Causes of necrotic features in fine-needle aspirates from cervical lymph nodes

Abstract

Fine-needle aspiration (FNA) is an excellent, minimally invasive diagnostic technique for evaluating a mass or lesion. In particular, FNA is commonly used for evaluating enlarged lymph nodes (LNs). In many cases, the aspirate can provide conclusive evidence for a diagnosis; sometimes, the cytology reveals only necrosis. Necrosis of LNs is found in various diseases. Malignant neoplasms (including lymphomas and metastatic carcinomas) must first be excluded. In addition, numerous benign conditions, such as tuberculosis (TB) and Kikuchi disease, also cause LN necrosis. When necrosis is identified in an LN FNA cytology sample, pathologists should consider various entities and attempt to find clues that lead to a final diagnosis. However, LN FNA cytology sometimes reveals necrosis alone, and few studies have investigated this situation. The aim of this study was to evaluate the causes of necrosis in FNA of enlarged LNs. MATERIALS AND METHODS We searched the electronic medical record system of the Keimyung University Dongsan Hospital from 2003-2017 to find patients who underwent FNA on cervical LNs. We selected cases with a description of necrotic features on the pathology report. In addition, we also collected the clinical parameters of these cases, including patient age, sex, biopsy findings, other ancillary tests for Mycobacterium tuberculosis (MTB; including acid-fast bacilli staining), and molecular studies carried out using conventional polymerase chain reaction (PCR) or real-time PCR. We classified these cases into five categories: granulomatous inflammation, Kikuchi disease, suppurative inflammation, malignant neoplasm, and necrosis only. When granuloma was included in the microscopic description (e.g., granulomatous inflammation with caseous necrosis, granulomatous inflammation with a necrotic background, or necrosis with a vague granuloma), it was classi

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