Abstract
Background: Fine-needle aspiration (FNA) coupled with flow cytometry (FC) can be helpful in suspicious pediatric lymph nodes or masses to exclude a lymphoproliferative disorder. The aim of this study was to analyze FC findings in a series of pediatric FNAs and to correlate abnormal findings with follow-up information. Materials and Methods: All pediatric FNAs performed at a tertiary-care children's hospital over a 46-month period that had FC performed were retrospectively analyzed and correlated with follow-up. Results: A total of 163 FNA procedures were performed in children (age ≤21 years), and 47 (28.8%) of these cases had FC performed. Specimens were mostly obtained from the head and neck (72.3% of cases). Nine cases (19.1%) had abnormal FC findings, including double-negative T cells (n = 3; 33.3%), double-positive T cells (n = 3; 33.3%), excess λ light chains (n = 1; 11.1%), weak CD34 positivity (n = 1; 11.1%), and T-lymphoblastic lymphoma (n = 1; 11.1%). Conclusion: Unusual FC results that are not diagnostic of malignancy can be seen in lymph node FNA in a minority of young patients. In our series, these findings were seen mainly in small populations of T cells and occurred primarily in the setting of reactive lymphoid hyperplasia or ectopic thymic tissue. Cytopathologists performing FNA on children should be aware of these abnormalities and, although they may warrant further investigation and follow-up, they are unlikely to be associated with malignancy.
References
1.
Friedmann AM: Evaluation and management of lymphadenopathy in children. Pediatr Rev 2008;29:53-60.
2.
Herzog LW: Prevalence of lymphadenopathy of the head and neck in infants and children. Clin Pediatr (Phila) 1983;22:485-487.
3.
Monaco SE, Khalbuss WE, Pantanowitz L: Benign non-infectious causes of lymphadenopathy: a review of cytomorphology and differential diagnosis. Diagn Cytopathol 2012;40:925-938.
4.
Hambleton LSJ, Hewitt M: Lymphadenopathy in children and young people. Paediatr Child Health 2015, DOI: .
5.
Soldes OS, Younger JG, Hirschl RB: Predictors of malignancy in childhood peripheral lymphadenopathy. J Pediatr Surg 1999;34:1447-1452.
6.
Celenk F, et al: Incidence and predictors of malignancy in children with persistent cervical lymphadenopathy. Int J Pediatr Otorhinolaryngol 2013;77:2004-2007.
7.
van de Schoot L, Aronson DC, Behrendt H, Bras J: The role of fine-needle aspiration cytology in children with persistent or suspicious lymphadenopathy. J Pediatr Surg 2001;36:7-11.
8.
Liu K, Stern RC, Rogers RT, Dodd LG, Mann KP: Diagnosis of hematopoietic processes by fine-needle aspiration in conjunction with flow cytometry: a review of 127 cases. Diagn Cytopathol 2001;24:1-10.
9.
Steliarova-Foucher E, Stiller C, Kaatsch P, et al: Geographical patterns and time trends of cancer incidence and survival among children and adolescents in Europe since the 1970s (the ACCIS project): an epidemiological study. Lancet 2004;364:2097-2105.
10.
Pritchard-Jones K, Kaatsch P, Steliarova-Foucher E, Stiller CA, Coebergh JW: Cancer in children and adolescents in Europe: developments over 20 years and future challenges. Eur J Cancer 2006;42:2183-2190.
11.
Monaco SE, Teot LA: Cytopathology of pediatric malignancies: where are we today with fine-needle aspiration biopsies in pediatric oncology? Cancer Cytopathol 2014;122:322-336.
12.
Lee DH, et al: Clinical value of fine needle aspiration cytology in pediatric cervical lymphadenopathy patients under 12-years-of-age. Int J Pediatr Otorhinolaryngol 2014;78:79-81.
13.
Anne S, Teot LA, Mandell DL: Fine needle aspiration biopsy: role in diagnosis of pediatric head and neck masses. Int J Pediatr Otorhinolaryngol 2008;72:1547-1553.
14.
Niedzielska G, Kotowski M, Niedzielski A, Dybiec E, Wieczorek P: Cervical lymphadenopathy in children - incidence and diagnostic management. Int J Pediatr Otorhinolaryngol 2007;71:51-56.
