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Langerhans cell histiocytosis in lymph nodes. Cytomorphologic diagnosis and pitfalls
1Cytopathology Laboratory, Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Fine needle aspiration can identify Langerhans cell histiocytosis (LCH) in lymph nodes in 85% of cases. The characteristic LCH cell is crucial for diagnosis, distinguishing it from other conditions.
Area of Science:
- Histopathology
- Cytopathology
- Oncology
Background:
- Langerhans cell histiocytosis (LCH) is a rare disorder.
- Lymph node involvement is common in LCH.
- Accurate cytologic diagnosis is essential for patient management.
Purpose of the Study:
- To define the cytomorphologic features of Langerhans cell histiocytosis (LCH) in lymph node aspirates.
- To evaluate the diagnostic accuracy of fine needle aspiration (FNA) for LCH in lymph nodes.
Main Methods:
- Retrospective review of 14 cases with confirmed or suspected lymph node LCH.
- Analysis of Papanicolaou- and May-Grünwald-Geimsa-stained smears.
- S-100 protein staining performed in a subset of cases.
Main Results:
- The pathognomic "LCH cell" was identified in 12 of 14 cases.
- Associated findings included eosinophils, polymorphs, and lymphocytes.
- Giant cells were present in six cases; plasma cells were rare.
- Initial cytologic diagnosis was accurate in six cases, suspected in four, and missed in four.
Conclusions:
- Fine needle aspiration can diagnose lymph node LCH in 85% of cases.
- Identification of the LCH cell is critical for diagnosis.
- Differential diagnoses include dermatopathic lymphadenitis, sinus histiocytosis, Hodgkin's lymphoma, and malignant histiocytosis.
Objective:
To delineate the cytomorphology of Langerhans cell histiocytosis (LCH) in lymph nodes.
Study Design:
Nine histologically documented LCH cases with a prior lymph node aspirate and five more cases in which a cytologic diagnosis of LCH was rendered in a background of corroborative clinical and radiologic findings were included in a retrospective study over a 12-year period (January 1988-January 2000). Papanicolaou- and May-Grünwald-Geimsa-stained smears were reviewed by two independent observers. Staining for S-100 protein was available in four cases.
Results:
Nine cases had multisystem involvement, while in five cases only lymph nodes were involved. The ages ranged from 5 months to 27 years, with 11 males and 3 females. An initial cytologic diagnosis of LCH had been rendered in six, suspected in four and missed in four. On review, all were reclassified as LCH except two cases, which were still thought to be reactive and necrotizing lymphadenitis. The pathognomic feature of LCH, the "LCH cell," was identified in 12 of 14 cases along with varying numbers of eosinophils, polymorphs and lymphocytes. Giant cells were seen in six cases, and plasma cells were rarely seen.
Conclusion:
Lymph node involvement by LCH can be identified by fine needle aspiration in 85% of cases. The presence of the LCH cell is a must. The differentials to be considered are dermatopathic lymphadenitis, sinus histiocytosis with massive lymph-adenopathy, Hodgkin's lymphoma and malignant histiocytosis.
