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Caputo A, Ciliberti V, Zeppa P, D'Antonio A. Cytological Diagnosis of Aggressive Small-Cell Lymphomas. Acta Cytol 2022; 66:269-278. [PMID: 35385847 DOI: 10.1159/000524270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite their sometimes deceivingly bland appearance, some small-cell lymphomas are very aggressive and the prognosis of patients depends on a prompt diagnosis that allows the initiation of appropriate therapy. SUMMARY The present review discusses the salient cytological features of the most common aggressive small-cell lymphomas and then proceeds to analyze their main diagnostic criteria, including the usage of ancillary techniques. KEY MESSAGES Lymph node fine-needle aspiration cytology is a fast, safe, cheap, minimally invasive, and accurate procedure that can be used for a prompt and accurate diagnosis of lymphomas.
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Affiliation(s)
- Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Valeria Ciliberti
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Antonio D'Antonio
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
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Uzun E, Erkilic S. Diagnostic accuracy of Thinprep® in cervical lymph node aspiration: Assessment according to the Sydney system. Diagn Cytopathol 2022; 50:253-262. [PMID: 35148033 DOI: 10.1002/dc.24943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) is a reliable technique that has been used for many years in lymphadenopathy diagnosis. Although conventional smear is the standard approach in FNAC, liquid-based cytology (LBC) is accepted as an alternative method. Reporting standardization is a significant gap in fine-needle aspiration cytology, leading to failure in pathologist-clinician dialog and interobserver variability. In 2020, an expert panel proposed the Sydney system for classifying and reporting lymph node aspiration cytology. This study aimed to evaluate the diagnostic accuracy of LBC in lymph node aspiration cytology under the guidance of the Sydney system. METHODS Five hundred-four LBC samples were reevaluated and classified according to the Sydney system. Of these, n = 24 were categorized as L1-inadequate/non-diagnostic, n = 283 as L2-benign, n = 36 as L3- atypical cells of undetermined significance/atypical lymphoid cells of uncertain significance (AUS/ALUS), n = 48 as L4-suspicious, and n = 113 as L5-malignant. Four hundred-one samples were histopathologically confirmed. The diagnostic accuracy of LBC and the risk of malignancy for each Sydney category were calculated. RESULTS The results were as follows: sensitivity 98.97%; specificity 98.60%; positive predictive value 94.80%; negative predictive value 99.29%; and overall diagnostic accuracy 98.75%. The ROM was 16.6% for L1, 0.7% for L2, 88.8% for L3, and 100% for L4 and L5. CONCLUSION LBC is suitable for use in lymph node aspiration under the guidance of the Sydney system and has high diagnostic accuracy. Future comprehensive studies will increase the applicability of the Sydney system and minimize interobserver variability.
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Affiliation(s)
- Evren Uzun
- Department of Pathology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Suna Erkilic
- Department of Pathology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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Gupta P, Gupta N, Bal A, Rastogi P, Prakash G, Malhotra P, Dey P, Srinivasan R, Das A. Cytomorphological characterisation of angioimmunoblastic T cell lymphoma: a case-control study. J Clin Pathol 2021; 76:320-326. [PMID: 34697030 DOI: 10.1136/jclinpath-2021-207887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/11/2021] [Indexed: 11/04/2022]
Abstract
AIMS Angioimmunoblastic T cell lymphoma (AITL) is often misdiagnosed in cytology. Hence, the present study was conducted to identify the distinctive cytomorphological features of AITL in lymph node fine-needle aspirates (LN-FNA). METHODS This was a 4-year retrospective case-control study. Cases included LN-FNAs from patients with histopathologically confirmed AITL. The controls included LN-FNAs from patients with histopathologically confirmed reactive lymphoid hyperplasia (RLH; n=25). Eleven cytomorphological features were assessed in all the aspirates; the strength of association was determined by OR, Cramer's V and multiple correspondence analysis (MCA). RESULTS Of a total of 22 cases of AITL reported on histopathology, 19 adequate aspirates from 14 patients (63.6%) were available for review. On univariate analysis, 5 of 11 cytomorphological variables were found to be significant for AITL; however, on MCA, 3 of these parameters, viz absence of tingible body macrophages (OR=0.014; V=0.74), presence of atypical lymphoid cells (OR=10.8; V=0.41) and singly scattered epithelioid cells (OR=19.3; V=0.31), were found to be the strongest predictors of AITL. CONCLUSIONS The absence of tingible body macrophages, presence of atypical lymphoid cells and singly scattered epithelioid cells in polymorphic LN-FNAs are significant cytomorphological predictors of AITL in comparison with RLH. Knowledge of these diagnostic predictors, supplemented by clinicoradiological correlation and appropriate ancillary studies, can help diagnose AITL on aspiration cytology.
