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Diagnosis of B-cell non-hodgkin lymphomas with small-/intermediate-sized cells in cytopathology.

Schwock J, Geddie WR - Patholog Res Int (2012)

Bottom Line: Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy.Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis.We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls.

View Article: PubMed Central - PubMed

Affiliation: Division of Anatomical Pathology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto General Hospital, Room E11-219, Toronto, ON, Canada M5G 2C4.

ABSTRACT
Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy. The cytologic diagnosis of B-cell non-Hodgkin lymphomas composed of small-/intermediate-sized cells, however, has been seen as an area of great difficulty even for experienced observers due to the morphologic overlap between lymphoma and reactive lymphadenopathies as well as between the lymphoma entities themselves. Although ancillary testing has improved diagnostic accuracy, the results from these tests must be interpreted within the morphological and clinical context to avoid misinterpretation. Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis. For these reasons, we here review the cytologic characteristics particular to five common B-cell non-Hodgkin lymphomas which typically cause the most diagnostic confusion based on cytological assessment alone: marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and lymphoplasmacytic lymphoma. We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls.

No MeSH data available.


Related in: MedlinePlus

Historical depiction of different lymphoid cell types. Schleip examined the heterogeneity of lymphoid cells in peripheral blood films. This image taken from the atlas published based on his observations illustrates the variable nuclear morphology and cytoplasmic content of benign lymphoid cells in different states of activation.
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fig1: Historical depiction of different lymphoid cell types. Schleip examined the heterogeneity of lymphoid cells in peripheral blood films. This image taken from the atlas published based on his observations illustrates the variable nuclear morphology and cytoplasmic content of benign lymphoid cells in different states of activation.

Mentions: Readily recognizable normal lymphoid constituents seen in fine-needle samples from benign/reactive lymph nodes include small round lymphocytes (either functionally “naïve” or terminally differentiated memory cells or unstimulated T-cells), centrocytes, centroblasts, immunoblasts, and plasma cells. Common nonlymphoid cell types present in the aspirate are follicular and interdigitating dendritic cells located mainly in germinal centers and paracortex, respectively. Constituents such as histiocytes, macrophages, plasmacytoid monocytes, and epithelioid cells are related to the mononuclear-phagocyte system. Other cell types are mast cells, basophils, neutrophils, eosinophils, endothelial cells, and occasional fat cells. Small lymphocytes have an approximate size of 6–12 micrometers, comparable to a histiocyte nucleus. Practically, erythrocytes and neutrophils are more convenient comparators. The small lymphocyte is usually about twice the size of an erythrocyte and somewhat smaller than the nucleus of a segmented neutrophil. Mature, circulating lymphocytes dominate at the lower end of this size spectrum and activated lymphocytes at the upper end. Large lymphocytes may exceed 20 micrometer size, equivalent to or greater than the diameter of 3 erythrocytes, and larger than a histiocyte or neutrophil nucleus. Lymphocytes that fulfill neither size criterion, usually designated as “intermediate,” include many centrocytes and some centroblasts. It is not unusual for a “small” B-cell lymphoma to be composed mainly of cells that fall into this intermediate size range. This broad spectrum of lymphocyte size and morphology has been long recognized and documented (Figure 1) [15].


Diagnosis of B-cell non-hodgkin lymphomas with small-/intermediate-sized cells in cytopathology.

Schwock J, Geddie WR - Patholog Res Int (2012)

Historical depiction of different lymphoid cell types. Schleip examined the heterogeneity of lymphoid cells in peripheral blood films. This image taken from the atlas published based on his observations illustrates the variable nuclear morphology and cytoplasmic content of benign lymphoid cells in different states of activation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3368210&req=5

fig1: Historical depiction of different lymphoid cell types. Schleip examined the heterogeneity of lymphoid cells in peripheral blood films. This image taken from the atlas published based on his observations illustrates the variable nuclear morphology and cytoplasmic content of benign lymphoid cells in different states of activation.
Mentions: Readily recognizable normal lymphoid constituents seen in fine-needle samples from benign/reactive lymph nodes include small round lymphocytes (either functionally “naïve” or terminally differentiated memory cells or unstimulated T-cells), centrocytes, centroblasts, immunoblasts, and plasma cells. Common nonlymphoid cell types present in the aspirate are follicular and interdigitating dendritic cells located mainly in germinal centers and paracortex, respectively. Constituents such as histiocytes, macrophages, plasmacytoid monocytes, and epithelioid cells are related to the mononuclear-phagocyte system. Other cell types are mast cells, basophils, neutrophils, eosinophils, endothelial cells, and occasional fat cells. Small lymphocytes have an approximate size of 6–12 micrometers, comparable to a histiocyte nucleus. Practically, erythrocytes and neutrophils are more convenient comparators. The small lymphocyte is usually about twice the size of an erythrocyte and somewhat smaller than the nucleus of a segmented neutrophil. Mature, circulating lymphocytes dominate at the lower end of this size spectrum and activated lymphocytes at the upper end. Large lymphocytes may exceed 20 micrometer size, equivalent to or greater than the diameter of 3 erythrocytes, and larger than a histiocyte or neutrophil nucleus. Lymphocytes that fulfill neither size criterion, usually designated as “intermediate,” include many centrocytes and some centroblasts. It is not unusual for a “small” B-cell lymphoma to be composed mainly of cells that fall into this intermediate size range. This broad spectrum of lymphocyte size and morphology has been long recognized and documented (Figure 1) [15].

Bottom Line: Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy.Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis.We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls.

View Article: PubMed Central - PubMed

Affiliation: Division of Anatomical Pathology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto General Hospital, Room E11-219, Toronto, ON, Canada M5G 2C4.

ABSTRACT
Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy. The cytologic diagnosis of B-cell non-Hodgkin lymphomas composed of small-/intermediate-sized cells, however, has been seen as an area of great difficulty even for experienced observers due to the morphologic overlap between lymphoma and reactive lymphadenopathies as well as between the lymphoma entities themselves. Although ancillary testing has improved diagnostic accuracy, the results from these tests must be interpreted within the morphological and clinical context to avoid misinterpretation. Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis. For these reasons, we here review the cytologic characteristics particular to five common B-cell non-Hodgkin lymphomas which typically cause the most diagnostic confusion based on cytological assessment alone: marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and lymphoplasmacytic lymphoma. We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls.

No MeSH data available.


Related in: MedlinePlus