Cytomorphologic Differentiation of Hodgkin’s Lymphoma and Ki-1+ Anaplastic Large Cell Lymphoma in Fine Needle Aspirates

Mourad, Walid A.; Nazer, Mona Al; Tulbah, Asma

doi:10.1159/000326599

Cited by 32 publications

(17 citation statements)

References 19 publications

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“…Although fine-needle aspirates should not be generally recommended, they may be justified in exceptional cases with otherwise not accessible tumors in critically ill patients [19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

EARLY AND RELIABLE DIAGNOSIS OF NON-HODGKIN LYMPHOMA in CHILDHOOD AND ADOLESCENCE: Contribution of Cytomorphology and Flow Cytometric Immunophenotyping

Mann

Attarbaschi

Steiner

et al. 2006

Pediatric Hematology and Oncology

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Non-Hodgkin lymphoma (NHL) represents one of the most rapidly growing malignancies in childhood and adolescence. About 80% of patients now are cured with adequate treatment. Serious complications at presentation due to tumor lysis syndrome or local tumor effects are commonly observed. Thus, a rapid diagnosis with the least invasive procedure enabling the initiation of early and specific therapy is necessary to diminish early fatality or persistent impairment. In 56 centrally registered patients with NHL, cytomorphologic analyses (FAB criteria) of May-Grünwald-Giemsa-stained touch imprints or malignant effusions and flow cytometric immunophenotyping (EGIL criteria) of fresh cell suspensions with a standardized panel of monoclonal antibodies were performed. The authors identified 23 patients with Burkitt lymphoma by the combination of FAB L3 morphology and a mature B-cell phenotype and 22 patients with lymphoblastic lymphoma by FAB L1/L2 morphology and a T-/B-cell precursor phenotype. They also found 11 patients with large cell lymphomas, 3 of them with anaplastic large cell lymphoma (T-cell phenotype; NPM/ALK-positive). In the remaining 8 patients diffuse large B-cell lymphoma was suspected by the combined use of cytologic and immunophenotypic findings (mature B-cell phenotype). In all cases with available solid tumor material (n = 42/56) the preliminary diagnosis was confirmed by histopathology. Burkitt lymphoma, lymphoblastic lymphoma, and, in a few cases, some large cell lymphomas could be classified reliably by cytomorphology and immunophenotyping of freshly obtained tumor cell material, enabling an early start of specific lymphoma treatment.

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Section: Discussionmentioning

confidence: 99%

EARLY AND RELIABLE DIAGNOSIS OF NON-HODGKIN LYMPHOMA in CHILDHOOD AND ADOLESCENCE: Contribution of Cytomorphology and Flow Cytometric Immunophenotyping

Mann

Attarbaschi

Steiner

et al. 2006

Pediatric Hematology and Oncology

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“…It is known that morphological and immunological similarities do exist between HL and ALCL and attempt has been made to compare and contrast these two entities. 28,29 Comparing the cytomorphology of 14 HL with those of 14 ALCL, Bizjack-Schwartzbartl 28 found that the proportion of blast cells exceeding 15 lm was >18% in ALCL and <9% in HL. According to Mourad et al, 29 the differentiation of ALCL from HL can be achieved in FNA smears through identification of abnormal cells population (median 30% for ALCL versus 3% in HL, P ¼ 0.0003), the spectrum of abnormal cells, and the presence of multilobated nuclei (in 93% ALCL cases versus 6.5% of HL, P ¼ 0.0008).…”

Section: Discussionmentioning

confidence: 99%

Hodgkin's lymphoma: Diagnostic difficulties in fine‐needle aspiration cytology

Das

Francis

Sharma

et al. 2009

Diagnostic Cytopathology

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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 cytodiagnosis of HL.

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“…However, other cell types can mimic the morphology of these cells, including large cells found in infectious mononucleosis, anaplastic large T-cell lymphoma, T-cell rich B-cell lymphoma, peripheral T-cell lymphoma of mixed type, metastatic carcinoma, melanoma, sarcoma, germ cell tumor, and reactive lymphoid hyperplasia. 1,[18][19][20][21] Immunohistochemical stains are important in confirming the diagnosis within these differentials. Hodgkin cells have characteristic immunostaining patterns with CD15, CD30, CD45, and CD20.…”

Section: Discussionmentioning

confidence: 99%

“…Ana- (2) 2 (100.0) Highly suspicious of HL (5) 3 (60.0) 1 (20.0) 1 (20.0) Suspicious of HL (22) 4 ( plastic large T-cell lymphoma sometimes shows large cells with large nuclei and prominent nucleoli, which resemble Hodgkin cells and Reed-Sternberg cells. 21 These cells are also CD30 positive and often EMA positive. However, CD15 positivity favors HL, and T-cell marker positivity favors anaplastic large cell lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Fine-needle aspiration diagnosis of Hodgkin lymphoma using current WHO classification—Re-evaluation of cases from 1999–2004 with new proposals

et al. 2006

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With the advent of modern therapy, the differences in prognoses and treatment regimens among different subtypes of Hodgkin lymphoma (HL) have largely vanished. Stage and the presence of systemic symptoms are much more important than histologic subtypes as predictive factors. The current (2001) WHO classification markedly de-emphasizes spatial relationships as critical to the diagnosis of lymphoma and emphasizes cell morphology, immunophenotype, genetic features, and clinical information to define the disease states. This classification, thus, greatly enhances the capability of fine-needle aspiration (FNA) to accurately diagnose HL. We searched all the FNA cases in our institute in years 1999 through 2004 and found 42 cases, for which 13 were primarily diagnosed (31.0%), 2 were recurrent (4.8%), 5 were highly suspicious (11.9%), and 22 were suspicious (52.3%) for HL. On follow-up tissue biopsy, all the primarily diagnosed, recurrent, and highly suspicious cases were confirmed to be HL (100% agreement). For the 22 suspicious cases, 13 were HL (59.1%), 5 were other lymphomas (22.8%), 1 was lymphoma unclassifiable (4.5%), and 3 were reactive processes (13.6%). The effect of immunostains on the diagnosis of HL was examined, and its importance was emphasized. Analysis of demographic data and the distribution of HL subtypes demonstrate that the study sample is representative of the general HL patient population. On the basis of these results, we propose: (1) If the FNA diagnosis of HL is confirmed both by morphology and immunostains, no further tissue confirmation, subclassification and grading is necessary, and appropriate treatment regimens should follow. (2) The nodular lymphocyte predominant HL and classical HL can be differentiated by adequate immunostaining. (3) If a definitive diagnosis cannot be achieved by FNA, a second FNA or a tissue biopsy should be recommended.

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Cytomorphologic Differentiation of Hodgkin’s Lymphoma and Ki-1+ Anaplastic Large Cell Lymphoma in Fine Needle Aspirates

Cited by 32 publications

References 19 publications

EARLY AND RELIABLE DIAGNOSIS OF NON-HODGKIN LYMPHOMA in CHILDHOOD AND ADOLESCENCE: Contribution of Cytomorphology and Flow Cytometric Immunophenotyping

EARLY AND RELIABLE DIAGNOSIS OF NON-HODGKIN LYMPHOMA in CHILDHOOD AND ADOLESCENCE: Contribution of Cytomorphology and Flow Cytometric Immunophenotyping

Hodgkin's lymphoma: Diagnostic difficulties in fine‐needle aspiration cytology

Fine-needle aspiration diagnosis of Hodgkin lymphoma using current WHO classification—Re-evaluation of cases from 1999–2004 with new proposals

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