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Affiliation(s)
- Parikshaa Gupta
- Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pulkit Rastogi
- Hematology Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Makarenko VV, DeLelys ME, Hasserjian RP, Ly A. Lymph node FNA cytology: Diagnostic performance and clinical implications of proposed diagnostic categories. Cancer Cytopathol 2021; 130:144-153. [PMID: 34661975 DOI: 10.1002/cncy.22523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite widespread clinical use, lymph node fine-needle aspiration cytology (LN-FNAC) lacks universal acceptance for definitively diagnosing lymphomas. This is likely due to reports of lower diagnostic performance, inconsistent terminology use in cytopathology diagnostic reports, and only limited data on the clinical implications of LN-FNAC diagnoses. Recently, a uniform LN-FNAC cytopathological diagnostic reporting system was proposed (the Sydney System). This study evaluated LN-FNAC diagnostic performance and risks of malignancy associated with the proposed diagnostic categories. METHODS LN-FNAC specimens obtained in 2018-2019, with and without concurrent core biopsy, to evaluate for suspected lymphoma were analyzed (n = 349). LN-FNAC diagnoses were compared with final diagnoses obtained via subsequent tissue biopsy and/or clinical assessment. RESULTS The mean patient age was 57.6 years, and 41% were female. LN-FNAC was the initial diagnostic test in 223 (63.9%), and it was used to evaluate for recurrence in 126 (36.1%). LN-FNAC diagnosed 202 hematological malignancies (57.9%), 23 nonhematological malignancies (6.6%), and 124 reactive processes (35.5%). Subsequent tissue biopsy was performed in 42 (12%). The risks of malignancy per diagnostic category were as follows: inadequate, 58.3%; benign, 6.4%; atypical, 69.2%; suspicious, 96.7%; and malignant, 99.3%. LN-FNAC demonstrated up to 96.3% sensitivity, 91.91% specificity, and 87.35% accuracy. Optimal specimen quality and the use of intradepartmental consultation reduced diagnostic error rates in FNA cases without concurrent core biopsy (P = .029 and P = .0002 respectively). CONCLUSIONS LN-FNAC is accurate and reliable for the diagnosis of lymphoma. Inadequate LN-FNAC samples should be resampled due to a significant associated risk of lymphoma. The diagnostic performance of LN-FNAC may be improved with good specimen quality and reviews by multiple pathologists. Understanding the risks of malignancy associated with LN-FNAC diagnostic categories will help to guide optimal patient management.
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Affiliation(s)
- Vladislav V Makarenko
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle E DeLelys
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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Gupta P, Gupta N, Kumar P, Bhardwaj S, Srinivasan R, Dey P, Rohilla M, Bal A, Das A, Rajwanshi A. Assessment of risk of malignancy by application of the proposed Sydney system for classification and reporting lymph node cytopathology. Cancer Cytopathol 2021; 129:701-718. [PMID: 33830657 DOI: 10.1002/cncy.22432] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) is one of the most commonly used techniques for evaluating lymphadenopathy. Recently, the Sydney system was proposed for assessing the performance, classification, and reporting of lymph node (LN) cytopathology. The present study was conducted to assess the risk of malignancy associated with each of the diagnostic categories of the proposed Sydney system. METHODS This was a 2-year retrospective study of LN-FNAs; cytologic diagnoses were categorized by the proposed Sydney system. Cytological diagnoses were correlated with the corresponding histopathological diagnoses to assess diagnostic accuracy and risk of malignancy for each diagnostic category. RESULTS Of 23,335 FNAs during the study period, 6983 (30%) were performed on LNs. Of these, 289 (4.1%) cases were reported as nondiagnostic/inadequate (L1); 3397 (48.6%) were reported as benign (L2); 33(0.5%) as atypical cells of undetermined significance (L3), 96 (1.4%) as suspicious for malignancy (L4) and 3168 (45.4%) as malignant (L5). Subsequent histopathology was available for 618 (8.8%) cases. On cytohistopathologic correlation, 552 (89.3%) were concordant and 66 (10.7%) discordant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LN-FNA were 79.9%, 98.7%, 98.4%, 83.1%, and 89.3%, respectively. The risk of malignancy was 27.5% for the nondiagnostic category, 11.5% for the benign, 66.7% for the atypical, 88% for the suspicious, and 99.6% for the malignant categories. CONCLUSIONS FNAC has high diagnostic accuracy for the diagnosis of various LN pathologies. Application of the proposed Sydney system can help in achieving uniformity and reproducibility in cytologic diagnoses and also help in risk-stratification on cytology.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Kumar
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunny Bhardwaj
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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van den Akker TA, Chen H. Angioimmunoblastic T-cell lymphoma masquerading as granulomatous lymphadenitis: Fine needle aspiration cytology, clinical and radiology correlation. Diagn Cytopathol 2021; 49:555-558. [PMID: 33629798 DOI: 10.1002/dc.24726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/09/2022]
Abstract
Fine needle aspiration (FNA) is a minimally invasive technique used in the initial diagnosis of superficial lesions, including lymphadenopathy. Its benefit in lymph node pathology, however, is highly variable, especially in heterogeneous lymphoproliferative disorders like angioimmunoblastic T-cell lymphoma (AITL). AITL is an aggressive hematopoietic malignancy, histologically characterized by medium-sized neoplastic cells, high endothelial venule proliferations, and a heterogeneous hematolymphoid background. Diagnostic difficulty arises at lymph node FNA, where cytology yields nonspecific polymorphous collections of medium-sized lymphocytes, hematolymphoid cells, dendritic cell-lymphoid complexes, and lymphoid tissue fragments with transgressing blood vessels; findings mimicking reactive lymphadenopathy. We present a case of a 62-year-old male who presented with cervical lymphadenopathy. Neck level II lymph node FNA revealed granulomatous inflammation. A cell block was prepared for additional infectious studies but was non-contributory due to lack of material. Flow cytometry showed no evidence of non-Hodgkin lymphoma. Excisional biopsy revealed lymph node effacement by a T-cell lymphoproliferative disorder consistent with AITL. This case contributes to the paucity of literature regarding the cytologic features of AITL observed at FNA, and becomes the premier case to emphasize the addition of granulomatous features. Despite the aggressive nature of this entity, cases are frequently misdiagnosed as reactive on initial evaluation resulting in delay of treatment. This report serves to raise suspicion of AITL and other polymorphic cellular lymphomas in the setting of reactive granulomatous cytomorphology, thus prompting histological examination of tissue biopsy, expediting treatment, and ultimately providing potential improvement to the current prognosis.
