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Subclassification of localized Leishmania lymphadenitis in fine needle aspiration smears
P V Kumar1, A Moosavi, M Karimi
1Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Iran.
Insights
Localized Leishmania lymphadenitis presents with specific cytologic findings in fine needle aspiration smears. Identifying Leishman-Donovan (LD) bodies is crucial for diagnosing this self-limited condition.
Area of Science:
- Cytopathology
- Infectious Diseases
- Immunology
Background:
- Leishmaniasis is a parasitic disease that can affect lymph nodes.
- Cervical lymphadenitis is a common condition with a broad differential diagnosis.
- Accurate cytologic diagnosis of lymphadenitis is essential for appropriate patient management.
Purpose of the Study:
- To characterize the cytologic features of localized Leishmania lymphadenitis.
- To aid in the differential diagnosis of lymphadenopathy.
- To highlight the diagnostic significance of Leishman-Donovan bodies.
Main Methods:
- Retrospective analysis of 133 fine needle aspiration (FNA) cases diagnosed with Leishmania lymphadenitis.
- Cytologic evaluation of FNA smears for cellular composition and presence of Leishman-Donovan (LD) bodies.
- Correlation of cytologic findings with clinical presentation and potential for granuloma formation.
Main Results:
- FNA smears showed a mixed inflammatory infiltrate including lymphocytes, histiocytes, giant cells, plasma cells, and tingible body macrophages.
- Leishman-Donovan (LD) bodies were consistently identified in all cases, though numbers varied.
- Characteristic cytologic patterns, including granulomas and specific cell types, were observed and categorized into five groups.
Conclusions:
- Leishmania lymphadenitis, while uncommon, should be considered in the differential diagnosis of unexplained cervical lymphadenopathy, especially in endemic regions.
- Definitive diagnosis relies on the cytomorphologic demonstration of LD bodies.
- This condition is self-limited and typically does not require specific treatment.
Objective:
To describe the cytologic findings of localized Leishmania lymphadenitis and discuss the differential diagnosis.
Study Design:
The study group consisted of 133 cases. All of them were diagnosed by fine needle aspiration (FNA) study. The ages ranged between 3 and 80 years, 102 were male and 31 female. Seventy lymph nodes were excised.
Results:
The FNA smears revealed a polymorphic population of cells composed of lymphocytes, histiocytes, giant cells, abnormal plasma cells and tingible body macrophages. Leishman-Donovan (LD) bodies were identified in all cases, but their number differed from case to case. Granulomas, dendritic cells, mast cells and lymphoglandular bodies were identified in a substantial number of cases. Depending upon the presence of characteristic cytologic findings, the cases were divided into five major groups: acute inflammation with giant cells, histiocytic granulomas, epithelioid cell granulomas, plasma cell type and mixed histioplasmacytic type.
Conclusion:
Leishmaniasis is an uncommon cause of cervical lymphadenitis but should be considered in the differential diagnosis of unexplained lymphadenopathy in endemic countries. Demonstration of LD bodies is necessary for the diagnosis of this self-limited condition, for which no treatment is required.