Lymphoid cell aggregates: A useful clue in the fine-needle aspiration diagnosis of follicular lymphomas

Abstract

Among the various types of lymphoma, follicular lymphoma (FL) is known to have significant limitations in cytologic diagnosis by the fine‐needle aspiration (FNA) method. The diagnostic accuracy (DA) for non‐Hodgkin's lymphoma (NHL) by FNA was evaluated by review of 82 cases of histologically proved NHL after prior FNA. The DA for all NHLs was 66% (54/82), and that for low‐grade lymphomas, including small lymphocytic lymphoma, follicular small‐cleaved cell lymphoma, and follicular mixed cell lymphoma, was 71% (12/17). The DA for FL was 69% (11/16). Review of individual surgical and cytologic materials from FLs revealed a tendency to show fibrosis in the cytologically false‐negative group and diffuse areas of lymphoma in the true‐positive group. The presence of “aggregation” of uniform lymphoid cells, probably due to cell adhesions with the support of dendritic reticulum cells, was seen in 55% of true‐positive FL (6/11). In contrast, only 28% of true‐positive diffuse large cell lymphomas (5/18) showed a mild degree of aggregation, and none of 7 cases of true‐positive diffuse small‐cleaved cell lymphoma showed this feature. The aggregation of cells was not pathognomonic of FL, but its presence with a homogeneous cellular constituent and the paucity of tingible‐body macrophages helped us to predict FL. Also, it was a feature distinguishing FL from diffuse small‐cleaved cell lymphoma (P = 0.025). Diagn. Cytopathol. 1997;17:467–471. © 1997 Wiley‐Liss, Inc.

Diagnosis of B-Cell Non-Hodgkin Lymphomas with Small-/Intermediate-Sized Cells in Cytopathology

“…An example is the recognition of FCFs in cases of FL initially reported by Suh et al [48], and their distinction from LHAs based on the presence of follicular dendritic cells alone in the former versus TBMs, follicular dendritic cells and activated cells in the latter. A stepwise approach as summarized in Table 1, which includes a low power assessment for cellularity, monomorphism, and predominant cell size with an astute examination for residual architectural features, that is, cell aggregates, followed by a detailed interrogation of the cytologic features at high power will yield the largest amount of information on which a tentative diagnosis can be built, and has the least potential to cause diagnostic confusion.…”

Cytology and immunophenotyping of low- and intermediate-grade B-cell non-Hodgkin's lymphomas with a predominant small-cell component: A study of 56 cases

“…13,27,29 -33 Recently, Suh et al reported that cell aggregates were noted in 55% of FCLs. 34 However, 28% of diffuse large-cell lymphomas also demonstrated such cell aggregates. Furthermore, artifactual cell aggregates secondary to improper smear preparation may be difficult to distinguish from true aggregates.…”

Diagnosis and subclassification of follicle center and mantle cell lymphomas on fine-needle aspirates

“…Suh et al reported recently that aggregation of uniform lymphoid cells is a relatively frequent finding in follicular lymphoma, whereas diffuse, small‐cleaved cell NHL lack this cytologic pattern 25. This observation could be supported by the immunocytochemical demonstration of an increased number of dendritic reticulum cells,26 which presumably may contribute to the adhesion of the individual lymphoma cells.…”