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Affiliation(s)
- Tayler A van den Akker
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Downtown Union Square Medical Center, New York, New York, USA
| | - Hua Chen
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Downtown Union Square Medical Center, New York, New York, USA
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Bandyopadhyay A, Roy S, Seth J, Boler AK, Mitra S, Mishra P. Peripheral T-Cell Lymphoma-Not Otherwise Specified Presenting as Disfiguring Facial Swelling. Indian J Dermatol 2021; 66:224. [PMID: 34188300 PMCID: PMC8208286 DOI: 10.4103/ijd.ijd_205_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Arghya Bandyopadhyay
- Department of Pathology, Burdwan Medical College, Burdwan, West Bengal, India. E-mail:
| | - Shreosee Roy
- Department of Pathology, Burdwan Medical College, Burdwan, West Bengal, India. E-mail:
| | - Joly Seth
- Department of Dermatology, Burdwan Medical College, Burdwan, West Bengal, India
| | - Anup Kumar Boler
- Department of Pathology, Burdwan Medical College, Burdwan, West Bengal, India. E-mail:
| | - Satabdi Mitra
- Department of Pathology, Burdwan Medical College, Burdwan, West Bengal, India. E-mail:
| | - Priyankar Mishra
- Department of Dermatology, Burdwan Medical College, Burdwan, West Bengal, India
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8
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Al-Abbadi MA, Barroca H, Bode-Lesniewska B, Calaminici M, Caraway NP, Chhieng DF, Cozzolino I, Ehinger M, Field AS, Geddie WR, Katz RL, Lin O, Medeiros LJ, Monaco SE, Rajwanshi A, Schmitt FC, Vielh P, Zeppa P. A Proposal for the Performance, Classification, and Reporting of Lymph Node Fine-Needle Aspiration Cytopathology: The Sydney System. Acta Cytol 2020; 64:306-322. [PMID: 32454496 DOI: 10.1159/000506497] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The evaluation of lymph nodes (LN) by fine-needle aspiration cytology (FNAC) is routinely used in many institutions but it is not uniformly accepted mainly because of the lack of guidelines and a cytopathological diagnostic classification. A committee of cytopathologists has developed a system of performance, classification, and reporting for LN-FNAC. METHODS The committee members prepared a document that has circulated among them five times; the final text has been approved by all the participants. It is based on a review of the international literature and on the expertise of the members. The system integrates clinical and imaging data with cytopathological features and ancillary techniques. The project has received the endorsement and patronage of the International Academy of Cytology and the European Federation of the Cytology Societies. RESULTS Clinical, imaging, and serological data of lymphadenopathies, indications for LN-FNAC, technical procedures, and ancillary techniques are evaluated with specific recommendations. The reporting system includes two diagnostic levels. The first should provide basic diagnostic information and includes five categories: inadequate/insufficient, benign, atypical lymphoid cells of undetermined/uncertain significance, suspicious, and malignant. For each category, specific recommendations are provided. The second diagnostic level, when achievable, should produce the identification of specific benign or malignant entities and additional information by utilizing ancillary testing. CONCLUSION The authors believe that the introduction of this system for performing and reporting LN-FNAC may improve the quality of the procedure, the report, and the communication between cytopathologists and the clinicians. This system may lead to a greater acceptance and utilization of LN-FNAC and to a better interdisciplinary understanding of the results of this procedure.
