Plasmacytoma with amyloidosis masquerding as tuberculosis on cytology

Abstract

Amyloid material on lymph node cytology smears can mimic caseous necrosis. We report one such case where a 50-year-old lady presented with a nasal mass and cervical lymphadenopathy. Fine needle aspiration cytology smears of the cervical lymph node were interpreted as tuberculous lymphadenitis based on the presence of an occasional epithelioid cell and caseous material. The patient did not respond to antituberculous therapy and was revaluated. Repeat aspiration from the lymph node showed numerous plasma cells and myeloma cells in addition to the amorphous material which was confirmed to be amyloid on staining with congo red. A diagnosis of plasmacytoma with amyloidosis was rendered. Imprint smears from nasal mass, detailed hematology workup and subsequent histology confirmed the diagnosis.

Cytological diagnosis of amyloidosis presenting as a supraclavicular swelling

“…Also, cytologically, caseous necrosis is seen as completely amorphous, granular, acellular material, which may mimic amyloid. A handful of case reports have described a similar presentation of amyloidosis where a neck swelling mimicked tubercular lymphadenopathy clinically and cytologically . Looking for morphological clues like epithelioid cell granulomas, multinucleated giant cells, and accompanying inflammatory infiltrate makes the diagnosis easier.…”

Diagnostic Role of Lymphnode Imprint: A Cyto-histopathological Correlation

“…Similar case has been reported by Sharma N et al where a case of plasmacytoma was misdiagnosed as tuberculosis. 7 Presence of occasional granuloma and sometimes even necrosis in lymphoma can creates dilemma between tuberculosis and high grade lymphoma in cytological diagnosis. Two cases of tuberculosis were falsely diagnosed as reactive lymphadenitis in this study.…”

Abdominal lymphadenopathy: An interesting and rare case diagnosed on endoscopic ultrasound-guided fine needle aspiration cytology

“…[ 5 ] Amorphous granular basophilic material was mistaken as caseous necrosis in Giemsa-stained smears of a lymph node aspirate, and diagnosis of tuberculous lymphadenitis was suggested. [ 6 ] Necrotizing granulomatous lymphadenitis is a commonly rendered diagnosis in our setting. [ 7 ] According to our observation: Amyloid had a more flocculent appearance as compared to the “spread out” character of caseous necrosis [ Figure 1 ] The amyloid deposits had well-defined borders in many foci which are not a feature of necrosis [ Figure 2 ] The amyloid had smooth and glassy texture as compared to the granular nature of caseous necrosis and this was better highlighted in Papanicolaou-stained smears [ Figure 2 ] Besides caseous necrosis, other differential diagnoses in lymph node would include protein deposition in angiocentric sclerosing lymphadenopathy and deposition of para-amyloid.…”

“…[ 5 ] Amorphous granular basophilic material was mistaken as caseous necrosis in Giemsa-stained smears of a lymph node aspirate, and diagnosis of tuberculous lymphadenitis was suggested. [ 6 ] Necrotizing granulomatous lymphadenitis is a commonly rendered diagnosis in our setting. [ 7 ] According to our observation:…”