Test 2- Cytology of Lymphnodes Flashcards
What are indications of lymph node aspirates?
Lymph node enlargement, suspect metastasis, normal sized lymph
nodes are almost always normal!
What are causes of lymphadenopathy?
• Hyperplasia/reactive (antigen stimulations-
- the antigen is outside the node in the drainage field)
• Lymphadenitis! supportive (mostly neutros. Low to 100% of
nucleated cells are neuters; degenerative neutros depend if bacT are in node), mixed, mononuclear(macrophagic or granulomatous)
• Metastatic neoplasia- clumps of neoplastic cells such as mast cells, epithelial cells, mesenchymal cells.
• Primary neoplasia (lymphoma)- >50% lymphoblasts (have nucleoli)
What are types of cells seen in lymph nodes?
Small lymphocytes, intermediate sized lymphocytes, lymphoblasts, plasma cells (often w/ reactive lymph node), macros (a few can be seen in any situation- if all macros- dealing w/ macrphagic inflammation), eos (often draining skin lesions), mast cells, abnormal cells
What do you see in a reactive (hyperplastic) lymph node?
The lymph node is enlarged due to proliferation of lymphoid cells.
Unlikely to see increase plasma cells w/ lymphoma You can see medium and large
lymphocytes increased by lymphoblstas are still less than 20%. Marcophages, neutros and mast cells are variable common to see reactive lymph nodes that are draining the GI
Why would you avoid aspirating submandibular lymph nodes?
Those lymph nodes that draining the GI (including the
mouth) are often reactive lymph nodes- may disrupt the
actual dx)
Ddx- If huge amount of plasma cells and a reactive lymph node; or
multiple myeloma involving a lymph node; or a plasma cell tumor
that has metastozied to a lymph node (not common)! perform flow
cytometry, PCR to see exactly what you are dealing w/. know the
other sings w/ monocloncal gammopathy
Lymph node metastasis?
Presence of cells not normally found in lymph nodes. Metastasis of
any malignant tumor is a possibility. Epithelial cells- easy to confuse w/ macrophages or accidental aspiration of submandibular salivary gland. Cytology is as accurate as histopath in predicting presence or absence of metastasis
What are problems w/ misdiagnosing lymph node aspirates?
Missed the lymph node (stick the perinodal fat) or salivary gland
• Under stained slides- look for etiologies in reactive nodes but
uncommon to find them.
If you stuck into the submandibular lymph node and examined the slide and found large finely vacuolated cells w/ hematoid crystals what can you say?
Missed the lymph node and accidentally stuck the salivary gland. You are looking at salivary cells. They are often large, adhered together, foamy cytoplasm and don’t see lymphocytes on the slide w/ salivary glands aspirate
