Baldi Carlo, Ieni Antonio, Cozzolino Immacolata, Cerbone Vincenzo, Memoli Domenico, Zeppa Pio
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Acta Cytol. 2014;58(3):303-8. doi: 10.1159/000363122. Epub 2014 Jun 7.
A primary lymph node leiomyoma diagnosed by fine needle aspiration cytology (FNAC) is reported.
A 22-year-old male complained of right groin swelling; ultrasound examination (US) showed a lymph node containing a 20-mm hypoechoic nodule. The residual lymph node was oval, with a well-characterized cortex and hilum. US-FNAC of the nodule showed oval spindle cells embedded in fibrillar matrix. Nuclei were naked and oval with dispersed chromatin but without nucleoli. Immunocytochemistry showed positivity for vimentin and actin, and negativity for cytokeratin, S100, CD23 and CD31. A smear of the residual lymph node showed a reactive lymphoid cell population. FNAC diagnosis was mesenchymal cell proliferation with smooth muscle phenotype; a lymph node is part of the lesion. A CT scan did not detect any inguinal or abdominal mass. The surgical sample was a lymph node containing a spindle cell tumor, which was actin and desmin positive, and S100, CD21, HMB45, CD23 and CD31 negative; MIB1 was positive in <5% of the cells. The residual lymph node was normal.
The final diagnosis was primary benign leiomyoma in a lymph node. US-FNAC may frame complex lymph node lesions and provide treatment options.
报告一例经细针穿刺细胞学检查（FNAC）诊断的原发性淋巴结平滑肌瘤。
一名22岁男性主诉右腹股沟肿胀；超声检查（US）显示一个淋巴结内有一个20毫米的低回声结节。残余淋巴结呈椭圆形，皮质和髓质特征明显。对该结节进行的超声引导下细针穿刺细胞学检查显示椭圆形梭形细胞嵌入纤维状基质中。细胞核裸露，呈椭圆形，染色质分散，但无核仁。免疫细胞化学显示波形蛋白和肌动蛋白呈阳性，细胞角蛋白、S100、CD23和CD31呈阴性。残余淋巴结涂片显示为反应性淋巴细胞群。FNAC诊断为具有平滑肌表型的间充质细胞增殖；淋巴结是病变的一部分。CT扫描未发现任何腹股沟或腹部肿块。手术标本为一个含有梭形细胞瘤的淋巴结，该肿瘤肌动蛋白和结蛋白呈阳性，S100、CD21、HMB45、CD23和CD31呈阴性；MIB1在<5%的细胞中呈阳性。残余淋巴结正常。
最终诊断为淋巴结原发性良性平滑肌瘤。超声引导下细针穿刺细胞学检查可明确复杂的淋巴结病变并提供治疗方案。