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Affiliation(s)
- Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, the University of Jordan, Amman, Jordan
| | - Helena Barroca
- Serviço de Anatomia Patológica, Hospital S João-Porto, Porto, Portugal
| | | | - Maria Calaminici
- Department of Cellular Pathology, Barts Health NHS Trust and Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Nancy P Caraway
- Department of Anatomic Pathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David F Chhieng
- Department of Pathology, University of Washington Medical Center, Seattle, Washington, USA
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mats Ehinger
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Andrew S Field
- University of NSW Medical School, Sydney, New South Wales, Australia
- University of Notre Dame Medical School, Sydney, New South Wales, Australia
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - William R Geddie
- University Health Network, UHN, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arvind Rajwanshi
- Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology of Porto University (IPATIMUP), Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
| | | | - Pio Zeppa
- Department of Medicine and Surgery, Università degli Studi di Salerno, Fisciano, Salerno, Italy,
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Miller TEA, Shelton D, Rana DN, Narine N. Angioimmunoblastic T Cell lymphoma mimics reactive lymphoid tissue on cytomorphology: A multimodality approach utilising cytology, immunocytochemistry and flow cytometry to resolve this diagnostic dilemma. Cytopathology 2017; 28:239-241. [DOI: 10.1111/cyt.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T. E. A. Miller
- Manchester Cytology Centre; Central Manchester University Hospitals NHS Foundation Trust; Manchester Royal Infirmary; Manchester UK
| | - D. Shelton
- Manchester Cytology Centre; Central Manchester University Hospitals NHS Foundation Trust; Manchester Royal Infirmary; Manchester UK
| | - D. N. Rana
- Manchester Cytology Centre; Central Manchester University Hospitals NHS Foundation Trust; Manchester Royal Infirmary; Manchester UK
| | - N. Narine
- Manchester Cytology Centre; Central Manchester University Hospitals NHS Foundation Trust; Manchester Royal Infirmary; Manchester UK
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Das DK, Pathan SK, Joneja M, Al-Musawi FA, John B, Mirza KR. T-cell prolymphocytic leukemia (T-PLL) with overlapping cytomorphological features with T-CLL and T-ALL: a case initially diagnosed by fine-needle aspiration cytology and immunocytochemistry. Diagn Cytopathol 2011; 41:360-5. [PMID: 21987484 DOI: 10.1002/dc.21781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 06/12/2011] [Indexed: 11/07/2022]
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a very unusual form of chronic lymphoproliferative disorder, which has rarely been diagnosed by fine needle aspiration (FNA) cytology. We report one such case with some overlapping cytomorphological features with chronic lymphocytic leukemia and acute lymphoblastic leukemia. A 91-year-old man presented with generalized lymphadenopathy, pleural effusion, ascites, and an ulcerated growth in rectum. FNA smears from the left cervical lymph node showed a monotonous population of small lymphoid cells having small but distinct nucleoli that was initially diagnosed as chronic lymphocytic leukemia (CLL). Smears from the left axillary lymph node contained both small and medium-sized lymphoid cells with frequent hand-mirror cell appearance, which has been described in acute lymphoblatic leukemia (ALL). Immunocyto/histochemical stainings on smears and cell block preparations of the aspirate showed the following immunophenotype: CD3+, CD4+, CD5+, CD7+, CD8-, CD20-, CD23-, and Tdt-. Total peripheral blood leukocyte count was 26.4 × 10(9) /L and total lymphocyte count, 8.3 × 10(9) /L with predominance of small lymphocytes. T-cell nature of the neoplasm was confirmed by biopsies from the cervical lymph node (T-cell lymphoma), bone marrow (T-cell lymphoid neoplasm/chronic lymphocytic leukemia), and the ulcerated rectal lesion (atypical T-cell lymphoproliferative disorder). The patient developed deep vein thrombosis, heparin-induced thrombocytopenia and bleeding from duodenal ulcer. By the time the reports of all the investigations were ready, the patient succumbed to bronchopneumonia. To the best of our knowledge, this T-CLL/T-PLL which was diagnosed initially by FNA cytology with immunocytochemical support is first of its kind to be reported.
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Affiliation(s)
- Dilip K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait; Cytology Unit, Mubarak Al-Kabeer Hospital, Hawalli area, Jabriya, Kuwait.
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Wakely PE. The diagnosis of non-Hodgkin lymphoma using fine-needle aspiration cytopathology. Cancer Cytopathol 2010; 118:238-43. [DOI: 10.1002/cncy.20106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Utility of Flow Cytometry Immunophenotyping in Fine-needle Aspirate Cytologic Diagnosis of Non-Hodgkin Lymphoma. Appl Immunohistochem Mol Morphol 2010; 18:311-22. [DOI: 10.1097/pai.0b013e3181827da8] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Zeppa P, Vigliar E, Cozzolino I, Troncone G, Picardi M, De Renzo A, Grimaldi F, Pane F, Vetrani A, Palombini L. Fine needle aspiration cytology and flow cytometry immunophenotyping of non-Hodgkin lymphoma: can we do better? Cytopathology 2010; 21:300-10. [PMID: 20132132 DOI: 10.1111/j.1365-2303.2009.00725.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the diagnostic efficiency of fine needle aspiration cytology/flow cytometry (FNAC/FC) in the diagnosis and classification of non-Hodgkin lymphoma (NHL) in a series of 446 cases and to compare the results with those of previous experiences to evaluate whether there had been an improvement in FNAC/FC diagnostic accuracy. METHODS FNAC/FC was used to analyse 446 cases of benign reactive hyperplasia (BRH), NHL and NHL relapse (rNHL) in 362 lymph nodes and 84 extranodal lesions. When a diagnosis of NHL was reached, a classification was attempted combining FC data and cytological features. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of FNAC/FC in the diagnosis and classification of NHL were calculated and compared with those available in the literature. RESULTS FNAC/FC provided a diagnosis of NHL and rNHL in 245 cases and of BRH in 188 cases. In nine cases, the diagnosis was 'suggestive of NHL' (sNHL) and in four cases was inadequate. Histology and clinical follow-up confirmed 102 cases of NHL and detected one false positive. In 18 cases of BRH diagnosed by FNAC/FC, histological examination revealed 14 BRH and four NHL (false negatives). All nine cases diagnosed as sNHL were confirmed by histology. Including sNHL cases as false negatives, statistical analysis showed 94.9% sensitivity, 99.4% specificity, 99.6% PPV and 93.4% NPV in the diagnosis of NHL. A specific subtype was diagnosed in 125 cases and confirmed in 67 of 70 cases that had histological biopsies. Statistical analysis did not demonstrate significant improvements between the present series and previous studies either in diagnosis or in classification of NHL. CONCLUSIONS FNAC/FC is a fundamental tool in the diagnosis and classification of NHL but the exiguity of diagnostic material and other technical and clinical limitations will probably continue to limit further improvement of the technique.
