title: Clinicocytopathologic correlation in an atypical presentation of lymphadenopathy with review of literature.
abstract: OBJECTIVE
  To present a clinicocytopathologic correlation of an atypical case of cat scratch disease (CSD) involving retroperitoneal lymph nodes, with emphasis on communication between service teams for managing lymphadenopathy of unknown origin. We consider clinical and cytologic differential diagnoses and review the literature on atypical cases of CSD, with emphasis on abdominal presentation and cytologic findings.
  
  
  METHODS
  Clinical services met with the cytology service to review clinical and pathologic features. Literature was reviewed via PubMed search (Harbor-UCLA subscriptions). Immunohistochemistry and Steiner silver stains were performed by Harbor-UCLA Department of Pathology. Enzyme-linked immunosorbent assay IgG and IgM Bartonella henselae titers were carried out by Quest Nichols Institute.
  
  
  RESULTS
  Fine-needle aspirate Diff-Quik and Papanicolaou smears and H&E-stained cell block showed abundant histiocytes, monocytoid B cells, and numerous neutrophils associated with necrosis corresponding to a late stage of CSD infection. Silver stain was positive for clumps of pleomorphic organisms. IgM and IgG antibody titers were elevated.
  
  
  CONCLUSIONS
  The cytologic findings of CSD in an atypical abdominal presentation are similar to those of a classic presentation. Laboratory workup for atypical CSD should include at least two other modalities aside from cytomorphologic features. Close clinical and cytologic correlation avoided potentially unnecessary and harmful surgery and enabled timely treatment.
authors: From the Departments of Pathology and choi.alexander7@gmail.com.
authors: Alexander H
authors: AH
authors: Choi
authors: Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA.
authors: Michael
authors: M
authors: Bolaris
authors: Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA.
authors: Diana K
authors: DK
authors: Nguyen
authors: Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA.
authors: Eduard H
authors: EH
authors: Panosyan
authors: Pediatrics, Los Angeles County-Harbor-UCLA Medical Center, Los Angeles, CA.
authors: Joseph L
authors: JL
authors: Lasky
authors: From the Departments of Pathology and.
authors: Gloria B
authors: GB
authors: Duane
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000097:blood; D017963:Azithromycin / Q000627:therapeutic use; D018416:Bartonella henselae / Q000276:immunology / Q000302:isolation & purification*; D002372:Cat-Scratch Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D005839:Gentamicins; D017963:Azithromycin
keywords: Abdominal lymphadenopathy/lymphadenitis; Atypical cat scratch disease; EUS-FNA cytology