Lymph node examination. What is an adequate workup?

Lymph node examination has traditionally been difficult to perform satisfactorily. Both pathologists and clinicians often lack confidence in the resulting diagnosis, and repeated biopsy or routine requests for consultative opinion may follow. Artifactual distortion of lymph nodes during removal and processing are partially responsible for these unsatisfactory circumstances. More recently, a developing awareness of the inherent complexity of lymphoproliferative diseases and the availability of more sophisticated studies have further compounded these traditional problems. This article describes the specific methods recommended to allow community pathologists to scale lymph node examination to the diagnostic difficulty of the disease present. In particular, simple and inexpensive procedures allow tissue samples to be saved for immunologic phenotyping and electron microscopy while routine histopathologic sections are being evaluated.