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Affiliation(s)
- P Zeppa
- Dipartimenti di Scienze Biomorfologiche e Funzionali, Facoltà di Medicina e Chirurgia, Università di Napoli "Federico II", Napoli, Italia.
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14
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Lymph nodes. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pai RK, Mullins FM, Kim YH, Kong CS. Cytologic evaluation of lymphadenopathy associated with mycosis fungoides and Sezary syndrome: role of immunophenotypic and molecular ancillary studies. Cancer 2008; 114:323-32. [PMID: 18798522 DOI: 10.1002/cncr.23793] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The most common presenting site of extracutaneous disease in mycosis fungoides and Sezary syndrome is the peripheral lymph node. Although fine-needle aspiration biopsy has been shown to be a valuable diagnostic technique in evaluating lymphadenopathy, its utility in patients with cutaneous T-cell lymphoma has not been extensively studied. With fine-needle aspiration biopsy, material can be collected for ancillary diagnostic studies and for morphologic evaluation. METHODS The authors report a series of 11 fine-needle aspiration biopsy specimens from 10 mycosis fungoides and Sezary syndrome patients. Flow cytometric immunophenotyping and T-cell receptor gamma chain polymerase chain reaction were performed on fine-needle aspiration biopsy material and correlated with cytologic findings. RESULTS Seven of 10 patients had lymph node involvement by cutaneous T-cell lymphoma, with 3 cases exhibiting large-cell transformation and 4 cases exhibiting a small-cell pattern. Flow cytometric immunophenotyping identified an abnormal T-cell population in 6 cases. A clonal T-cell rearrangement by T-cell receptor gamma chain polymerase chain reaction (TCR-gamma PCR) was identified in 1 case in which insufficient events were present for evaluation by flow cytometry and in 1 case in which flow cytometry was not diagnostic of T-cell lymphoma. Two cases showed involvement by classic Hodgkin lymphoma diagnosed by immunohistochemistry on cell block material. CONCLUSIONS Fine-needle aspiration biopsy in conjunction with immunophenotyping and T-cell receptor gamma chain polymerase chain reaction is significantly useful in evaluation of lymphadenopathy in patients with mycosis fungoides and Sezary syndrome, especially for triaging lymph nodes that would otherwise not be sampled or for evaluating multiple lymph nodes.
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Affiliation(s)
- Reetesh K Pai
- Department of Pathology, Stanford University, Stanford, California 94305, USA.
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16
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de Larrinoa AF, del Cura J, Zabala R, Fuertes E, Bilbao F, Lopez JI. Value of ultrasound-guided core biopsy in the diagnosis of malignant lymphoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:295-301. [PMID: 17486566 DOI: 10.1002/jcu.20383] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Ultrasound-guided core needle biopsy for the diagnosis and management of malignant lymphomas is controversial and has not been accepted as an alternative to surgical biopsy. We investigate the clinical usefulness of this procedure in a large series of patients. METHODS Over a 5-year period (2000-2004), ultrasound-guided core needle biopsies were performed in 102 malignant lymphomas. Five diagnostic categories were considered: large B-cell lymphomas (LBCL), small B-cell lymphomas (SBCL), Hodgkin's disease (HD), T cell lymphomas, and miscellaneous. Surgical excisional biopsy of the node was performed in 47 cases (46.1%) for diagnostic confirmation. RESULTS The overall diagnostic accuracy of ultrasound-guided core needle biopsy was 88.2% (90/102). SBCL (39), LBCL (36), HD (15), T cell lymphomas (5), and miscellaneous (7) [including T cell-rich B cell (2), natural killer cell (1), Burkitt's lymphoma (1), and non-Hodgkin's lymphoma of the B cell type, NOS (3)] were correctly diagnosed. Three HDs, 1 natural killer cell lymphoma, 1 follicular lymphoma, and 1 LBCL were not correctly diagnosed. The core needle biopsy did not yield tumor tissue in 6 cases. CONCLUSIONS Ultrasound-guided core needle biopsy is effective in the diagnosis of malignant lymphomas and can be used as the first diagnostic approach in selected clinical situations.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy/methods
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/pathology
- Female
- Hodgkin Disease/diagnosis
- Humans
- Killer Cells, Natural/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Lymph Nodes/pathology
- Lymphoma/diagnosis
- Lymphoma/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, Follicular/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, T-Cell/diagnosis
- Male
- Middle Aged
- Prospective Studies
- Ultrasonography, Interventional
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17
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Mellanby RJ, Mellor P, Villiers EJ, Herrtage ME, Halsall D, O'Rahilly S, McNeil PE, Mee AP, Berry JL. Hypercalcaemia associated with granulomatous lymphadenitis and elevated 1,25 dihydroxyvitamin D concentration in a dog. J Small Anim Pract 2006; 47:207-12. [PMID: 16573764 DOI: 10.1111/j.1748-5827.2006.00019.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A seven-year-old Labrador was presented with weight loss and mild generalised lymphadenopathy. Histopathology of an excised lymph node by the referring veterinarian demonstrated granulomatous lymphadenitis. At the time of referral, fine-needle aspirates of the lymph nodes confirmed the presence of ongoing granulomatous inflammation. Further investigations revealed marked hypercalcaemia, a low parathyroid hormone concentration, a parathyroid hormone related protein concentration within the reference range, and an elevated serum concentration of 1,25 dihydroxyvitamin D. An underlying cause of the granulomatous lymphadenitis could not be identified. The clinical signs, hypercalcaemia and elevated serum concentrations of 1,25 dihydroxyvitamin D resolved following prednisolone treatment. In contrast to dogs, hypercalcaemia occurred secondarily to granulomatous disease and elevated 1,25 dihydroxyvitamin D concentrations is a well-recognised condition in human beings. To the authors' knowledge, this is the first case report to describe elevated serum calcium and 1,25 dihydroxyvitamin D concentrations in a dog with histologically confirmed granulomatous disease.
