Adrenal extranodal NK/T‐cell lymphoma diagnosed by fine‐needle aspiration and cerebrospinal fluid cytology and immunophenotyping: A case report

Abstract

The cytologic findings of an extranodal NK/T-cell lymphoma (NKTCL) presenting as a large adrenal mass with leptomeningeal involvement diagnosed by CT-guided fine-needle aspiration and cerebrospinal fluid (CSF) cytology are described. The 65-year-old Caucasian patient presented with progressive headache and multiple cranial nerve neuropathies. Magnetic resonance imaging showed leptomeningeal enhancement surrounding the conus medullaris and cauda equine, and a subsequent PET/CT demonstrated a large right adrenal gland mass. Fine-needle aspiration of the adrenal mass showed occasional large pleomorphic cells with prominent nucleoli, moderate amounts of cytoplasm, and rare large cells with sparse cytoplasmic granules admixed with numerous small lymphocytes. Initial flow cytometry from this sample showed no clonal B-cell population. Immunoperoxidase stains performed on the cell block/core specimen showed that the large atypical cells were positive for CD2, CD30, CD43 and CD56, TIA-1, granzyme, and perforin, but for none of the other T-cell markers used (CD3, CD4, CD5, CD8, CD45RO), which stained the abundant background lymphocytes. A CSF specimen showed similar neoplastic cells and flow cytometry showed an NK-cell population with aberrant immunophenotype. The cytologic findings of the neoplastic cells and the extensive panel of immunoperoxidase stains allowed the diagnosis of NKTCL, which was confirmed by the subsequent flow-cytometric immunophenotyping performed on the CSF. This is, to the best of our knowledge, the first case of NKTCL diagnosed by FNA of the adrenal gland and by CSF cytology.

Comparison of Diagnostic Cytomorphology of Natural Killer/T-Cell Lymphoma (Nasal Type) in Conventional Smears, Liquid-Based Preparations, and Histopathology

“…The tumor cells show readily discernible nuclear atypia with an irregular nuclear outline (including elongated, twisted, “banana shaped,” or “cucumber-like” cells) [10]. The presence of cytoplasmic “tongue-like” protrusions may serve as a useful diagnostic clue [11, 12]. Cytoplasmic azurophilic granules are often identified in touch preparations of the tissue samples [7, 9, 11, 12, 14].…”

“…The presence of cytoplasmic “tongue-like” protrusions may serve as a useful diagnostic clue [11, 12]. Cytoplasmic azurophilic granules are often identified in touch preparations of the tissue samples [7, 9, 11, 12, 14]. Abundant necrotic areas and karyorrhectic debris may be present.…”

Cytomorphologic and Flow Cytometric Analysis of Cerebrospinal Fluid with T-Cell Lymphoma Involvement: A Retrospective Study of Rare Cases

“…The number of cases with T-cell lymphoma involving the leptomeninges is extremely low. Most T-cell lymphomas secondarily involve the CNS by spreading from systemic malignancies [8,9,10,15,16,17,18], as seen in all of the patients in this study. However, T-cell lymphomas confined to leptomeninges [19,20] or local extension to the leptomeninges from CNS T-cell lymphomas [16,17,18] have also been reported.…”

“…There is only minimal description of the features and subtypes of T-cell lymphomas involving the CSF in the cytopathology literature [3,7,8,9,10,11,12]. Therefore, we aimed to evaluate the diagnostic efficacy of cytomorphologic analysis and FC regarding T-cell lymphoma involvement in the CSF.…”

A case report of primary unilateral adrenal NK/T cell lymphoma: good clinical outcome with trimodality treatment

“…There have been seven reported cases of NK/T cell lymphoma involving adrenal masses worldwide [1–7]. Among them, only one was primary adrenal NK/T cell lymphoma [2].…”