A rare case of signet ring cell lymphoma: Diagnosis aided by immunofluorescent staining

Abstract

Signet ring cell lymphomas are the proliferations of malignant lymphoid cells containing cytoplasmic vacuoles or globules which displace the nuclei, imparting it a signet ring appearance. This rare tumor is a variant of non-Hodgkin lymphoma. Signet ring appearance is due to cytoplasmic accumulation of immunoglobulin or vacuoles derived from multivesicular bodies. These cells, particularly with cytoplasmic vacuoles, may be mistaken for adenocarcinoma cells. We are presenting one such case where immunofluorescence helped us to demonstrate the immunoglobulins on fine needle aspiration smears. This is an innovative technique and has not been reported earlier. Our aim of presenting this case is to review the awareness of this rare lymphoma among pathologists to give due consideration for avoiding inappropriate investigations and treatment.

Unusual sighting in the bone marrow

“…Signet ring lymphoma is a rare morphological variant of non‐Hodgkin lymphoma generally involving the lymph node. Bone marrow involvement as seen in our case has been published only in a few case reports 2 . Diagnosis of this condition can be challenging, and an extensive immunohistochemical panel may be required to solve this dilemma.…”

Signet ring B cell lymphoma: A potential diagnostic pitfall

“…According to the different inclusions in the cytoplasm of tumor cells, signet ring cell lymphoma could be divided into three types [5]. Transparent vacuolar type shows clear vacuoles in the cytoplasm of tumor cell while special staining for PAS, mucus and fat are negative.…”