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Affiliation(s)
- R J Mellanby
- Queen's Veterinary School Hospital, University of Cambridge
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18
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Meara RS, Reddy V, Arnoletti JP, Jhala D, Varadarajulu S, Jhala N. Hairy cell leukemia: a diagnosis by endoscopic ultrasound guided fine needle aspiration. Cytojournal 2006; 3:1. [PMID: 16430774 PMCID: PMC1402319 DOI: 10.1186/1742-6413-3-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 01/23/2006] [Indexed: 11/10/2022] Open
Abstract
Background Endosonography (EUS) guided FNA is a relatively new imaging modality which is increasingly used for sampling deep-seated lymph nodes in the diagnosis and staging of various malignancies, both primary as well as metastatic. It is also useful for staging of non-Hodgkin's lymphoma as well as diagnosing recurrence. The diagnosis of leukemia on FNA samples from deep-seated lymphadenopathy poses an even greater challenge. Hairy cell leukemia (HCL) is an uncommon, but distinct, lympho-proliferative disorder of B cell origin. It usually affects the spleen and bone marrow and uncommonly involves lymph nodes. There are only a few cases reported where HCL was diagnosed on FNA specimens. Case presentation We report the first case of HCL accurately rendered on EUS-FNA samples. Conclusion This report underscores the concept that the presence of a cytopathologist in the endoscopy suite plays an important role in providing accurate diagnoses of lymphoid lesions biopsied with EUS-FNA.
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Affiliation(s)
- Regina S Meara
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishnu Reddy
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Darshana Jhala
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shyam Varadarajulu
- Department of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nirag Jhala
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
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19
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Caraway NP. Strategies to diagnose lymphoproliferative disorders by fine-needle aspiration by using ancillary studies. Cancer 2005; 105:432-42. [PMID: 16222688 DOI: 10.1002/cncr.21452] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nancy P Caraway
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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20
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Laane E, Tani E, Björklund E, Elmberger G, Everaus H, Skoog L, Porwit-MacDonald A. Flow cytometric immunophenotyping including Bcl-2 detection on fine needle aspirates in the diagnosis of reactive lymphadenopathy and non-Hodgkin's lymphoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2005; 64:34-42. [PMID: 15669024 DOI: 10.1002/cyto.b.20043] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) with immunophenotyping by immunocytochemistry (IC) on cytospins has recently received increased consideration in the diagnosis of lymphoma. The aim of our study was to establish the diagnostic value of a four-color flow cytometric (FCM) panel, including cytoplasmic Bcl-2, in cytologic diagnosis of malignant non-Hodgkin's lymphoma (NHL) and reactive lymphoid hyperplasia (RH). METHODS We investigated 424 FNAs from 396 patients. FCM panel included lambda/kappa/CD19/CD5, CD23/CD10/CD20/CD19, CD4/CD7/CD8/CD3 and Bcl-2/CD10/CD19/CD3 in fluorescein isothiocyanate, phycoerythrin, and peridinin chlorophyll protein or a tandem conjugate of R-phycoerythrin and indodicarbocyanine and allophycocyanin. Bcl-2 expression was evaluated separately for gated B and T cells. RESULTS In 97% of 172 RH samples, FCM was concordant with the diagnosis. FCM gave correct immunologic diagnosis in 95% of low-grade B-cell NHLs, 78% of high-grade B-cell NHLs, and 53% of T-cell lymphomas. Malignant B cells had higher Bcl-2 expression than did reactive B and T cells. This helped to establish a correct diagnosis especially in cases where no clear-cut monoclonality could be shown by kappa/lambda staining or where there was no expression of surface light chain. The highest Bcl-2 expression was found in follicular lymphomas. CONCLUSION Our FCM panel allowed precise classification of NHL in FNA material in 89.5% of all samples. Bcl-2 staining can be recommended for primary differentiation between reactive hyperplasia and NHL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- B-Lymphocytes/chemistry
- B-Lymphocytes/pathology
- Biopsy, Fine-Needle
- CD4-CD8 Ratio
- Cell Proliferation
- Child
- Child, Preschool
- Female
- Flow Cytometry/methods
- Humans
- Immunoglobulin kappa-Chains/analysis
- Immunoglobulin lambda-Chains/analysis
- Immunophenotyping/methods
- Lymphocyte Count
- Lymphoma, Non-Hodgkin/blood
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, T-Cell/blood
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/pathology
- Male
- Middle Aged
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Pseudolymphoma/blood
- Pseudolymphoma/diagnosis
- Pseudolymphoma/pathology
- Sensitivity and Specificity
- T-Lymphocytes/chemistry
- T-Lymphocytes/pathology
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Affiliation(s)
- Edward Laane
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
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21
