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

Affiliations
  • 1Department of Pathology, Keimyung University Dongsan Hospital, Daegu, Korea
  • 2Department of Pathology, Keimyung University School of Medicine, Daegu, Korea

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

  • 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

References

1. van Schaik JE, Muller Kobold AC, van der Laan B, van der Vegt B, van Hemel BM, Plaat BEC. 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. 2019; 41:2561–5.
2. Aljafari AS, Khalil EA, Elsiddig KE, et al. Diagnosis of tuberculous lymphadenitis by FNAC, microbiological methods and PCR: a comparative study. Cytopathology. 2004; 15:44–8.
Article
3. Das DK, Bhambhani S, Pant JN, et al. Superficial and deep-seated tuberculous lesions: fine-needle aspiration cytology diagnosis of 574 cases. Diagn Cytopathol. 1992; 8:211–5.
Article
4. Ersoz C, Polat A, Serin MS, Soylu L, Demircan O. Fine needle aspiration (FNA) cytology in tuberculous lymphadenitis. Cytopathology. 1998; 9:201–7.
5. Kumar N, Tiwari MC, Verma K. AFB staining in cytodiagnosis of tuberculosis without classical features: a comparison of Ziehl-Neelsen and fluorescent methods. Cytopathology. 1998; 9:208–14.
Article
6. Chantranuwat C, Assanasen T, Shuangshoti S, Sampatanukul P. 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. 2006; 37:940–7.
7. Xia F, Poon RT, Wang SG, Bie P, Huang XQ, Dong JH. Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China. World J Gastroenterol. 2003; 9:1361–4.
Article
8. Berzosa M, Tsukayama DT, Davies SF, et al. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of extra-pulmonary tuberculosis. Int J Tuberc Lung Dis. 2010; 14:578–84.
9. Itaba S, Yoshinaga S, Nakamura K, et al. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis. J Gastroenterol. 2007; 42:83–6.
Article
10. Mittal P, Handa U, Mohan H, Gupta V. Comparative evaluation of fine needle aspiration cytology, culture, and PCR in diagnosis of tuberculous lymphadenitis. Diagn Cytopathol. 2011; 39:822–6.
Article
11. Sun J, Teng J, Yang H, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis. Ann Thorac Surg. 2013; 96:2021–7.
Article
12. Florentine BD, Cohen AN. Nodular sclerosing classical Hodgkin lymphoma masquerading as acute suppurative-necrotizing lymphadenitis. Diagn Cytopathol. 2014; 42:238–41.
Article
13. Okuni M, Yakushijin K, Sakai Y, et al. A case of classical Hodgkin lymphoma with total lymph node infarction. J Clin Exp Hematop. 2018; 58:24–6.
Article
14. Phulware RH, Guleria P, Iyer VK, et al. Cytological diagnosis of Langerhans cell histiocytosis: a series of 47 cases. Cytopathology. 2019; 30:413–8.
Article
15. Sneige N, Dekmezian RH, Katz RL, et al. Morphologic and immunocytochemical evaluation of 220 fine needle aspirates of malignant lymphoma and lymphoid hyperplasia. Acta Cytol. 1990; 34:311–22.
16. Tani E, Liliemark J, Svedmyr E, Mellstedt H, Biberfeld P, Skoog L. Cytomorphology and immunocytochemistry of fine needle aspirates from blastic non-Hodgkin’s lymphomas. Acta Cytol. 1989; 33:363–71.
17. Dao TH, Fleury-Feith J, Haioun C, et al. Percutaneous fine needle aspiration cytology and biopsy in the diagnosis and classification of lymphoma: clinical evaluation. Leuk Lymphoma. 1991; 5:237–42.
Article
18. Dunphy CH, Ramos R. Combining fine-needle aspiration and flow cytometric immunophenotyping in evaluation of nodal and extra-nodal sites for possible lymphoma: a retrospective review. Diagn Cytopathol. 1997; 16:200–6.
Article
