Cytologie ganglions lymphatiques

Question 1

FNA ganglionnaire

Answer 1

Hyperplasie lymphoïde réactionnelle

Immunoblasts and plasmacytoid lymphocytes are interspersed throughout a smear dominated by small round lymphocytes, creating a polymorphous cell picture. Lymphoglandular bodies are sprinkled between the cells (Romanowsky stain).

Question 2

FNA ganglionnaire

Answer 2

Hyperplasie lymphoïde réactionnelle

A capillary emanates diagonally from this follicular center fragment (dendritic-­lymphocytic aggregate), which contains a mixture of dendritic cells and a heterogeneous lymphocyte population. Note the dispersed lymphoglandular bodies (Romanowsky stain).

Question 3

FNA ganglionnaire

Answer 3

Hyperplasie lymphoïde réactionnelle

This dendritic-lymphocytic aggregate is a loose collection of small round lymphocytes and dendritic cells. The latter have pale nuclei with delicate cytoplasmic extensions (Papanicolaou stain).

Question 4

FNA ganglionnaire

Answer 4

Hyperplasie lymphoïde réactionnelle

This dendritic-lymphocytic aggregate is a loose collection of small round lymphocytes and dendritic cells. The latter have pale nuclei with delicate cytoplasmic extensions (Papanicolaou stain).

Question 5

FNA ganglionnaire

Answer 5

Sarcoïdose (granulome)

In sarcoidosis, the granulomas are tight aggregates of epithelioid histiocytes. The cells have oval or curved nuclei and abundant cytoplasm with indistinct borders (Romanowsky stain).

Question 6

FNA ganglionnaire

Answer 6

Lymphadénite aiguë

Neutrophils are mixed with small round lymphocytes. Note the chains of bacterial cocci (arrows) (Romanowsky stain).

Question 7

FNA ganglionnaire

Answer 7

Maladie de la griffe de chat

Cat Scratch Disease. A discrete aggregate of epithelioid histiocytes is surrounded by large numbers of neutrophils (Romanowsky stain).

Question 8

FNA ganglionnaire

Answer 8

Maladie de la griffe de chat

Cat Scratch Disease. A discrete aggregate of epithelioid histiocytes is surrounded by large numbers of neutrophils (Romanowsky stain).

Question 9

FNA ganglionnaire

Answer 9

Lymphadénite mycobactérienne

Mycobacterial Lymphadenitis. (A) There is necrotic material and degenerating nuclei (Romanowsky stain). (B) A stain for acid-fast bacilli shows many extracellular bacilli and a macrophage filled with organisms (Ziehl–Neelsen stain).

Question 10

FNA ganglionnaire

Answer 10

Mycobacterial Lymphadenitis. (A) There is necrotic material and degenerating nuclei (Romanowsky stain). (B) A stain for acid-fast bacilli shows many extracellular bacilli and a macrophage filled with organisms (Ziehl–Neelsen stain).

Question 11

FNA ganglionnaire

Answer 11

Maladie de Rosai-Dorfman

An enormous histiocyte has engulfed many small lymphocytes (Romanowsky stain).

Question 12

FNA ganglionnaire

Jeune femme, lymphadénopathie cervicale

Answer 12

Lymphadénite de Kikuchi

Histiocytes with contorted nuclei, including one with a c shape, contain ingested debris. These cells are significantly smaller than tingible-body macrophages (Romanowsky stain).

Question 13

FNA ganglionnaire

Answer 13

Lymphadénite réactionnelle (mononucléose infectieuse)

Many immunoblasts are mixed with small round lymphocytes and plasmacytoid lymphocytes (Romanowsky stain).

Question 14

FNA ganglionnaire

Answer 14

Lymphadénite à VIH

The FNA features are not specific, but hiv lymphadenitis can be suspected when (a) “giant” intact lymphoid follicles are seen (liquid-based preparation, Papanicolaou stain), and (b) numerous plasma cells and large lymphocytes are present (Romanowsky stain) in the appropriate clinical setting.

Question 15

FNA ganglionnaire

Answer 15

Lymphadénite dermatopathique

(A) Several macrophages contain coarse granular pigment in this aspirate from an enlarged inguinal node adjacent to a large tattoo. A heterogeneous population of lymphocytes is also present (Romanowsky stain). (B) Macrophages containing melanin pigment are characteristic of dermatopathic lymphadenitis associated with primary inflammatory dermatoses. Nonpigmented histiocytes or dendritic cells and small lymphocytes are also seen (hematoxylin and eosin stain).

Question 16

FNA ganglionnaire axillaire

Answer 16

Lymphadénite à silicone

This cluster of macrophages contains cells with multiple cytoplasmic vacuoles of varying size (liquid-based preparation, Papanicolaou stain).

Question 17

FNA ganglionnaire

Answer 17

Lymphome de Hodgkin classique

(A) A classic binucleated Reed–Sternberg (rs) cell is present (Romanowsky stain).

Question 18

FNA ganglionnaire

Answer 18

(B) Two conspicuous mononuclear RS cells are surrounded by lymphocytes. The RS nucleus at the right is lobulated, whereas the one to the left has only slight bosselation. Both have macronucleoli (Papanicolaou stain).

Question 19

FNA ganglionnaire

Answer 19

Lymphome de Hodgkin nodulaire à prédominance lymphocytaire

The characteristic cell is the LP or “popcorn” cell, which has a large, highly convoluted nucleus. Although there are two nice examples here, they are often difficult to find: one must hunt for them because they are vastly outnumbered by small lymphocytes and other nonneoplastic lymphoid cells (Romanowsky stain).

