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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

Smears produced from lymph node fine-needle samples and examined at high power. High power assessment shows the differences in cell composition between reactive lymphoid hyperplasia (a) and the cytological features of the neoplastic cells in marginal zone lymphoma (b), follicular lymphoma (c), mantle cell lymphoma (d), chronic lymphocytic leukemia/small lymphocytic lymphoma (e), and lymphoplasmacytic lymphoma (f). Follicular dendritic cells (black arrowheads), tingible body macrophages (black arrow) and mitoses (white arrows) are present within a lymphohistiocytic aggregate seen in reactive lymphoid hyperplasia. Monocytoid B-cells (red arrow) and plasmacytoid cells (white arrowheads) are often found in marginal zone lymphoma. Follicular dendritic cells are a prominent feature of follicle center fragments present in samples of follicular lymphoma. These follicle center fragments do not show the other constituents seen in the lymphohistiocytic aggregates of a reactive lymph node. Mitoses are also a frequent finding in mantle cell lymphoma, but are not commonly seen in the other types of B-cell non-Hodgkin lymphoma illustrated here. Prolymphocytes (red arrowheads) are often found in areas of vague nodularity present in smears of chronic lymphocytic leukemia/small lymphocytic lymphoma and identified by a nucleolus which has a tinctorial quality similar to the cytoplasm of the cell. Plasmacytoid cells and mast cells (f: left lower image quadrant) are constituents seen in lymphoplasmacytic lymphoma. (d: Diff-Quik, all other: May-Grünwald-Giemsa; 63x).
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fig4: Smears produced from lymph node fine-needle samples and examined at high power. High power assessment shows the differences in cell composition between reactive lymphoid hyperplasia (a) and the cytological features of the neoplastic cells in marginal zone lymphoma (b), follicular lymphoma (c), mantle cell lymphoma (d), chronic lymphocytic leukemia/small lymphocytic lymphoma (e), and lymphoplasmacytic lymphoma (f). Follicular dendritic cells (black arrowheads), tingible body macrophages (black arrow) and mitoses (white arrows) are present within a lymphohistiocytic aggregate seen in reactive lymphoid hyperplasia. Monocytoid B-cells (red arrow) and plasmacytoid cells (white arrowheads) are often found in marginal zone lymphoma. Follicular dendritic cells are a prominent feature of follicle center fragments present in samples of follicular lymphoma. These follicle center fragments do not show the other constituents seen in the lymphohistiocytic aggregates of a reactive lymph node. Mitoses are also a frequent finding in mantle cell lymphoma, but are not commonly seen in the other types of B-cell non-Hodgkin lymphoma illustrated here. Prolymphocytes (red arrowheads) are often found in areas of vague nodularity present in smears of chronic lymphocytic leukemia/small lymphocytic lymphoma and identified by a nucleolus which has a tinctorial quality similar to the cytoplasm of the cell. Plasmacytoid cells and mast cells (f: left lower image quadrant) are constituents seen in lymphoplasmacytic lymphoma. (d: Diff-Quik, all other: May-Grünwald-Giemsa; 63x).

Mentions: Reactive lymphoid hyperplasia (RLH) is the most common cause for a polymorphic lymphoid cell pattern in a fine-needle sample and is mostly associated with benign, reactive and reversible lymphadenopathy. The histologic correlate is an expansion of the sinusoidal, follicular, paracortical, or medullary area of a lymph node leading to corresponding changes in cellular composition. Two distinct patterns of RLH exist with (a) follicular hyperplasia as correlate of a B-cell response and (b) paracortical hyperplasia as correlate of a T-cell response [12]. Both patterns are characterized by a spectrum of differentiation of the lymphoid cells with numerous small mature lymphocytes in the background resulting in a polymorphic impression at low power assessment (Figure 3(a)). In follicular hyperplasia, LHAs of variable size with conspicuous TBMs are often evident at low power, and a mixture of centrocytes, centroblasts, and plasma cells is prominent (Figure 4(a)). Immunoblasts are dominant in paracortical hyperplasia, particularly viral lymphadenopathy. It is important to note, however, that the two reaction patterns, follicular and paracortical hyperplasia, often present together. Also, temporal changes in the cell composition occur until the RLH resolves and are associated with concomitant cytologic variations.


