Volume 20, Supplement 3, 2012
Review
Lymph node fine needle cytology in infectious diseases: a clinical perspective
Zeppa Pio,
Esposito Silvano
Not available
Lymph node and lymphoid organs fine needle aspiration cytology: historical background
Cozzolino Immacolata,
Vigliar Elena,
Vetrani Antonio,
Zeppa Pio
Lymph node has probably been the first target of Fine Needle Cytology (FNC) and among the latest to be accepted as an affordable diagnostic procedure. In 1912, dr. Hirschfeld performed FNC to diagnose cutaneous lymphomas and other tumours. Subsequently FNC was used to diagnose lymphoblastoma and splenic FNC to diagnose leishmaniasis on Romanowsky-stained smears. One of the first systematic study on lymph node FNC was then performed at John Hopkins Hospital, in Baltimore (USA) using FNC and Romanowsky stain on air-dried smears. In the twenties, two independent groups from Memorial Hospital (New York, USA), worked on FNC of a large scale of different human pathologies. One of this study reported 1,405 diagnoses of cancer and other diseases by means of FNC, mainly performed on lymph nodes (662 cases). In the sixties, at the Karolinska Hospital (Stockholm, Sweden) a group of cytopathologists started a Cytopathology Service available to the whole Institution, which exploited all fields of FNC. Since then, the procedure spread all over the word and nowadays it is routinely used for the diagnosis of different organs and pathologies including lymph node. Distinguished cytopathologists have worked on lymph nodal FNC producing significant advances and highlighting advantages and inevitable limitations of the technique. Despite some persistent criticism, FNC is a generally accepted procedure in the first diagnosis of lymph nodes enlargement. Moreover, numerous studies have demonstrated that vital cells obtained by FNC are excellent samples suitable for molecular evaluation, offering new challenging application to lymph node FNC.
Lymph nodes fine needle cytology in the diagnosis of infectious diseases: clinical settings
Natella Valentina,
Cozzolino Immacolata,
Sosa Fernandez Laura Virginia,
Vigliar Elena
Lymph node reactive hyperplasia, caused by specific infectious etiologic factors, represents the most frequent cause of enlarged peripheral lymph nodes. The main infectious agents are viruses, pyogenic bacteria, mycobacteria, fungi and protozoa that may determine unspecific or specific pathological entities, such as cat-scratch disease, toxoplasmosis or infectious mononucleosis. Lymph node fine needle cytology (FNC) is a safe, simple, cost-effective and efficient technique that quickly provides information about the cell population and the nature of the process. FNC can also provide suitable material for ancillary techniques, such as flow cytometry, immunocytochemistry, molecular biology and microbiological examinations. This study focuses on the cytological features of benign lymphadenopathy of infectious origin and their possible contribution to the clinical setting definition of corresponding patients.
Lymph nodes fine needle cytology in the diagnosis of infectious diseases: cytological and histological correlations
Cozzolino Immacolata,
Scognamiglio Giosuè,
Sosa Fernandez Laura Virginia,
Zeppa Pio
Fine Needle Cytology (FNC) is often used in the diagnosis of lymph node enlargement as first diagnostic procedure. In some cases different cytological features may occur, with different histological aspects. In other cases, FNC samples are neither representative nor sufficient to exclude a possible lymphoproliferative process or a metastasis. In these cases, specific ancillary techniques such as microbiological tests, immunocytochemistry, flow cytometry or molecular biology procedures may be used to assess the benign reactive nature of lymph node enlargement, allow clinical surveillance and avoid surgical biopsies. Cytology and ancillary techniques may also identify, in selected cases, possible aetiological agents. Notwithstanding these procedures, FNC unsolvable cases may occur; in these cases, indication for a direct histological examination should be promptly given in order to avoid any delay to further investigations and appropriate treatments. This study reports the most common cytological patterns occurring in reactive lymph nodes as well as ancillary techniques required in different conditions. Lymph nodal FNC should be performed by expert cytopathologists ensuring a safe and correct execution and a rapid evaluation of the smears for the assessment and the application of specific ancillary techniques.
