Nevus-cell aggregates in lymph nodes: Fine-needle aspiration cytologic findings and resulting diagnostic difficulties

Texas A&M University - Galveston, Galveston, Texas, United States
Diagnostic Cytopathology (Impact Factor: 1.12). 09/2004; 31(3):180-4. DOI: 10.1002/dc.20101
Source: PubMed


We report a case of nodal nevus present in enlarged lymph nodes with changes of dermatopathic lymphadenopathy sampled by fine-needle aspiration (FNA) cytology prior to clinical evaluation of the patient. This lymph node pathology was established later by lymph node excisional biopsy, by which along with a skin biopsy the dermatopathic lymphadenopathy was tentatively attributed to early mycosis fungoides. The FNA revealed fairly atypical melanotic tissue from the dermatopathic lymphadenopathy along with nodules of uniform melanocytic nevoid cells, the presence of which in combination with the dermatopathic atypical tissue provided a tentative diagnosis of metastatic melanoma of unknown primary, with the diagnosis of nodal nevus presented as a less likely possibility. This is to our knowledge the first cytologic report on FNA of nodal nevus, which besides presenting cytologic findings of this entity highlights some of the problems related to providing an accurate diagnosis, if this exceptionally unusual pathologic entity is encountered in lymph nodes sampled for enlargement from pathologies unrelated to this entity. The subject of nevus changes in lymph nodes is briefly discussed.

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    • "Furthermore, while SLNB is a useful tool for detecting nodal metastases, it does not always differentiate between malignant and benign lesions. Benign nevus-cell aggregates in lymph nodes are known to occur with benign primary lesions and in up to 22% of malignant melanomas [16, 17]. Any of these factors may have contributed to our patient's unnecessary surgical interventions. "
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    ABSTRACT: We report a case of capsular melanocytic nevus morphologically mimicking metastatic melanoma during intraoperative imprint cytology analysis of sentinel lymph nodes for metastatic melanoma. The benign nevus cells stained positively for S-100 protein like melanoma, but were negative for HMB-45, lacked cytologic atypia, and had a distinct intracapsular location, unlike melanoma. These features are useful in distinguishing capsular melanocytic nevi from metastatic melanoma. As a false-positive diagnosis intraoperatively may result in unnecessary lymphadenectomy, pathologists must be aware of capsular melanocytic nevi as potential false-positive interpretation.
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