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

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

Smears produced from lymph node fine-needle samples and examined at high power. High power assessment shows the differences in cell composition between reactive lymphoid hyperplasia (a) and the cytological features of the neoplastic cells in marginal zone lymphoma (b), follicular lymphoma (c), mantle cell lymphoma (d), chronic lymphocytic leukemia/small lymphocytic lymphoma (e), and lymphoplasmacytic lymphoma (f). Follicular dendritic cells (black arrowheads), tingible body macrophages (black arrow) and mitoses (white arrows) are present within a lymphohistiocytic aggregate seen in reactive lymphoid hyperplasia. Monocytoid B-cells (red arrow) and plasmacytoid cells (white arrowheads) are often found in marginal zone lymphoma. Follicular dendritic cells are a prominent feature of follicle center fragments present in samples of follicular lymphoma. These follicle center fragments do not show the other constituents seen in the lymphohistiocytic aggregates of a reactive lymph node. Mitoses are also a frequent finding in mantle cell lymphoma, but are not commonly seen in the other types of B-cell non-Hodgkin lymphoma illustrated here. Prolymphocytes (red arrowheads) are often found in areas of vague nodularity present in smears of chronic lymphocytic leukemia/small lymphocytic lymphoma and identified by a nucleolus which has a tinctorial quality similar to the cytoplasm of the cell. Plasmacytoid cells and mast cells (f: left lower image quadrant) are constituents seen in lymphoplasmacytic lymphoma. (d: Diff-Quik, all other: May-Grünwald-Giemsa; 63x).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: Smears produced from lymph node fine-needle samples and examined at high power. High power assessment shows the differences in cell composition between reactive lymphoid hyperplasia (a) and the cytological features of the neoplastic cells in marginal zone lymphoma (b), follicular lymphoma (c), mantle cell lymphoma (d), chronic lymphocytic leukemia/small lymphocytic lymphoma (e), and lymphoplasmacytic lymphoma (f). Follicular dendritic cells (black arrowheads), tingible body macrophages (black arrow) and mitoses (white arrows) are present within a lymphohistiocytic aggregate seen in reactive lymphoid hyperplasia. Monocytoid B-cells (red arrow) and plasmacytoid cells (white arrowheads) are often found in marginal zone lymphoma. Follicular dendritic cells are a prominent feature of follicle center fragments present in samples of follicular lymphoma. These follicle center fragments do not show the other constituents seen in the lymphohistiocytic aggregates of a reactive lymph node. Mitoses are also a frequent finding in mantle cell lymphoma, but are not commonly seen in the other types of B-cell non-Hodgkin lymphoma illustrated here. Prolymphocytes (red arrowheads) are often found in areas of vague nodularity present in smears of chronic lymphocytic leukemia/small lymphocytic lymphoma and identified by a nucleolus which has a tinctorial quality similar to the cytoplasm of the cell. Plasmacytoid cells and mast cells (f: left lower image quadrant) are constituents seen in lymphoplasmacytic lymphoma. (d: Diff-Quik, all other: May-Grünwald-Giemsa; 63x).
Mentions: Reactive lymphoid hyperplasia (RLH) is the most common cause for a polymorphic lymphoid cell pattern in a fine-needle sample and is mostly associated with benign, reactive and reversible lymphadenopathy. The histologic correlate is an expansion of the sinusoidal, follicular, paracortical, or medullary area of a lymph node leading to corresponding changes in cellular composition. Two distinct patterns of RLH exist with (a) follicular hyperplasia as correlate of a B-cell response and (b) paracortical hyperplasia as correlate of a T-cell response [12]. Both patterns are characterized by a spectrum of differentiation of the lymphoid cells with numerous small mature lymphocytes in the background resulting in a polymorphic impression at low power assessment (Figure 3(a)). In follicular hyperplasia, LHAs of variable size with conspicuous TBMs are often evident at low power, and a mixture of centrocytes, centroblasts, and plasma cells is prominent (Figure 4(a)). Immunoblasts are dominant in paracortical hyperplasia, particularly viral lymphadenopathy. It is important to note, however, that the two reaction patterns, follicular and paracortical hyperplasia, often present together. Also, temporal changes in the cell composition occur until the RLH resolves and are associated with concomitant cytologic variations.

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