More Than Skin Deep: Histopathologic Assessment of Tattoo Ink Deposition in Lymph Nodes

IntroductionA variety of dermatologic conditions have been described in association with tattoos. Relatively recently, an increased risk of lymphoma has been described based on population studies. Tattoo ink deposition in lymph nodes is not uncommon in a busy surgical pathology service.MethodsNinety lymph nodes with tattoo ink deposition were reviewed. Histopathologic features including site of lymph node, diagnosis, amount of pigment, ink color, location in lymph node, hyperplastic follicles, regressed follicles, follicular dendritic cell prominence, plasmacytosis, paracortical T cell hyperplasia, foreign body reaction, vascular prominence, sinus histiocytosis, histiocytic aggregates, and the presence of granulomas were evaluated.ResultsIn patients averaging 45 years, approximately equal numbers of men and women were seen. Eleven patients had hematologic neoplasms (11/90, 12%) and six had increased IgG4 positive plasma cells. Ink was seen in perivascular and perisinusoidal locations. While individual specimens showed prominent specific histopathologic changes, we did not find any unifying combination of findings other than the ink itself.ConclusionsGiven emerging epidemiologic data suggesting an association between tattoo exposure and lymphoma risk, we feel that the presence of tattoo ink in lymph nodes should be noted in all specimens. The clinical implications of these findings require further longitudinal investigation.