15.
Pambuccian SE, Bardales RH: Lymph Node Cytopathology, ed 1. New York, Springer, 2011, pp 95-113.
16.
Ward E, DeSantis C, Robbins A, Kohler B, Jemal A: Childhood and adolescent cancer statistics 2014. CA Cancer J Clin 2014;64:83-103.
17.
Zardawi IM, Jain S, Bennett G: Flow-cytometric algorithm on fine-needle aspirates for the clinical workup of patients with lymphadenopathy. Diagn Cytopathol 1998;19:274-278.
18.
D'Acquisto F, Crompton T: CD3+CD4-CD8- (double negative) T cells: saviours or villains of the immune response? Biochem Pharmacol 2011;82:333-340.
19.
Crispin JC, et al: Expanded double negative T cells in patients with systemic lupus erythematosus produce IL-17 and infiltrate the kidneys. J Immunol 2008;181:8761-8766.
20.
Voelkl S, Gary R, Mackensen A: Characterization of the immunoregulatory function of human TCR-alphabeta+ CD4- CD8- double-negative T cells. Eur J Immunol 2011;41:739-748.
21.
Teachey DT, Seif AE, Grupp SA: Advances in the management and understanding of autoimmune lymphoproliferative syndrome (ALPS). Br J Haematol 2010;148:205-216.
22.
Lim MS, et al: Pathological findings in human autoimmune lymphoproliferative syndrome. Am J Pathol 1998;153:1541-1550.
23.
Autoimmune lymphoproliferative profile. 2016. ltd.aruplab.com/Tests/Pub/0095505.
24.
Dervovic D, Zuniga-Pflucker JC: Positive selection of T cells, an in vitro view. Semin Immunol 2010;22:276-286.
25.
Rahemtullah A, Reichard KK, Preffer FI, Harris NL, Hasserjian RP: A double-positive CD4+CD8+ T-cell population is commonly found in nodular lymphocyte predominant Hodgkin lymphoma. Am J Clin Pathol 2006;126:805-814.
26.
Parel Y, Chizzolini C: CD4+ CD8+ double positive (DP) T cells in health and disease. Autoimmun Rev 2004;3:215-220.
27.
Ortolani C, Forti E, Radin E, Cibin R, Cossarizza A: Cytofluorimetric identification of two populations of double positive (CD4+, CD8+) T lymphocytes in human peripheral blood. Biochemical Biophys Res Commun 1993;191:601-609.
28.
Nascimbeni M, Shin EC, Chiriboga L, Kleiner DE, Rehermann B: Peripheral CD4(+)CD8(+) T cells are differentiated effector memory cells with antiviral functions. Blood 2004;104:478-486.
29.
Lee YY, Wang WC, Li CF: Aspiration cytology of an ectopic cervical thymoma misinterpreted as a lymphoproliferative lesion of the thyroid: a case report. Oncol Lett 2015;10:1255-1258.
30.
Zeppa P, Varone V, Cozzolino I, Salvatore D, Vetrani A, Palombini L: Fine needle cytology and flow cytometry of ectopic cervical thymoma: a case report. Acta Cytol 2010;54(suppl 5):998-1002.
31.
Ponder TB, Collins BT, Bee CS, Silverberg AB, Grosso LE, Dunphy CH: Diagnosis of cervical thymoma by fine needle aspiration biopsy with flow cytometry: a case report. Acta Cytol 2002;46:1129-1132.
32.
Kussick SJ, Kalnoski M, Braziel RM, Wood BL: Prominent clonal B-cell populations identified by flow cytometry in histologically reactive lymphoid proliferations. Am J Clin Pathol 2004;121:464-472.
33.
Bhargava P, Parker JA, Dezube BJ: Pitfalls of diagnosis based on abnormal flow cytometry and [(18)F]fluorodeoxyglucose positron emission tomography. Clin Lymphoma Myeloma 2008;8:117-120.
34.
Cozzolino I, Nappa S, Picardi M, DeRenzo A, Troncone G, Palombini L, Zeppa P: Clonal B-cell population in a reactive lymph node in acquired immunodeficiency syndrome. Diagn Cytopathol 2009;37:910-914.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
