Blood, 1955, Vol. 10, No. 10, pp. 1030-1054.
© 1955 American Society of Hematology, Inc.
Lymph Node Smears in the Diagnosis of Lymphadenopathy:
A Review
P. F. LUCAS 1
1 St. Bartholomew’s Hospital, London.
1. A description of the cells of normal lymph nodes is presented, based on the
examination and differential counts of smears from 15 nodes obtained at operation.
2. 95 per cent of the cells of normal nodes are lymphocytes. The most primitive
cell is the multipotent hemohistioblast which gives rise to the histiocyte and the
hemocytoblast the parent of three differentiated 'blast cells, the lymphoblast,
monoblast and plasmoblast. 'Blast cells are rare in normal nodes but can be observed in inflammation.
3. The cytology of 85 pathologic nodes is described, the final diagnoses being
confirmed histologically in most instances.
4. The features of inflammation are similar irrespective of the cause. Some
types of inflammation result in excess of one series of cells more than another; it
is rarely possible to distinguish them on these grounds, but the cytology may
indicate those cases in which search for tubercle bacilli is likely to be rewarding.
5. Sternberg cells and their precursors are almost specific for Hodgkin’s disease.
Diagnosis is possible if they are present together with a pleomorphic cytology.
6. A diagnosis of leukosis or primary or secondary neoplasm can be made if 80
per cent of the cells are abnormal. Distinction of these three groups from smears
depends on the type and distribution of cells. The degree of abnormality bears no
relation to prognosis.
7. Diagnosis depends on finding abnormal cells; differential counts are of
little value.
8. Analysis of the few cases of reticulosis examined suggest that cytologic
classification is unlikely to be useful.
9. Examination of one smear from each of 85 nodes for 15 minutes without
clinical information enabled a diagnosis to be in 52 cases; the only error was that
monocytic leukosis was called reticulosarcoma.
10. On two occasions, one of secondary carcinoma and one of reticulosis, the
correct diagnosis was made from smears at a time when histology showed nonspecific changes only.
11. The method should find a useful place as a screening test in diagnosis of
lymphadenopathy, excision of a node being carried out if aspiration fails or if the
diagnosis cannot be made from smears.
Submitted on September 23, 1954
Accepted on June 25, 1955
