Lymph nodes - not lymphoma
Inclusions, pigment, ectopic cells or tissue
Anthracosis

Author: Jaya Balakrishna, M.D. (see Authors page)
Editor: Abdelsalam Sharabi, M.D.

Revised: 22 June 2018, last major update February 2014

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: anthracosis [title] lymph node

Cite this page: Balakrishna, J. Anthracosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphnodesanthracosis.html. Accessed July 16th, 2018.
Definition / general
  • Accumulation of carbon in lymph nodes, more commonly in intrapulmonary lymph nodes, due to coal dust, smoke or pollution
  • May be associated with storiform pattern of histiocytes that resembles a neoplasm (Hum Pathol 1998;29:851)
  • Associated with silica, although often no history of industrial exposure
  • Associated with hyalinization in nodes of elderly Japanese (Histol Histopathol 2003;18:1169)
Epidemiology
  • Very common
Sites
  • Common in hilar and bronchial lymph nodes
Clinical features
  • Enlargement of involved lymph nodes, prominent mediastinal lymphadenopathy is common
Radiology description
  • Enlarged lymph nodes, especially mediastinal and bronchial lymph nodes
Radiology images

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Apical lung lesion

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Increased uptake in left upper lobe

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FDG PET/CT scan shows
high-grade metabolic activity
in right hilar soft tissue lesion

Prognostic factors
  • Benign process with no significant clinical implications
Case reports
  • 71 year old woman, with life-long exposure to soot from a wood cook stove, with anthracosis and large mediastinal mass with healed pulmonary tuberculosis (Clin Med Res 2010;8:99)
  • Women who cooked over wood fires, with primary nodal anthracosis identified as a cause of FDG PET/CT positive mediastinal lymphadenopathy (Respiratory Medicine Case Reports 2013;10:48)
  • A case of anthracosis presenting with mediastinal lymph nodes mimicking tuberculous lymphadenitis or malignancy (Eur J Intern Med 2003;14:444)
Treatment
  • If significant enlargement, excision biopsy
Gross description
  • Enlarged lymph nodes with firm dark brown to black cut surfaces
Microscopic (histologic) description
  • Anthracotic macrophages in clusters and singly dispersed
  • There may be storiform arrangement of spindle cells or granuloma like aggregates of macrophages
  • Fine anthracotic pigment
  • Also nodal hyaline scars and polarizable material suggestive of silica
Microscopic (histologic) images

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Abundant anthracotic pigment

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Pulmonary hilar lymph node

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Lymph node anthracosis

Cytology description
  • Cellular smears with a population of anthracotic macrophages that are both singly dispersed and in variously sized aggregates
  • Variable foreign body type, multinucleated giant cells
  • No necrosis or atypical cells
Cytology images

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Abundant anthracotic pigment

Positive stains
  • CD68 (macrophages containing pigment)
Differential diagnosis