculosis; KFD, Kikuchi-Fujimoto disease.

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  Fig. 4. High-power magnification cellular population patterns of lymph node fine needle aspiration cytology interpretation. HL, Hodgkin’s Lymphoma; TCR-BCL, T-cell/histiocyte-rich B-cell lymphoma; LyG, lymphomatoid granulomatosis; FL, follicular lymphoma; ALCL, anaplastic large cell lymphoma; PTCL, NOS, peripheral T-cell lymphoma, not otherwise specified; AITL, angioimmunoblastic T-cell lymphoma; MSRCT, malignant solitary fibrous tumor of the pleura; SmCC, small cell carcinoma; ARMS, alveolar rhabdomyosarcoma; MCL, mantle cell lymphoma; LBL, lymphoblastic lymphoma; SLL/CLL, small lymphocytic lymphoma/chronic lymphocytic leukemia; SqCC, squamous cell carcinoma; PD, poorly differentiated; NPUC, non-papillary urothelial carcinoma; DLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma.

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  Fig. 5. Exemplary images of the two-cell population pattern. (A) Reactive hyperplasia. (B) Follicular lymphoma. (C) Hodgkin’s lymphoma. (D) Metastatic adenocarcinoma.

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  Fig. 6. Exemplary images of continuous range of variably sized cells pattern. (A) Peripheral T-cell lymphoma, not otherwise specified. (B) Angioimmunoblastic T-cell lymphoma.

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  Fig. 7. Exemplary images of monotonously small population pattern. (A) Small lymphocytic lymphoma/chronic lymphocytic leukemia. (B) Mantle cell lymphoma. (C) Lymphoblastic lymphoma. (D) Metastatic small round cell tumor (small cell carcinoma).

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  Fig. 8. Exemplary images of monotonously large population pattern. (A) Diffuse large B-cell lymphoma. (B) Burkitt lymphoma. (C) Squamous cell carcinoma, poorly differentiated. (D) Undifferentiated carcinoma, nasopharynx.

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  Fig. 9. Disease-specific diagnostic clues. (A) Reed-Sternberg cells in Hodgkin’s lymphoma. (B) Russell body (Mott cells) in mature B-cell lymphoma such as lymphoplasmacytic lymphoma. (C) Lymphoglandular bodies in reactive hyperplasia. (D) Ill-defined granuloma in tuberculosis.

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  Fig. 10. Diagnostic algorithm for lymph node fine needle aspiration cytology.

Reference

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