Lymph node infarction: role of underlying malignancy, tumour proliferation fraction and vascular compromise - a study of 35 cases and a comprehensive review of the literature

Necrosis in lymph nodes and their differential diagnoses: application of reticulin staining

This study aimed to enhance the histopathological diagnosis of necrotic lymph node specimens. A chart review was conducted, revealing that the most common causes of lymph node necrosis were Kikuchi disease (33%), granulomatous inflammation (25%), metastasis (17%), and lymphomas (12%). Histological analysis of necrotic tissue in 333 specimens demonstrated significant differences between the four diseases. The necrotic tissue of Kikuchi disease was amorphous, and hypercellular, and exhibited karyorrhexis and congestion. Granulomatous inflammation presented amorphous necrotic tissue with a nodular-like pattern. Metastasis exhibited heterogeneous morphology that varied between cancer types. Lymphomas displayed extensive necrosis with ghost cells, congestion, and bubbles. Reticulin staining patterns also differed between diseases. Kikuchi disease and lymphomas exhibited preserved reticular fiber networks in the necrotic tissue, resembling the viable tissue. Granulomatous inflammation and metastasis showed disrupted reticular fiber networks in the necrotic tissue. Based on these findings, histological features and reticulin staining patterns can aid in diagnosing Kikuchi disease, granulomatous inflammation, metastasis, and lymphomas in necrotic lymph node specimens.

Diagnostic Difficulties in Evaluation of Neck Masses - Idiopathic Lymph Node Infarction

Palpable neck masses are often the only signs of patients visiting their ENT specialists. Lymphadenopathy may be a primary or secondary manifestation of numerous benign and malignant disorders. The medical history, physical examination, imaging and pathological examination may help to set the appropriate diagnosis. Lymph node infarction is a very rare entity among the various pathologies involving the lymph nodes. We hereby present three cases, in which infarction was the only symptom, no associated condition occurred.

A Case of Classical Hodgkin Lymphoma with Total Lymph Node Infarction

Lymph node infarction is very rare, and is frequently associated with neoplasms, such as malignant lymphoma and non-neoplastic disease, or interventions such as fine-needle aspiration (FNA). A 76-year-old-man presented with cervical lymph node swelling. Although FNA was performed, the findings were insufficient for a definitive diagnosis. Consequently, surgical biopsy of the cervical lymph node was performed, which revealed total infarction; a diagnosis of classical Hodgkin lymphoma was made later. Both lymphoma itself and FNA may cause total lymph node infarction, which makes diagnosis confusing. Therefore, it is important to repeat the biopsy rather than repeat FNA to correctly diagnose malignant lymphoma, including Hodgkin lymphoma.

Imaging of head and neck lymph nodes

The cervical lymph nodes can be affected by a variety of infectious, inflammatory, benign, and malignant pathologic conditions. Clinical history and physical examination with the complementary use of imaging is essential to accurately make a diagnosis or appropriate differential. Knowledge of cervical lymph node anatomy, drainage pathways, morphologic variations, and common nodal pathology is key to correct interpretation of cervical lymph nodes on imaging. Computed tomography (CT), MR, ultrasound, and PET/CT are complementary imaging modalities that can be used in the evaluation of cervical lymph node pathology.