Approach to Lymph Node Cytology

  • Min En NgaEmail author


Lymph nodes are often a microcosm of diseases in the rest of the body, reflecting not only local, but regional and sometimes systemic disease. This chapter provides a framework of the role and limitations of lymph node FNAs. A sequential, pattern-based approach to lymph node cytology is outlined, together with a summary of the types of ancillary tests available, with an emphasis on one’s individual laboratory practice setting.

Lastly, specific danger zones in terms of potential false positives, negatives and mimics are also discussed, along with clues and practical tips.


  1. 1.
    Nayak A, Sugrue C, Koenig S, Wasserman PG, Hoda S, Morgenstern NJ. Endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA): a proposal for on-site adequacy criteria. Diagn Cytopathol. 2012;40(2):128–37.PubMedCrossRefGoogle Scholar
  2. 2.
    Alsharif M, Andrade RS, Groth SS, Stelow EB, Pambuccian SE. Endobronchial ultrasound–guided transbronchial fine-needle aspiration: the University of Minnesota experience, with emphasis on usefulness, adequacy assessment, and diagnostic difficulties. Am J Clin Pathol. 2008;130(3):434–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds). WHO Classification of Tumours of Haematopoeitic and Lymphoid Tissues (Revised 4th edition). IARC: Lyon 2017.Google Scholar
  4. 4.
    Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. Am J Roentgenol. 2005;184(5):1691–9.CrossRefGoogle Scholar
  5. 5.
    Boringi M, Bontha SC, Kaur M, Shireen A. Branchial cleft cyst—a case report with review of literature. J Orofac Sci. 2014;6(2):125.CrossRefGoogle Scholar
  6. 6.
    Valentino M, Quiligotti C, Carone L. Branchial cleft cyst. J Ultrasound. 2013;16(1):17–20.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Goldenberg D, Sciubba J, Koch WM. Cystic metastasis from head and neck squamous cell cancer: a distinct disease variant? Head Neck. 2006;28(7):633–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Al-Hilli Z, Strajina V, McKenzie TJ, Thompson GB, Farley DR, Regina Castro M, et al. Thyroglobulin measurement in fine-needle aspiration improves the diagnosis of cervical lymph node metastases in papillary thyroid carcinoma. Ann Surg Oncol. 2017;24(3):739–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Maygarden SJ, Flanders EL. Mycobacteria can be seen as ‘negative images’ in cytology smears from patients with acquired immunodeficiency syndrome. Mod Pathol. 1989;2(3):239–43.PubMedGoogle Scholar
  10. 10.
    Ang GA, Janda WM, Novak RM, Gerardo L. Negative images of mycobacteria in aspiration biopsy smears from the lymph node of a patient with acquired immunodeficiency syndrome (AIDS): report of a case and a review of the literature. Diagn Cytopathol. 1993;9(3):325–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Mills SE, editor. Histology for pathologists: includes online access for fully searchable text and image bank. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2012. 1331 p.Google Scholar
  12. 12.
    Wong MP, Yuen ST, Collins RJ. Fine-needle aspiration biopsy of pilomatrixoma: still a diagnostic trap for the unwary. Diagn Cytopathol. 1994;10(4):365–9; discussion 369–370.PubMedCrossRefGoogle Scholar
  13. 13.
    Sharma D, Agarwal S, Jain LS, Kamal V. Pilomatrixoma masquerading as metastatic adenocarcinoma. A diagnostic pitfall on cytology. J Clin Diagn Res. 2014;8(10):FD13–4.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Sivakumar S. Pilomatrixoma as a diagnostic pitfall in fine needle aspiration cytology: a case report. Acta Cytol. 2007;51(4):583–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Tindle BH, Parker JW, Lukes RJ. ‘Reed-Sternberg cells’ in infectious mononucleosis? Am J Clin Pathol. 1972;58(6):607–17.PubMedCrossRefGoogle Scholar
  16. 16.
    Stanley MW, Steeper TA, Horwitz CA, Burton LG, Strickler JG, Borken S. Fine-needle aspiration of lymph nodes in patients with acute infectious mononucleosis. Diagn Cytopathol. 1990;6(5):323–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Pileri SA, Facchetti F, Ascani S, Sabattini E, Poggi S, Piccioli M, et al. Myeloperoxidase expression by Histiocytes in Kikuchi’s and Kikuchi-like lymphadenopathy. Am J Pathol. 2001;159(3):915–24.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Viguer JM, Jiménez-Heffernan JA, Pérez P, López-Ferrer P, Gónzalez-Peramato P, Vicandi B. Fine-needle aspiration cytology of Kikuchi’s lymphadenitis: a report of ten cases. Diagn Cytopathol. 2001;25(4):220–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Perry AM, Choi SM. Kikuchi-Fujimoto disease: a review. Arch Pathol Lab Med. 2018;142(11):1341–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Crapanzano JP, Lin O. Cytologic findings of marginal zone lymphoma. Cancer. 2003;99(5):301–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Matsushima AY, Hamele-Bena D, Osborne BM. Fine-needle aspiration biopsy findings in marginal zone B cell lymphoma. Diagn Cytopathol. 1999;20(4):190–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Kishimoto K, Kitamura T, Fujita K, Tate G, Mitsuya T. Cytologic differential diagnosis of follicular lymphoma grades 1 and 2 from reactive follicular hyperplasia: cytologic features of fine-needle aspiration smears with Pap stain and fluorescence in situ hybridization analysis to detect t(14;18)(q32;q21) chromosomal translocation. Diagn Cytopathol. 2006;34(1):11–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Chhieng DC, Cangiarella JF, Symmans WF, Cohen JM. Fine-needle aspiration cytology of Hodgkin disease: a study of 89 cases with emphasis on false-negative cases. Cancer. 2001;93(1):52–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Subhawong AP, Ali SZ, Tatsas AD. Nodular lymphocyte-predominant Hodgkin lymphoma: cytopathologic correlates on fine-needle aspiration. Cancer Cytopathol. 2012;120(4):254–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Burns BF, Colby TV, Dorfman RF. Differential diagnostic features of nodular L & H Hodgkin’s disease, including progressive transformation of germinal centers. Am J Surg Pathol. 1984;8(4):253–61.PubMedCrossRefGoogle Scholar
  26. 26.
    Murakami T, Kayano H, Itoh T, Shimizu Y, Ban S, Ogawa F, et al. Lymphoglandular bodies in malignant tumors: with special reference to histologic specimens. Ann Diagn Pathol. 2008;12(4):249–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Ng W-K, Ip P, Choy C, Collins RJ. Cytologic and immunocytochemical findings of anaplastic large cell lymphoma: analysis of ten fine-needle aspiration specimens over a 9-year period. Cancer. 2003;99(1):33–43.PubMedCrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2021

Authors and Affiliations

  1. 1.Department of PathologyNational University HospitalSingaporeSingapore

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