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Tong GX, Hernandez O, Yee HT, Zheng SH, Yang GCH. Human T-lymphotropic virus type-1 related adult T-cell leukemia/lymphoma presenting as a parotid mass diagnosed by fine-needle aspiration biopsy. Diagn Cytopathol 2004; 31:333-7. [PMID: 15468115 DOI: 10.1002/dc.20121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 48-yr-old black woman with a history of blood transfusions for menorrhagia secondary to uterine fibroids but no known Caribbean association presented with a 6-wk history of a rapidly enlarging right parotid mass. At the time of presentation, she could not close her right eye. An aspiration biopsy showed small, medium, and large lymphoma cells with angulated nuclei, red macronucleoli, and basophilic cytoplasm with fine vacuoles. Flow cytometry indicated a (CD25(+)/CD7(-)) T-cell lineage, suggesting an human T-lymphotropic virus (HTLV) 1-related T-cell leukemia/lymphoma, which was confirmed by polymerase chain reaction (PCR)-based amplification on DNA extracted from fresh tissue with specific oligonucleotide primers for HTLV-1 DNA sequence. Histology showed interstitial infiltration and destruction of the parotid parenchyma by lymphoma cells without involvement of adjacent lymph nodes. Total body CT scan and magnetic resonance imaging (MRI) studies were negative for lymphadenopathy but showed liver metastasis. To our knowledge, this is the first reported case of HTLV-1-related primary parotid lymphoma as the initial presentation of adult T-cell leukemia/lymphoma.
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Affiliation(s)
- Guo-Xia Tong
- Department of Pathology, New York University School of Medicine, New York, New York 10016, USA
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22
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De Samblanx H, Verhoef G, Zachée P, Vandenberghe P. A male with angioimmunoblastic T-cell lymphoma and proliferative glomerulonephritis. Ann Hematol 2004; 83:455-9. [PMID: 15034757 DOI: 10.1007/s00277-003-0828-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Accepted: 11/06/2003] [Indexed: 11/29/2022]
Abstract
In this article we present the case report of a 67-year-old male with a nephrotic syndrome due to a proliferative glomerulonephritis, associated with an angioimmunoblastic T-cell lymphoma. Diagnosis was made on an axillary lymph node biopsy and showed expanded T-cell areas with multiple blood vessels, small mature lymphocytes, eosinophils, and plasma cells. A kidney biopsy was suggestive for a proliferative glomerulonephritis with intra- and extracapillary proliferation. Hypercellular glomeruli were seen, as well as multiple floride crescents. Interstitial edema and fibrosis were absent. Immunohistochemical reactions were negative; there was some mesangial reaction with IgM in the glomeruli. Treatment with high-dose corticosteroids was initiated, with clinical improvement, and was immediately followed by therapy with cyclophosphamide, hydroxydaunomycin, vincristine, and prednisone (CHOP), which induced complete remission with a follow-up of 1 year. To our knowledge, the association of angioimmunoblastic T-cell lymphoma and proliferative glomerulonephritis has only been described twice. It concerned elderly men who developed acute renal failure a couple of months after the diagnosis of an angioimmunoblastic T-cell lymphoma. In both, immunoglobulin-containing dense deposits within glomeruli were observed, which was not the case in our patient, where only some mesangial colorization of the IgM in the glomeruli was seen.
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23
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Zeppa P, Marino G, Troncone G, Fulciniti F, De Renzo A, Picardi M, Benincasa G, Rotoli B, Vetrani A, Palombini L. Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-Hodgkin lymphoma: a critical review of 307 cases with technical suggestions. Cancer 2004; 102:55-65. [PMID: 14968418 DOI: 10.1002/cncr.11903] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Flow cytometry (FC) is a useful adjunct to fine-needle aspiration cytology (FNC) in evaluating lymphoproliferative disorders. The authors present a critical review of 307 lymph nodal and extra lymph nodal lymphoproliferative disorders that were diagnosed with FNC and FC. METHODS FC was performed over a 4-year period on 185 palpable and 122 impalpable lymph nodal and extra lymph nodal lymphoproliferative processes under ultrasound or computed tomography guidance. FC was performed using the following fluoresceinated antibodies: CD3, CD4/CD8, CD2/CD7/CD3, CD5/CD10/CD19, CD19/kappa/lambda, FMC7/CD23/CD19, CD38/CD56/CD19, and bcl-2. The series included 15 inadequate, 10 suspicious, and 135 benign reactive hyperplasias (BRHs); 70 primary non-Hodgkin lymphomas (NHLs), and 77 recurrent NHLs (rNHLs). FC/FNC diagnoses of suspicious, NHL, and rNHL were controlled either histologically or clinically or by the interphase fluorescence in situ hybridization demonstration of t(11;14)(q13;q32) in two cases of mantle cell lymphoma. BRHs were controlled by follow-up. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the FC/FNC diagnoses of NHL, rNHL, and BRH were calculated as well as the identification of specific subtypes among the small- and medium-sized cells. RESULTS Statistical analysis showed 93% sensitivity, 100% specificity, 100% PPV, and 91% NPV in NHL, rNHL, and BRH discrimination. The subclassification of small cell and medium-sized NHLs showed 63% sensitivity, 88% specificity, 95% PPV, and 37% NPV. CONCLUSIONS FC applied to FNC enhanced the precision of cytologic diagnosis in lymph nodal and extra lymph nodal lymphoproliferative disorders and allowed further subclassification in more than half of the cases, thus avoiding invasive surgical biopsies in many patients.
