Differential Diagnosis for Lymph Node with No Eccentric Fatty Hilus

• Single Most Likely Diagnosis
  • Metastatic disease: The absence of an eccentric fatty hilus in a lymph node is highly suggestive of metastatic disease, as normal lymph nodes typically have a fatty hilus. Metastases often replace the normal lymph node architecture, including the fatty hilus.
• Other Likely Diagnoses
  • Lymphoma: Both Hodgkin and non-Hodgkin lymphomas can involve lymph nodes and may not have a visible fatty hilus due to the replacement of normal lymph node tissue by malignant cells.
  • Inflammatory or infectious processes: Certain infections or inflammatory conditions can cause lymphadenopathy (enlargement of the lymph nodes) and may alter the normal appearance of the lymph node, including the fatty hilus.
• Do Not Miss Diagnoses
  • Malignant lymphoma with transformation: Although less common, some lymphomas can transform into more aggressive forms, which might not present with a typical fatty hilus.
  • Leukemic infiltration: Involvement of lymph nodes by leukemia can lead to architectural distortion, including the loss of the fatty hilus.
• Rare Diagnoses
  • Castleman disease: A rare disorder that involves an overgrowth of cells in the lymph node, which can lead to the absence of a normal fatty hilus.
  • Kikuchi-Fujimoto disease: A rare, self-limiting condition that causes lymphadenopathy and can alter the normal lymph node appearance, including potentially affecting the fatty hilus.
  • Kimura disease: A chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia, potentially altering the normal lymph node architecture.