Question 20

FNA ganglionnaire

Answer 20

Lymphome de Hodgkin nodulaire à prédominance lymphocytaire

The characteristic cell is the LP or “popcorn” cell, which has a large, highly convoluted nucleus. Although there are two nice examples here, they are often difficult to find: one must hunt for them because they are vastly outnumbered by small lymphocytes and other nonneoplastic lymphoid cells (Romanowsky stain).

Question 21

FNA ganglionnaire

Answer 21

Lymphome folliculaire

(A) Note the nuclear irregularities and occasional clefted nucleus. Lymphoglandular bodies are numerous (Romanowsky stain).

Question 22

FNA ganglionnaire

Answer 22

Lymphome folliculaire

(A) Note the nuclear irregularities and occasional clefted nucleus. Lymphoglandular bodies are numerous (Romanowsky stain).

Question 23

FNA ganglionnaire

Answer 23

Lymphome à petits lymphocytes

(A) The monomorphous neoplastic small lymphocytes have scant cytoplasm; some bare nuclei are present. The mostly round nuclei have very dense (“clotted”) chromatin. Lymphoglandular bodies are present in the background (Romanowsky stain).

Question 24

FNA ganglionnaire

Answer 24

Lymphome à petits lymphocytes

Question 25

FNA ganglionnaire

Answer 25

Lymphome (ici manteau)

Question 26

FNA ganglionnaire

Answer 26

Lymphome (ici manteau)

Question 27

FNA ganglionnaire

Answer 27

DLBCL

Question 28

FNA ganglionnaire

Answer 28

DLBCL

Question 29

FNA ganglionnaire

Answer 29

DLBCL (B) By definition, the nucleus of dlbcl cells (black arrow) is at least the size of a histiocyte nucleus (black arrowhead on foam-cell nucleus); the background t-cell nuclei (red arrow) are much smaller (Romanowsky stain).

Question 30

FNA ganglionnaire

Answer 30

Lymphome B de haut-grade A monomorphous population of intermediate-sized cells closely mimics Burkitt lymphoma; note the tingible-body macrophage at upper right. Fish evaluation showed both myc and BCL2 translocations (not pictured) (Romanowsky stain).

Question 31

FNA ganglionnaire

Answer 31

Lymphome de Burkitt (A) The intermediate-sized neoplastic lymphocytes have round nuclei, multiple indistinct nucleoli, blue cytoplasm, and small cytoplasmic vacuoles. Apoptotic bodies (arrows) are present (Romanowsky stain).

Question 32

FNA ganglionnaire

Answer 32

Lymphome plasmablastique Plasmablastic Lymphoma. Large malignant cells are dispersed in a noncohesive pattern. The eccentric position of the nucleus is the only “plasmacytic” feature. Because this image is virtually impossible to distinguish from a plasmablastic myeloma or melanoma, correlation with clinical history and ancillary testing are necessary for definitive diagnosis (Romanowsky stain).

Question 33

FNA ganglionnaire

Answer 33

Lymphome T anaplasique à grandes cellules Very large cells with marked variation in nuclear shape, including “donut” forms, are seen (Romanowsky stain).

Question 34

Sang périphérique

Answer 34

Lymphome/Leucémie à cellules T de l'adulte (A) The most distinctive cell is the floret cell, a large lymphocyte with multiple radiating nuclear lobes (Romanowsky stain)

Question 35

FNA ganglionnaire

Answer 35

Lymphome lymphoblastique A pure population of blasts is present with finely dispersed chromatin and nuclear molding. A mitotic figure is seen. Compare the size of the blasts with the neutrophil at the lower right (Romanowsky stain).

Question 36

FNA ganglionnaire

Answer 36

Sarcome myéloïde (A) at low and medium magnification, blasts mimic lymphoma cells. Recognition of these cells as myeloid is often precluded when a tumor lacks cytoplasmic granules (Romanowsky stain). (B) Myeloid blasts are also difficult to identify as such with the pap stain, even if they show characteristic (but nonspecific) folded nuclear membranes and dispersed chromatin (liquid-based preparation, Papanicolaou stain). (C) Blasts are more easily recognized with romanowsky stains if the characteristic chromatin pattern, nucleoli, cytoplasmic granules (upper left), and accompanying granulocytic/eosinophilic forms are all present (Romanowsky stain).

Question 37

FNA ganglionnaire

Answer 37

Carcinome épidermoïde HPV-induit (B) Nuclei are round to oval, and cytoplasm is scant. Cell borders are indistinct and intercellular bridges are not apparent (Papanicolaou stain).

Question 38

FNA ganglionnaire

Answer 38

Mélanome métastatique Large nonpigmented cells are distributed in a noncohesive pattern. Tiny cytoplasmic bubbles (best seen with Romanowsky stains) and binucleated cells with wide spacing between the mirror-image nuclei are clues to the diagnosis (Romanowsky stain).

Question 38

FNA ganglionnaire

Answer 38

Mélanome métastatique Large nonpigmented cells are distributed in a noncohesive pattern. Tiny cytoplasmic bubbles (best seen with Romanowsky stains) and binucleated cells with wide spacing between the mirror-image nuclei are clues to the diagnosis (Romanowsky stain).

Question 39

FNA ganglionnaire

Answer 39

Séminome Partially vacuolated detached strips of cytoplasm create a striking “tigroid” background. Large germ cells are mixed with small lymphocytes (Romanowsky stain).