Primary mixed cellularity classical Hodgkin lymphoma of the lumbar spine - an unusual presentation

Primary spinal epidural lymphoma [PSEL] is a subset of lymphoma. For the diagnosis of PSEL there should be no other recognizable sites of lymphoma other than the spine at the time of diagnosis. The incidence of this subset of lymphomas is very low. Hodgkin lymphoma [HL] usually presents with painless enlargement of peripheral lymph nodes and only a small percentage arises from extra nodal regions.Very few patients with HL develops spinal cord compression due to an epidural tumor at some time during the course of their disease. But patients with HL presenting with isolated primary involvement of the epidural spinal region is very rare with very few reports available in the literature. A 19-year-old male presented to the local hospital with history of low back pain for almost one year. An initial biopsy was non-contributory and was reported as showing inflammatory change. The patient was empirically started on antituberculosis medication but his condition worsened and within weeks he developed paraplegia. MRI of the spine showed a large paraspinal mass with compression of L1 vertebral body. Urgent surgical decompression was done and final histopathology showed a mixed cellularity classical Hodgkin lymphoma [MCCHL]. Systemic work-up did not show evidence of nodal disease. Following surgery, he received chemotherapy. We report this case because of the unusual presentation of HL as a primary spinal mass. We would also like to highlight that apart from common causes, a differential diagnosis of HL should also be entertained while dealing with spinal masses. Otherwise diagnosis can be missed leading to delay in treatment and complications

Utility of fine needle aspiration cytology in evaluation of lymphadenopathy - an audit from a Cancer Centre in South India

Background: Cytological evaluation and diagnosis of lymphadenopathy plays an important role in distinction between reactive hyperplasia and malignancy. Being a tertiary cancer care centre, lymph node enlargement clinically suspected to be due to malignancy constitute the commonest indication for fine needle aspiration cytology [FNAC] at our centre. The aim of this study was to determine the utility of FNAC in evaluating enlarged lymph nodes and to categorizethe causes of lymphadenopathy diagnosed by FNAC at our centre

Material and Methods: Data was collected from the records of department of Pathology over a period of three months from January to March 2014. The data was analyzed and various parameters studied

Results: There were 2000 aspirates over a period of three months of which 270 [13.5%] were from lymph nodes. Of these, 130cases [48.2%] have metastatic deposits.We also came across 16 cases [5.9%] of lymphoma, 5 cases[1.9%] of granulomatous lymphadenitis, 2 cases[0.7%] of suppurative lesion and 99 cases [36.7%] of reactive hyperplasia during this period. In 3 cases [1.1%], the lesion turned out to be of salivary gland origin. Aspirates were suboptimal for diagnosis in 15 cases [5.5%]. Aspirates were more in males [181] as compared to females [89]. The most common site of aspiration was the cervical lymph node[64.5%],followed by supraclavicular=81[30%], inguinal=33[12.22%], axillary=19[7.04%] sub mental=1[0.37%] and others=7[2.59%]. Apart from metastatic carcinomas other metastatic malignancies we came across were malignant melanoma, neuroblastoma, germ cell tumor and synovial sarcoma

Conclusion: FNAC of lymph nodes helps in rapid diagnosis of lymphadenopathy. Categorizing the cause of lymph node enlargement as metastatic malignancy,lymphoma, reactive change, inflammatory cause,suppuration etc. can be done by FNAC.In patients with known histologically proven malignancy in whom a subsequent enlargement of lymph node occurs,a cytological diagnosis of metastasis helps in avoiding unwanted surgery for confirming metastasis.In patients without a previous diagnosis of malignancy, FNAC not only confirm metastatic deposit but in most conditions give a clue regarding site of primary. The use of immunocytochemistry and cell block preparations have increased the scope of FNAC