Lymph node infarction in classical Hodgkin's lymphoma

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.

Role of Immunohistochemistry in Acute Leukemias with Myelonecrosis

Myelonecrosisis a rare antemortem finding most commonly seen in haematopoeitic neoplasms, especially in acute leukemia. When myelonecrosis occurs at the time of presentation, it imposes certain diagnostic issues in sub categorization of leukemias which is necessary for therapeutic as well as prognostic purposes. Flow cytometry, though is a powerful modality, has its own limitations especially when the cells are not fresh and viable; and when the specimen is not of adequate cellularity which is usual in cases of myelonecrosis. In such situations, immunocytochemistry (ICC) or immunohistochemistry (IHC) may play a major role in lineage specification in leukemias as the necrosed marrow with the ghost cells can still retain the antigenicity for certain immunomarkers. Four such interesting cases of common B acute lymphoblastic leukemia (ALL) where IHC was used for diagnosis were included. ICC and IHC done on the necrosed marrow contributed to the diagnosis of ALL in all the four cases and contributed to subsequent management. ICC and IHC if contributory can play a major role in identifying the primary cause of myelonecrosis as the ghost cells can retain the antigenicity despite being morphologically non-viable.