Fine needle aspiration cytology of dermatopathic lymphadenitis

Fine needle aspiration cytology of dermatopathic lymphadenitis in an asymptomatic female: A case report

Dermatopathic lymphadenopathy usually presents as enlarged superficial lymph nodes, most often involving the axillary or inguinal regions. Most patients have a chronic dermatopathy that precedes the development of dermatopathic lymphadenopathy. This condition can be confused with lymphoma in adults. There are very few case reports on cytological features of this disease in literature. We describe a case of dermatopathic lymphadenopathy in a 50-year-old female without any skin disease.

Dermatopathic lymphadenitis of the head and neck

Dermatopathic lymphadenitis is a histopathologic diagnosis of patients with enlarged lymph nodes classically in the setting of a variety of inflammatory erthrodermas without known malignancy. While considered a benign histopathologic finding, differentiation of this disorder from mycosis fungoides or lymphoma can be difficult.

Cytologic findings of angioimmunoblastic T-cell lymphoma: analysis of 16 fine-needle aspirates over 9-year period

BACKGROUND

Peripheral T-cell lymphoma often represents an important diagnostic pitfall in fine-needle aspiration biopsy due to the heterogeneous cell population present. A classic example of this group is angioimmunoblastic T-cell lymphoma (AILD-T). The fine-needle aspiration cytology of this relatively well-defined histologic subtype of T-cell lymphoma is rarely described in the literature.

METHODS

The authors reviewed 16 fine-needle aspirates of AILD-T from 9 patients in Queen Mary Hospital and Pamela Youde Nethersole Eastern Hospital, Hong Kong, over a 9-year period from early 1993 to mid-2001. The morphologic features seen in cytology smears and/or cell block sections were correlated with histologic and immunohistochemical findings of excisional biopsy specimens.

RESULTS

The smears and cytospin preparations showed a heterogeneous population of hematolymphoid cells, including small lymphocytes; nondescript, medium-sized lymphoid cells; immunoblasts; plasma cells; eosinophils; and reticulum cells, including follicular dendritic cells. In general, tingible body macrophages were not identified. Conversely, follicular dendritic cells were discernible easily in most cases and sometimes were admixed intimately with lymphoid cells, forming dendritic cell-lymphocyte complexes. There also were large lymphoid tissue fragments containing a scaffold of arborizing small vessels. Pleomorphic cells with high mitotic activity or lymphoid cells with clear cytoplasm were not identified. The cell block sections often showed an intimate admixture of small lymphocytes, plasma cells, eosinophils, and reticulum cells amid a background of reticulin fibers. Lymphoid follicles with well-developed germinal centers were never found. The features seen in cytologic preparations were reminiscent of those seen in histologic sections of the corresponding lymph node excisional biopsies.

CONCLUSIONS

though ancillary investigative methods, including flow cytometry and molecular study, are of limited value in fine-needle aspiration cytology assessment of AILD-T due to the heterogeneous cell population present, recognition of the peculiar combination of cytologic features, especially in the right clinical setting, should provide a clue about the diagnosis. A high index of suspicion is essential to avoid a false negative diagnosis of reactive lymphadenopathy.

On the utility of fine-needle aspiration in the diagnosis of primary scalp lesions

A study of the clinico-cytologic findings of 62 primary palpable lesions located in the scalp is reported. Trichilemmal cyst (16 cases) followed by lipoma (8 cases) and benign melanocytic proliferation (4 cases) were the most frequent benign conditions (n = 45); basal-cell carcinoma (6 cases) and squamous-cell carcinoma (5 cases) were the most frequently aspirated malignant tumors (n = 17). In the cytologic category of benign lesions (n = 45), cytohistologic correlation was carried out in 19 cases and the cytohistologic agreement was 100%, except for the three actinic keratosis cases that were diagnosed as atypical epidermal lesions. Cytohistologic agreement was 100% in the 16 malignant lesions in which excisional biopsy was performed. Based on the findings reported here, fine-needle aspiration is indicated as the first-choice technique for the clinical evaluation of primary scalp lesions. Experience with cutaneous cytopathology is essential in order to be able to carry out this task.

Pathologic analysis of the sentinel lymph node

The development of the sentinel lymph node concept has had a revolutionary effect on the way radical cancer surgery is viewed. The selective excision of the sentinel node alone has been proposed as an alternative to complete regional lymphadenectomy. This article addresses the sentinel lymph node hypothesis and the role of pathologic analysis, radiation safety, intraoperative and postoperative assessment, pathologic analysis in prognosis, and polymerase chain reaction-based studies.

Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes

BACKGROUND

The presence of lymph node metastases in patients with malignant melanoma implies a significant decrease in survival. The authors investigated the efficacy of fine-needle aspiration biopsy (FNAB) in the diagnosis of metastatic malignant melanoma in 115 patients with melanoma and clinically suspicious regional lymph nodes.

METHODS

One hundred thirty-three FNABs were performed by cytopathologists after referral from surgeons or oncologists using a 25-gauge or 27-gauge needle.

RESULTS

The cytologic diagnosis was negative in 35, atypical in 1, suspicious in 2, and positive for malignant melanoma in 95. Regional lymph node dissections were performed in 78 patients. Of these, 70 positive FNABs were confirmed with no false-positive results. The atypical FNAB was proven positive for malignant melanoma at surgery. Of the two suspicious FNABs, one was confirmed as positive and one showed dermatopathic lymphadenopathy. Of the 35 negative FNAB specimens, 5 patients underwent surgery; 3 FNABs were found to be negative and 2 FNABS were falsely negative. Twenty patients with negative aspirates were followed clinically for 22-45 months (mean, 32 months); 19 patients had no evidence of disease and 1 patient died of disseminated melanoma.

CONCLUSIONS

FNAB of palpable lymphadenopathy in patients with malignant melanoma can provide a rapid and accurate assessment of lymph node status and expedite the therapeutic management of these patients.

Fine-needle aspiration biopsy in the evaluation of lymphadenopathy associated with cutaneous T-cell lymphoma (mycosis fungoides/Sézary syndrome)

We studied the role of fine-needle aspiration (FNA) in the evaluation of lymphadenopathy associated with cutaneous T-cell lymphoma (CTCL) in 11 patients with lymphadenopathy and compared findings with corresponding histologic material. Molecular genetic analysis for T-cell clonality by polymerase chain reaction (PCR) was performed on all aspirates. Immunophenotyping was successful in 4 of 7 cases in which flow cytometry was attempted from the aspirated material. Cytologic evaluation of FNA samples correlated strongly with histologic rating of involvement based on numbers of atypical cerebriform lymphocytes in the nodal specimen. Of 7 nodal specimens with scattered or small groups of atypical cells in the background of dermatopathic lymphadenopathy (LN1-2), the cytologic diagnosis was interpreted as reactive in all instances. Of 4 specimens with highly suspect (LN3) or definite histologic involvement (LN4), the cytologic diagnosis was likewise suspect or malignant. The correlation between molecular genetic studies on FNA samples and studies on tissue was not significant; in 2 cases, a T-cell clone was detected in the nodal tissue sample but not in the FNA sample, suggesting undersampling. A T-cell clone was detected by PCR in 5 of 7 nodal specimens judged reactive by FNA biopsy or histologic assessment. FNA for cytologic and molecular genetic analysis is a useful method to evaluate lymphadenopathy associated with CTCL and may obviate the need for surgical biopsy.