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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

Fine needle samples of chronic lymphocytic leukemia/small lymphocytic lymphoma examined after Papanicolaou stain. Several ill-defined cellular aggregates (circle) are visible at low power inspection giving the impression of vague nodularity (a). High-power examination reveals the peculiar chromatin distribution and presence of numerous prolymphocytes (red arrowheads) within this area of increased cell density (b). Note the coarse distribution of the chromatin and tinctorial quality of the nucleoli in the prolymphocytes in this stain. ((a) and (b): Papanicolaou; (a): 10x, (b): 63x).
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fig5: Fine needle samples of chronic lymphocytic leukemia/small lymphocytic lymphoma examined after Papanicolaou stain. Several ill-defined cellular aggregates (circle) are visible at low power inspection giving the impression of vague nodularity (a). High-power examination reveals the peculiar chromatin distribution and presence of numerous prolymphocytes (red arrowheads) within this area of increased cell density (b). Note the coarse distribution of the chromatin and tinctorial quality of the nucleoli in the prolymphocytes in this stain. ((a) and (b): Papanicolaou; (a): 10x, (b): 63x).

Mentions: SLL/CLL is characterized by a monomorphic cellular aspirate often without conspicuous nodularity or presence of aggregates. Thicker areas of a smear occasionally show poorly defined aggregates of cells that may correspond to the proliferation centers associated with SLL/CLL (Figures 3(e) and 5(a)). In Romanowsky-stained smears these are appreciated as darker zones at low power, whereas in H&E-stained histologic sections proliferation centers appear as pale zones. Proliferation centers differ from FCFs in that they do not contain follicular dendritic cells. At higher magnification, small lymphoid cells with smooth-contoured nuclei and minimal cytoplasm predominate (Figure 4(e)). The chromatin frequently has a peculiar coarsely clumped appearance best appreciated on Papanicolaou-stained slides which led to the original designation as “cellules grumelées” [33, 34] (Figure 5(b)), a term which refers to clotted milk or cheese curd. “Soccer balls” might be a better modern appellation. Most cases have interspersed intermediate-sized prolymphocytes with dispersed chromatin and obvious nucleolus as well as paraimmunoblasts with broader, pale cytoplasm, vesicular chromatin, and large central nucleolus (Figures 4(e) and 5(b)). Both cell types are most often seen in those ill-defined aggregates corresponding to the proliferation centers, and their presence provides a clue towards the diagnosis. A common artifact in smears from patients with CLL/SLL is the presence of smudge cells, also referred to as basket cells or shadow cells of Gumprecht, which are lymphoid cells stripped of their cytoplasm with the nuclear material dispersed on the slide. This artifact, however, is not specific to CLL/SLL. In samples with more than a few cells with plasmacytoid features, lymphoplasmacytic lymphoma (LPL) needs to be considered in the differential diagnosis to CLL/SLL. Another important differential diagnosis is the benign, minimal enlarged lymph node with a high proportion of small lymphocytes and few secondary follicles which, at first glance, may cause a similarly monotonous impression as CLL/SLL [35].


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

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

Fine needle samples of chronic lymphocytic leukemia/small lymphocytic lymphoma examined after Papanicolaou stain. Several ill-defined cellular aggregates (circle) are visible at low power inspection giving the impression of vague nodularity (a). High-power examination reveals the peculiar chromatin distribution and presence of numerous prolymphocytes (red arrowheads) within this area of increased cell density (b). Note the coarse distribution of the chromatin and tinctorial quality of the nucleoli in the prolymphocytes in this stain. ((a) and (b): Papanicolaou; (a): 10x, (b): 63x).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Fine needle samples of chronic lymphocytic leukemia/small lymphocytic lymphoma examined after Papanicolaou stain. Several ill-defined cellular aggregates (circle) are visible at low power inspection giving the impression of vague nodularity (a). High-power examination reveals the peculiar chromatin distribution and presence of numerous prolymphocytes (red arrowheads) within this area of increased cell density (b). Note the coarse distribution of the chromatin and tinctorial quality of the nucleoli in the prolymphocytes in this stain. ((a) and (b): Papanicolaou; (a): 10x, (b): 63x).
Mentions: SLL/CLL is characterized by a monomorphic cellular aspirate often without conspicuous nodularity or presence of aggregates. Thicker areas of a smear occasionally show poorly defined aggregates of cells that may correspond to the proliferation centers associated with SLL/CLL (Figures 3(e) and 5(a)). In Romanowsky-stained smears these are appreciated as darker zones at low power, whereas in H&E-stained histologic sections proliferation centers appear as pale zones. Proliferation centers differ from FCFs in that they do not contain follicular dendritic cells. At higher magnification, small lymphoid cells with smooth-contoured nuclei and minimal cytoplasm predominate (Figure 4(e)). The chromatin frequently has a peculiar coarsely clumped appearance best appreciated on Papanicolaou-stained slides which led to the original designation as “cellules grumelées” [33, 34] (Figure 5(b)), a term which refers to clotted milk or cheese curd. “Soccer balls” might be a better modern appellation. Most cases have interspersed intermediate-sized prolymphocytes with dispersed chromatin and obvious nucleolus as well as paraimmunoblasts with broader, pale cytoplasm, vesicular chromatin, and large central nucleolus (Figures 4(e) and 5(b)). Both cell types are most often seen in those ill-defined aggregates corresponding to the proliferation centers, and their presence provides a clue towards the diagnosis. A common artifact in smears from patients with CLL/SLL is the presence of smudge cells, also referred to as basket cells or shadow cells of Gumprecht, which are lymphoid cells stripped of their cytoplasm with the nuclear material dispersed on the slide. This artifact, however, is not specific to CLL/SLL. In samples with more than a few cells with plasmacytoid features, lymphoplasmacytic lymphoma (LPL) needs to be considered in the differential diagnosis to CLL/SLL. Another important differential diagnosis is the benign, minimal enlarged lymph node with a high proportion of small lymphocytes and few secondary follicles which, at first glance, may cause a similarly monotonous impression as CLL/SLL [35].

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