Fine-Needle Aspiration Biopsy Findings in Patients With Small Lymphocytic Lymphoma Transformed to Hodgkin Lymphoma (original) (raw)
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Hodgkin's lymphoma: Diagnostic difficulties in fine-needle aspiration cytology
Diagnostic Cytopathology, 2009
It is commonly believed that cytodiagnosis of Hodgkin's lymphoma (HL) is much easier than that of non-Hodgkin lymphoma (NHL). However, recognition of certain NHL subtypes with Reed-Sternberg (R-S)-like cells and results of immunohistochemical studies point to the contrary. To study the limitations of cytology in diagnosis of HL, fine-needle aspiration (FNA) smears of 130 lymphoma or suspected lymphoma cases were reviewed. Initial and reviewed cytodiagnoses were compared with histopathology in 89 cases. Immunocytochemical and immunohistochemical studies were performed in 56 and 59 cases, respectively. Among histologically diagnosed HL cases, definitive cytodiagnosis of HL (initial as well as reviewed) was significantly less frequent than cytodiagnosis of NHL among histologically diagnosed NHL cases (P = 0.0328 and = 0.0001, respectively). On the other hand, cytologically diagnosed HL/NHL cases were significantly more frequent in the former group (P = 0.0001 and = 0.0018, respectively). ALCL and TCRBCL were the two NHL subtypes which created confusion with HL in FNA smears. Twenty-one cytohistological concordant HL cases and equal number of discordant cases were compared. When compared with discordant group, the patients in concordant group were significantly younger (P = 0.045). Hodgkin/Hodgkin-like cells and typical R-S cells were significantly more frequent in FNA smears of the concordant group (P = 0.0478 and = 0.0431, respectively). Immunocytochemical and immunohistochemical studies showed good correlation with histological diagnosis of HL. It is suggested that proper interpretation of cytologic features, together with use of immunocytochemical parameters can help in reducing the margin of error in cytodiagnois of HL. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc.
Cancer, 2003
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//, 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.
An uncommon morphological presentation of Hodgkin lymphoma
Pathology, 2017
Background: Intravascular lymphoma (IVL) is a rare form of large B cell lymphoma mostly limited to small vessels with relative sparing of surrounding tissues. IVL has a poor prognosis and is often difficult to diagnose antemortem. Case report: A 41-year-old male presented with lethargy, fever and fluid retention. Further investigations were delayed as the patient went overseas. On return to Australia, CT abdomen demonstrated splenomegaly without lymphadenopathy. Clinical differential diagnoses included dengue fever, lymphoproliferative disorder and HLH. Bone marrow aspirate performed for PUO demonstrated a 1% monoclonal B-cell population. CT-PET revealed hypermetabolic spleen, marrow and kidney. Liver biopsy demonstrated sinusoidal atypical lymphocytes and TCR gene rearrangement was requested. Spleen biopsy was inconclusive showing necrotic tissue. Kidney biopsy showed an interstitial infiltrate of diffuse large B cell lymphoma. Within 24 hours of commencing treatment the patient had a right hemicolectomy for massive GI bleed. He died 12 hours post-operatively. Careful examination of the small vessels throughout the resection specimen showed atypical lymphocytes filling their lumina (CD20+, bcl6+, CD10−, CD3−, CD5−, cyclin D1−). No diffuse infiltrate was noted and the lymph nodes appeared reactive. The diagnosis of IVL was established. The review of renal and liver biopsies with CD31 also confirmed IVL. His autopsy showed similar infiltrates. Conclusion: We present this case to highlight the challenges in diagnosing this rare lymphoma. As in many cases, the patient underwent many investigations before the diagnosis was established. It is important to be aware of this entity and examine the small vessels carefully, more so in view of flow cytometry finding of clonal B-cell population.
Diagnostic Cytopathology, 2003
, phenotypic, genotypic, and clinical characteristics of NHL. For the most part, the classification does not rely on architectural pattern for classification of neoplasms. This classification makes it possible to diagnose and classify lymphomas by fine-needle aspiration (FNA). In this study, we attempted to evaluate the accuracy of FNA in diagnosing and classifying NHL within the context of the REAL/ WHO classifications. Cases included only those in which FNA was the primary diagnosis, followed by a surgical biopsy for confirmation. Flow cytometry (FCM) for phenotyping was carried out whenever material was available. Two groups of pathologists were identified. Group A consisted of pathologists with background training in cytopathology and/or hematopathology (three pathologists). Group B consisted of experienced surgical pathologists with no training in cytopathology and/or hematopathology (four pathologists). Seventy-four cases were included in the study. FCM phenotyping was performed in 53 cases (71%). Large cell lymphoma constituted 63% of the cases. The remaining lymphomas included Burkitt's, small lymphocytic, lymphoblastic, follicle center cell, Ki-1, mantle cell, marginal zone, and natural killer cell lymphoma. The diagnosis of lymphoma was rendered for all cases. The correct classification was seen in 63% of the cases. Classification was more accurate in immunophenotyped than in nonimmunophenotyped cases (84% vs 33%; P ϭ 0.00004). Group A pathologists showed higher incidence of proper classification than group B (80% vs 56%; P ϭ 0.046). The diagnosis and classifica-tion of NHL can be achieved in a large number of cases on FNA material. This accuracy can be increased if cytomorphologic criteria are established for different entities of NHL aided by FCM for phenotyping. Diagn. Cytopathol. 2003;28:191-195.
Case Reports in Oncology
Chronic lymphocytic leukemia (CLL) typically pursues a prolonged course. Its transformation into a more aggressive lymphoma occurs in 2–8% of all patients. Most commonly, diffuse large B-cell lymphoma develops. Transformation into a classical Hodgkin’s lymphoma (cHL) occurs in <1%. Plasmablastic transformation has been only rarely reported. Cases of synchronous divergent transformation of CLL into a composite lymphoma are exceedingly rare. We describe the unique occurrence of the transformation of a long-standing CLL into a synchronous clonally related cHL as well as plasmablastic lymphoma (PBL) in an 85-year-old female patient. After 10 years of asymptomatic CLL, our patient was treated with a rituximab-chlorambucil scheme in combination with pegfilgrastim for recurrent infections and the development of B symptoms. Five cycles (of six planned) were administrated with no adverse effects. After the fifth cycle, lymphadenopathy with pronounced B symptoms appeared. Histology showed ...