19. Handa U, Mohan H, Punia RS, Nada R. FNAC in a case of NHL presenting initially as nodal infarction. Indian J Pathol Microbiol. 2005; 48:510–2.
20. Banet N, Rooper LM, Maleki Z. 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. 2016; 44:206–14.
Article
21. Lastra RR, Pramick MR, Nakashima MO, et al. Adequacy of fine-needle aspiration specimens for human papillomavirus infection molecular testing in head and neck squamous cell carcinoma. Cytojournal. 2013; 10:21.
Article
22. Allison DB, Bishop JA, Ali SZ. Cytopathologic characteristics of SMARCB1 (INI-1) deficient sinonasal carcinoma: a potential diagnostic pitfall. Diagn Cytopathol. 2016; 44:700–3.
Article
23. Rollo F, Dona MG, Pellini R, et al. 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. 2018; 29:449–54.
Article
24. Mac DeMay R. The art and science of cytopathology. Chicago: American Society for Clinical Pathology;2012.
25. Kumar N, Jain S, Murthy NS. Utility of repeat fine needle aspiration in acute suppurative lesions: follow-up of 263 cases. Acta Cytol. 2004; 48:337–40.
26. Tong TR, Chan OW, Lee KC. Diagnosing Kikuchi disease on fine needle aspiration biopsy: a retrospective study of 44 cases diagnosed by cytology and 8 by histopathology. Acta Cytol. 2001; 45:953–7.
27. Mokhtari S. Mechanisms of cyst formation in metastatic lymph nodes of head and neck squamous cell carcinoma. Diagn Pathol. 2012; 7:6.
Article
28. Choi AH, Bolaris M, Nguyen DK, Panosyan EH, Lasky JL 3rd, Duane GB. Clinicocytopathologic correlation in an atypical presentation of lymphadenopathy with review of literature. Am J Clin Pathol. 2015; 143:749–54.
Article
29. Gailey MP, Klutts JS, Jensen CS. Fine-needle aspiration of histoplasmosis in the era of endoscopic ultrasound and endobronchial ultrasound: cytomorphologic features and correlation with clinical laboratory testing. Cancer Cytopathol. 2013; 121:508–17.
30. Aerts JG, Kloover J, Los J, van der Heijden O, Janssens A, Tournoy KG. EUS-FNA of enlarged necrotic lymph nodes may cause infectious mediastinitis. J Thorac Oncol. 2008; 3:1191–3.
Article
31. Lapuerta P, Martin SE, Ellison E. Fine-needle aspiration of peripheral lymph nodes in patients with tuberculosis and HIV. Am J Clin Pathol. 1997; 107:317–20.
Article
32. Ulu-Kilic A, Gulen G, Sezen F, Kilic S, Sencan I. Tularemia in central Anatolia. Infection. 2013; 41:391–9.
Article
33. Tuncer E, Onal B, Simsek G, et al. Tularemia: potential role of cytopathology in differential diagnosis of cervical lymphadenitis: multicenter experience in 53 cases and literature review. APMIS. 2014; 122:236–42.
Article
34. Markoc F, Koseoglu RD, Koc S, Gurbuzler L. Tularemia in differential diagnosis of cervical lymphadenopathy: cytologic features of tularemia lymphadenitis. Acta Cytol. 2014; 58:23–8.
Article
35. Hsueh EJ, Ko WS, Hwang WS, Yam LT. Fine-needle aspiration of histiocytic necrotizing lymphadenitis (Kikuchi’s disease). Diagn Cytopathol. 1993; 9:448–52.
Article
36. Viguer JM, Jimenez-Heffernan JA, Perez P, Lopez-Ferrer P, Gonzalez-Peramato P, Vicandi B. Fine-needle aspiration cytology of Kikuchi’s lymphadenitis: a report of ten cases. Diagn Cytopathol. 2001; 25:220–4.
Article
37. Fite JJ, Maleki Z. Paraganglioma: cytomorphologic features, radiologic and clinical findings in 12 cases. Diagn Cytopathol. 2018; 46:473–81.
Article
38. Annema JT, Veselic M, Rabe KF. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Eur Respir J. 2005; 25:405–9.
39. Vrbica Z, Boras Z, Rakusic N, et al. Necrotising sarcoid granulomatosis of the spinal cord: case report. Coll Antropol. 2010; 34:713–7.
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