两例颈部淋巴结病例讨论【中美加非妇科细胞学交流群病例6】

小王

荆欣
Hi everyone- would like to share two interesting cases from our case collection for your exercise. Both are FNA of "neck lymph node" .

荆欣
Case 1







Case 2





What is your differential dx? Any ancillary tests do you want to run?

流河
@荆欣@UMich-AA 谢谢分享！病例1穿刺细胞成分有限，可见少量粘液变的物质，图2中见少量拉丝样改变，图3像细胞切片，见有少量梭形善良细胞，从三张图上看，没看到与淋巴结相关联的细胞学表现，不知穿刺针感如何，患者有放射性麻木感吗？这个部位神经鞘瘤也要考虑下？

杨旭
@荆欣@UMich-AA 荆医生好！第一例除了多核细胞和坏死组织外，没看具体病变。会做GMS和AFB染色。第二例应该是看出小东东了。

童国遐
Pink acellular material, amyloid?

杨旭
@童国遐 good thought

党鸿蔚
Case 1 考虑间叶组织的良性病变，Case 2还是考虑淋巴结病变，视野不全，良恶待定

李建民
例2，弥漫的淋巴细胞，裸核状，核仁明显，图2示上皮样细胞。考虑：lennert淋巴瘤。建议切除淋巴结明确诊断。@荆欣@UMich-AA 

流河
例2中凋亡与吞噬是否有意义?@李建民 山东临清市医院

荆欣



@童国遐 @杨旭 Good point! Amyloid deposition

杨旭







三图放在一起可以看出pattern上的区别。

荆欣
The added pix for case 1 Apple-green birefringence of Congo Red staining.Case 2- The referring pathologist wanted to call it Lymphoma. Our dx - C/W Rossi-Dorfman Disease (RDD). The two pictures here show characteristic emperipolesis, meaning phagocytosis of lymphocytes, neutrophils or plasma cells by histiocytes. Further Immunoprofile ( positive for S100 and CD68, negative for CD1 ) supports the dx of RDD.

赵澄泉



RDD, 组织细胞吃淋巴细胞。excellent, I never see RDD in cytology。thank for sharing. @荆欣@UMich-AA 

徐海苗
中文：噬淋巴细胞现象

童国遐
@荆欣@UMich-AA Case1 有没有进一步work-up? 病人有没有全身(systemic) amyloidosis或只是局部? 这个amyloid的成分是什么?头颈部含amyloid的肿块是否要排除甲状腺medullary ca转移?

荆欣
@童国遐 It was a case signed out by one of my colleagues. When she showed me the conventional smears, I got a gut feeling that the material is most likely amyloid interspersed with fibroblasts. The patient has no relevant hx, i. e. systemic amyloidosis, medullary thyroid ca). I did not track the type of the amyloid.

童国遐
请问大家amyloid和amyloidosis的中文翻驿是什么?

赵澄泉
后者淀粉样变性（病），Amyloid 淀粉样变的