Extranodal NK/T‐cell lymphoma, nasal type of the uterine cervix: A case report

Abstract

We report a rare case of extranodal NK/T-cell lymphoma, nasal type of the uterine cervix that showed cytologic features mimicking cervical cancer. A 65-year-old woman presented with vaginal bleeding. Gynecological examination revealed a bulky tumor of the cervix. A conventional Papanicolaou-stained cervical smear showed hypercellularity consisting of numerous variably sized cohesive clusters that mimicked epithelial tumors, with a necrotic and inflammatory background. A small number of individually scattered cells were also identified. These scattered cells showed pleomorphic, often cleaved, or horseshoe-shaped nuclei and pale cytoplasm. Biopsy specimens revealed a diffuse growth of atypical cells with an angiocentric pattern. Extensive necrosis and infiltration of inflammatory cells were present. There were numerous mitotic figures. The tumor cells were positive for CD45RO, CD3ε, CD56, granzyme B, TIA-1, CD7, and Epstein-Barr virus (EBV)-encoded small RNA (EBER) by in situ hybridization, and negative for cytokeratin, chromogranin A, synaptophysin, CD4, CD5, CD8, CD20, and CD30. Based on these findings, this tumor was diagnosed as extranodal NK/T-cell lymphoma, nasal type of the uterine cervix.

Spectrum of cytomorphological features of extranodal NK/T‐cell lymphoma, nasal type

“…Cytological features of ENKTL tend to deviate from those normally observed in other lymphomas, with the neoplastic cells showing a tendency towards cohesion and aggregate formation . Our cases showed both small and large aggregates of cells, similar to those described by Jimenez‐Heffernan et al and Omori et al . Interestingly, the large clusters of atypical cells were found in proximity to blood vessels, whereas the smaller aggregates of lymphoid cells did not show this tendency.…”

“…Literature on the cytological findings of ENKTL is scant . A summary of the main cytological findings observed in previous series is reported in Table .…”

“…Biopsies often demonstrate extensive necrosis with scant viable cells whose morphology is poorly preserved, thus requiring multiple biopsies to achieve a correct final diagnosis. Literature on cytological findings of ENKTL is scant, comprising mostly of single case reports . So far, only three cases have been diagnosed as ENKTL on fluid cytology .…”

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

“…Nevertheless, reactive hyperplasia is typically marked by a predominance of large cells and immunoblasts, sometimes even with atypical forms (common in clinical conditions associated with viral infections, such as infectious mononucleosis). Immunostaining and flow cytometry may be employed for further characterization of such cases [10, 13]. …”

“…Grade 1 or grade 2 follicular lymphoma shows predominantly medium-sized centrocytes with irregularly cleaved nuclei, centroblasts with noncleaved nuclei, and follicular aggregates on Pap staining. In contrast to the Reed–Sternberg cells in Hodgkin's lymphoma, the atypical lymphoid cells of NK/T-cell lymphoma do not contain large, inclusion-like, eosinophilic nucleoli [10, 13]. NK/T-cell lymphoma displays a wide cytological spectrum, from small to large pleomorphic cells, and a necrotic background containing abundant apoptotic material.…”