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I think it would help greatly to have some low-power views of this lymph
 
node, to assess nodal architecture. Can these be provided?
 

Dr. Farhi ; thank u for your care; but these images are fine needle aspiration biopsy  

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Thanks. I thought it looked like a cytology specimen instead of a
 
tissue...I wouldn't be able to make any diagnosis on this material. I
 
see a mix of small and large lymphocytes, which is consistent with a
 
reactive process, but if there is a clinical suspicion of malignancy,
 
the node should be biopsied.
 

 

I as well would favour a reactive process.On images 5 and 6 cells with elongated nuclei and ample cytoplasm are seen, consistent with epitheloid cells. On image 6 I got the impression of a small cluster of epitheloid cells, consisitent with a granuloma.  
If there is serious clinical suspicion of malignancy a biopsy is indicated, if not a wait and see approach could be discussed, depending on the clinical situation.

We at the University of Chicago (Dr. J.W Vardiman, Dr. J Anastasi and me), are thinking that the FNA material is insufficient to make diagnosis and we would recommend biopsy.

The cytology of this FNAB is consistent with a reactive process: small and large lymphocytes and centroblasts with normal morphological appearances, plus macrophages. There is no cytological evidence of neoplasia on the images provided. I recommend "watch and wait" if asymptomatic. If "B" symptoms, or nodes enlarge, biopsy may be indicated.

I think tat in a 9-year old child is is almost surely reactive. But the key word is "almost": if there is a clinical doubt, biopsy should be performed.

Within this material there is no indication of malignancy, why not wait and see ?

Cellular heterogeneity is in favour of reactive lympho node. Presence of histiocytes is compatible with a toxoplasmosis. Serology must be done for an eventual antibiotherapy.  
 

This case was found to have a previous history of treatment at chest hospital for TB and this history makes the diagnosis consistent with reactive lymphadinitis. Thanks for comments  

Cytology is very good for screening, especially in children if corroborated by immunological methods (see attached recent publication from our department). By morphology alone one can miss a pathological population.