Fine needle aspiration cytology in the diagnosis of uncommon types of lymphoma

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. I n the past 10 years, fine needle aspiration (FNA) cytology has become accepted as a means of diagnosing and typing common forms of lymphoma, particularly small lymphocytic lymphoma, follicular lymphoma, and large B cell lymphoma.1-8 These types of lymphoma alone make up approximately 70% of all lymphomas. The usefulness of FNA cytology in the diagnosis of these lymphomas is reliant on immunoflow cytometry (IFC) and cell block immunohistochemistry (IHC). It is also reliant on the pathologist making ''near patient'' provisional assessment of the nature of the specimen and then collecting appropriate specimens.However, the usefulness of FNA cytology in the diagnosis of less common forms of lymphoma is not clearly established, and our study set out to examine this issue. METHODSThe method was similar to that described in a previous study from our department. 6 The study was set in a large tertiary referral hospital in rural New Zealand. We reviewed the FNAs of suspected lymphomas collected over a period of approximately five years. Most of these were either benign or were common forms of lymphoma that were not the focus of our present study. The cases selected for further examination were those with a final diagnosis of Burkitt lymphoma, Burkitt-like large B cell lymphoma, classic Hodgkin lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, mediastinal (thymic) large B cell lymphoma, peripheral T cell lymphoma, and T cell ...

Monitoring diagnostic accuracy and complications. A report from the Children's Oncology Group Hodgkin lymphoma study

“…However, other studies have not been as definitive. [15] A study by Mayall et al found the diagnostic accuracy of FNA lower, with HL being particularly difficult to diagnose by FNA [15]. Thus, the role of FNA in the diagnosis of pediatric HL requires further study.…”

Value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas using automated biopsy gun

“…However, this theoretical drawback is rarely encountered [16,28] . Also, primary diagnosis of uncommon lymphomas may be compromised by small samples obtained by needle biopsy, and as with biopsies negative for lymphoma, surgical intervention may be required [16,29] . Indeed, some subtypes of malignant lymphoma might not be definitely diagnosed and categorized by CT-guided core-needle biopsy alone [29,30] .…”

“…Also, primary diagnosis of uncommon lymphomas may be compromised by small samples obtained by needle biopsy, and as with biopsies negative for lymphoma, surgical intervention may be required [16,29] . Indeed, some subtypes of malignant lymphoma might not be definitely diagnosed and categorized by CT-guided core-needle biopsy alone [29,30] . Ben-Yehuda et al [31] , suggested that the most problematic category is mixed small-and large-cell NHL, because of the difficulty in making a reliable assessment of the relative number of large cells present and distinguishing diffuse from nodular patterns in these cases.…”

Cell Block in Cytological Diagnostics: Review of Preparatory Techniques

“…After solidification, it is flooded by formalin and picked up, dried out, and processed. The cells in this block are ­densely packed and suitable for immunohistochemistry [18, 19]. …”