Diagnosis of peripheral T-cell lymphoma by fine-needle aspiration biopsy: A cytomorphologic and immunophenotypic approach

Abstract

The diagnosis of T‐cell lymphomas by fine‐needle aspiration biopsies (FNAB) is extremely difficult. This is mainly due to the rarity of the disease, the morphologic similarity to reactive lymphadenopathy, and the difficulty in identifying abnormal T‐cell antigen expression. We studied FNAB of histologically proven T‐cell lymphomas in an attempt to identify the salient cytomorphologic features as well as the surface marker attributes of the disease. Twenty cases were reviewed. The smears were evaluated for overall cytologic pattern and percentage of abnormal cells. A critical review of flow cytometric (FCM) antigen expression of the lymphomas was also performed. There were 6 female and 14 male patients, with an age range of 9–84 yr (median, 36 yr). Fourteen cases (70%) showed polymorphous smears, and 6 cases (30%) showed monomorphous smears. Abnormal cells ranged from 10–100% (median, 60%). Abnormal T‐cell antigen expression by FCM analysis was seen in 17 cases (85%). The most common aberrant T‐cell antigen pattern was loss of 3 or more pan‐T‐cell antigens (n = 10). The most common individual T‐cell antigen loss was that of CD7 (n = 10), followed by loss of CD5 (n = 5). There was also loss of CD4 and CD8 (n = 5), loss of CD5 and CD7 (n = 5), complete loss of CD3 (n = 4), coexpression of CD4 and CD8 (n = 1), and partial loss of CD3 (n = 1). CD56 was expressed in 2 cases. CD1a was tested in one case and was positive. CD4/CD8 ratio was elevated (>2.5) in 9 cases (53%), with a range of 3/1–57/1 (median, 12/1). TCR gene rearrangement using PCR was positive in 7 of 9 tested cases. Our findings suggest that the diagnosis of peripheral T‐cell lymphomas can be achieved by FNAB in the majority of cases through close analysis of the morphology. This can be supported by a critical analysis of the phenotype using two or three‐color flow cytometry with an attempt at identification of one or more abnormal T‐cell antigen expression and/or loss. This can be supplemented by CD4/CD8 ratios and T‐cell receptor gene rearrangement analysis. Diagn. Cytopathol. 2000;23:375–379. © 2000 Wiley‐Liss, Inc.

Adult T-cell leukemia/lymphoma

“…4,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In the REAL classification, ATLL belongs to the category of peripheral T-cell and natural killer cell neoplasms. Although several reports of peripheral Tcell lymphoma have been published in the cytology literature, [33][34][35][36][37] we are aware of only a single cytologic study of T-cell lymphoma in HTLV-1 positive patients. 38 In our study, we reviewed 114 samples from 34 patients already diagnosed with ATLL, from diverse anatomic sites.…”

“…Unlike other peripheral T-cell lymphomas in which the diagnosis depends on lack of expression of B-cell markers and detection of aberrant expression of pan T-cell markers, 36,37 ATLL has a distinctive immunophenotypic profile. In conclusion, we believe that despite the polymorphous appearance of lymphocytes in ATLL, the diagnosis can be suspected morphologically by paying close attention to nuclear details and the spectrum of cell sizes and confirmed by utilizing a …”

Endoscopic ultrasound-guided fine needle aspiration cytology and biopsy in the evaluation of lymphoma

“…FC may also be helpful in the immunological subtyping of the lymphoma, although some subtypes cannot be reliably diagnosed; consequently, the evaluation of tissue core biopsies remains the standard criterion for the final diagnosis 1. The limitations of FC include difficulties in the diagnosis of T-cell lymphoma because these cells usually express markers found normally in mature T-cells and in Hodgkin lymphoma, rarity of Reed-Steinberg cells, and absence of monoclonality 1415…”

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

“…Loss of CD7 was found in half of the cases. 12 Another study by Yao et al showed abnormal T antigen expression in 13 of 21 cases of peripheral T cell lymphoma. 13 If a greater variety of T cell IFC markers had been used in our laboratory, including CD7, then we might have found abnormal expression in more of the peripheral T cell lymphomas.…”