Lymph node fine needle cytology in the diagnosis of infectious diseases and instrumental guides: ultrasound and computed tomography
Micol Pizzuti Laura,
Todaro Paolo,
Caleo Alessia,
Pace Leonado
Imaging techniques, such as ultrasound imaging (US), computed tomography (CT), positron emission tomography-CT (PET-CT) or PET-magnetic resonance imaging (MRI), are highly accurate procedure in the lymph node enlargement detection, but none of them has the same sensitivity in the biological definition and in the cause of enlargement identification. Therefore, a direct evaluation of corresponding lymph nodes is necessary in much of the cases and Fine Needle Cytology (FNC) is one of the most frequently used technique for this purpose. The same imaging procedures are often used to perform targeted biopsies including FNC. This study discusses procedures, indications, advantages and limitations of imaging techniques as a support to FNC
Lymph node fine needle cytology in the diagnosis of infectious diseases and reactive unspecific processes
Cipullo Ciro,
Amato Bruno,
Vigliar Elena,
Di Crescenzo Vincenzo
Infectious diseases are one of the main causes of lymph node enlargement both in children and adults and represent a benign and reversible process. Clinical evaluation, serological data, microbiological and molecular tests and imaging techniques are generally used in the diagnosis of reactive lymph nodes determined by infectious diseases but, in some cases, do not assess their origin and nature. Surgical excision and histological control represent the gold standard in the diagnosis of lymphadenopaties, but they might be unnecessary procedures just for diagnostic purposes in benign reactive lymph nodal enlargement. Fine Needle Cytology (FNC) has gained a definitive role in the diagnosis of lymphadenopaties being an accurate, rapid, minimal invasive and cost-effective procedure useful for the clinical management and therapeutic decisions. This study reports the use of FNC in the diagnosis of reactive lymph nodes in infectious diseases, exploring possibilities and limitations of the technique in this specific clinical setting.
Lymph node fine needle cytology, Epstein Barr virus infection and Hodgkin lymphoma
Varone Valeria,
Ciancia Giuseppe,
Caleo Alessia,
Puzziello Alessandro,
Giuffrè Giuseppe
Epstein-Barr virus (EBV) is a double-stranded DNA virus of the herpes family; it is one of the most common human viruses and it is associated with a wide spectrum of benign and malignant conditions. EBV is related to the development of several neoplasms, globally 1% of tumours, including lymphoproliferative, epithelial and mesenchymal neoplasm. Lymphoproliferative disorders include Hodgkin lymphoma (HL) and B and T cell non-Hodgkin lymphomas. HL is one of the most common lymphoma in the developed world, affecting both young people and adults. HL pathogenesis is complex and includes various and partially unknown mechanisms. EBV has been detected in some HL neoplastic cells and expresses genes with a potential oncogenic function, therefore many studies suggest that viral infections have a causative role in neoplastic transformation. Fine Needle Cytology (FNC) is extensively used in the first diagnosis of any lymph-nodal enlargement, including reactive lymphadenopathies and lymphoproliferative processes; therefore cytopathologists are likely to encounter EBV-associated malignancies in cytology samples, mainly HL, which is one of the most common lymphoma. This study focuses on the cytological features and ancillary studies required to diagnose EBV-related HL.
Fine needle cytology, infectious diseases and non-Hodgkin lymphoma
Vigliar Elena,
Cipullo Ciro,
Todaro Paolo,
Giuffrè Giuseppe,
Pepe Stefano
L’associazione tra agenti infettivi e l’insorgenza di linfomi non Hodgkin (NHL) è nota. Il primo virus identificato come responsabile di una malattia linfoproliferativa è stato il virus umano linfotropo per le cellule T (HTLV-1) associato alla leucemia/linfoma a cellule T dell’adulto. L’infezione da virus di Epstein-Barr è strettamente associata al linfoma di Burkitt, sia endemico che sporadico, ma anche al linfoma di Hodgkin, ai disordini linfoproliferativi post trapianto, al linfoma extranodale a cellule NK/T e ai NHL B cellulari che insorgono in pazienti affetti da HIV. Anche l’infezione dal virus dell’epatite C può causare linfomi di basso grado. Tra i batteri implicati nella linfomagenesi, l’Helicobacter pylori è coinvolto dello sviluppo di NHL del tessuto linfoide associato alle mucose (MALT) ed infezioni da Chlamydia psittaci sono spesso associate a linfomi degli annessi oculari. In queste patologie la valutazione istologica è la base diagnostica delle corrispondenti linfoadenopatie, tuttavia la citologia per ago sottile (FNC), associata a tecniche ancillari, può fornire una corretta diagnosi e classificazione pre-operatoria nella maggior parte dei NHL contribuendo potenzialmente anche alle strategie terapeutiche. L’FNC può svolgere inoltre un ruolo anche nella diagnosi differenziale tra recidiva di linfoma e linfadenopatie reattive in pazienti con storia di NHL. In questo studio sono descritti gli aspetti citologici osservabili in linfonodi affetti dai principali NHL associati ad agenti infettivi batterici e virali, valutando le possibilità e i limiti del FNC nella loro diagnosi e classificazione.
