Lymph nodes & spleen, nonlymphoma

Lymph nodes-general

Grossing & features to report-lymph nodes

Last author update: 1 December 2010
Last staff update: 26 March 2021

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PubMed Search: lymph node grossing

Nikhil Sangle, M.D.
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Cite this page: Sangle N., Depond W. Grossing & features to report-lymph nodes. website. Accessed June 5th, 2023.
Grossing for diagnosis
  • Cut perpendicular to long axis if possible
  • Avoid squeezing nodes, which may alter histology
  • For culture (if clinically indicated) or for flow cytometry, use end of lymph node
  • For touch imprints, fix in ethanol, stain with H&E, Wright stain or use for immunocytochemistry
  • Use scrapes / cell suspension for flow cytometry, cytogenetics, molecular gene rearrangement studies, FISH
  • Sections for formalin or B5 fixation should be 3 - 4 mm thick to allow for proper fixation; B5 (mercury containing fixative) provides best morphologic details
  • Snap freezing is best for research, some immunohistochemistry, future molecular studies
  • Formalin fixation is best for PCR
  • EM is helpful only rarely to diagnose Langerhans histiocytosis or occasionally metastatic tumors
  • Include extranodal fat (infiltration implies malignant process)
  • Note: the most important slides to obtain are sufficient H&E for diagnosis
  • Frozen sections may confirm involvement of node by a disease process, but do not use to obtain a specific diagnosis because freezing artifacts may hinder diagnosis
Grossing for staging
  • Most lymph nodes are near the wall of the organ
  • Be aware of minimal number of nodes required for staging some carcinomas
  • May want to fix first overnight - lymph nodes stand out as white nodules
  • Carnoy solution helps clear the fat
  • Clearing solutions (such as ethanol, diethyl ether, glacial acetic acid and formalin) may help identify additional lymph nodes (Am J Surg Pathol 1997;21:1387, Arch Pathol Lab Med 2003;127:1552, Arch Pathol Lab Med 2001;125:642)
  • For each anatomic group, describe the number of nodes, the size of the largest node and any gross features
  • Submit all lymph nodes for histology; section node if 5 mm or greater in diameter
  • For large nodes grossly involved by tumor, only one section needs to be submitted to demonstrate tumor and possible extranodal extension but save remainder for resampling if necessary
  • For other large nodes, submission of entire node detects additional metastases in some cases (Am J Clin Pathol 1998;109:571)
  • Describe number of nodes in each cassette and whether whole or sectioned
Features to report
  • Clinical history: prior diagnoses of lymphoma, presence of lymphadenopathy or organomegaly, hematologic findings, constitutional symptoms, HIV status, prior immune abnormalities, autoimmune disorders, other relevant serology and other related conditions such as H. pylori infection
  • Anatomic site
  • Tumor type(s) (WHO classification), grade (if relevant)
  • Focal or complete involvement of lymph node or other structures
  • Specimen inadequacy
  • Results of ancillary studies
  • Diagnosis should incorporate all of the above findings or explain any inconsistencies
  • Checklist (2004)
  • References: Hum Pathol 2002;33:1064, Mod Pathol 2004;17:131
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