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Affiliation(s)
- Pio Zeppa
- Dipartimento di Anatomia Patologica e Citopatologia, Facoltà di Medicina e Chirurgia, Università di Napoli Federico II, Naples, Italy
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24
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Bultoma en hipocondrio y vacío izquierdos tras traumatismo casual en parrilla costal izquierda. Rev Clin Esp 2004. [DOI: 10.1016/s0014-2565(04)71459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Affiliation(s)
- Aseem Lal
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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26
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Mayall F, Darlington A, Harrison B. Fine needle aspiration cytology in the diagnosis of uncommon types of lymphoma. J Clin Pathol 2003; 56:821-5. [PMID: 14600125 PMCID: PMC1770093 DOI: 10.1136/jcp.56.11.821] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Fine needle aspiration (FNA) cytology is an accepted means of diagnosing and typing common forms of lymphoma, particularly small lymphocytic lymphoma, follicular lymphoma, and large B cell lymphoma. However, its usefulness for diagnosing less common forms of lymphoma is not clearly established and this study was designed to examine this. METHODS The study reviewed the FNAs of suspected lymphomas collected over a period of approximately five years. RESULTS FNA samples were available for 138 definite lymphomas; most were common forms of B cell lymphoma. However, there was also one Burkitt lymphoma (BL), two Burkitt-like large B cell lymphomas, 15 classic Hodgkin lymphomas (HLs), two nodular lymphocyte predominant Hodgkin lymphomas, four mantle cell lymphomas, two mediastinal (thymic) large B cell lymphomas (MLBCLs), 11 peripheral T cell lymphomas (PTCLs), and five T cell rich large B cell lymphomas (TCRLBCLs). CONCLUSIONS FNA diagnosis of BL was possible with immunoflow cytometry (IFC), cell block immunohistochemistry (IHC), and cell block fluorescent in situ hybridisation for c-myc alteration. It was difficult to make a definite diagnosis of HL and MLBCL on FNA alone. Both tend to be sclerotic tumours and FNA tends to yield scanty neoplastic cells. The FNA diagnosis of PTCL depended on cell block IHC; IFC was not usually useful. TCRLBCL did not show light chain restriction on IFC of FNA samples, probably because of frequent reactive B cells in the tumour. Thus, HL, MLBCL, and TCRLBCL are often difficult to diagnose accurately on FNA cytology, even when using IFC and cell block IHC.
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Affiliation(s)
- F Mayall
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand.
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Dahmoush L, Hijazi Y, Barnes E, Stetler-Stevenson M, Abati A. Adult T-cell leukemia/lymphoma: a cytopathologic, immunocytochemical, and flow cytometric study. Cancer 2002; 96:110-6. [PMID: 11954028 DOI: 10.1002/cncr.10480] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Adult T-cell leukemia/lymphoma (ATLL) is a postthymic lymphoproliferative neoplasm of T cells caused by human T-cell lymphotropic virus (HTLV-1). Most cases are found in Japan, the Caribbean basin, and West Africa. DESIGN To identify diagnostic parameters for cytology in this neoplasm, the authors undertook a retrospective review of all ATLL samples from 1990 to 2000. RESULTS One hundred fourteen samples from 34 patients with the diagnosis of ATLL were reviewed: 80 cerebrospinal fluids, 7 pleural effusions, 4 bronchoalveolar lavages, 2 peritoneal effusions as well as fine-needle aspirations of 15 lymph nodes, 4 subcutaneous lesions, and 2 breast nodules. Twenty-one patients were women and 13 were men, with an age range of 30 to 71 years. Morphologically, all specimens were characterized by the presence of a polymorphous population of lymphocytes ranging from small bland-appearing lymphocytes to large atypical ones with bizarre, multilobulated nuclei (flower-like or clover leaf cells) with coarse chromatin and prominent nucleoli. The cytoplasm was deeply basophilic with occasional vacuoles. Immunocytochemistry was performed on 17 specimens from 14 patients. In all cases tested, tumor cells were immunoreactive for CD3, CD4, CD5, and CD25 and were nonimmunoreactive for CD7 and CD8. Flow cytometry was performed on 12 specimens from 9 patients. The tumor cells in all cases tested were positive for CD2, CD3, CD4, CD5, and CD25 and were negative for CD7. CONCLUSIONS Despite the polymorphous nature of ATLL, diagnosis can be established by close attention to nuclear cytologic features in conjunction with ancillary studies such as immunocytochemistry and/or flow cytometry.
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Affiliation(s)
- Laila Dahmoush
- National Institutes of Health/National Cancer Institute, Section of Cytopathology, Bethesda, Maryland 20892, USA
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