Value of lymphocyte marker studies in diagnostic cytopathology

The separation of lymphoreticular neoplasms from poorly differentiated epithelial and mesenchymal tumors and reactive processes can be a difficult problem in cytopathology. Immunodiagnostic techniques can be applied to cytologic specimens to detect cellular antigens, which may aid in their proper identification. We have reviewed 67 cytologic specimens in which immunoperoxidase techniques were employed using antibodies to common leukocyte antigen (HLE1), B-cell markers (B1, Leu 12 and kappa and lambda light chains), T-cell markers (Leu 1, OKT11, Leu 12 and kappa and lambda light chains), T-cell markers (Leu 1, OKT11, OKT4 and OKT8) and monocytes (OKM1 and LeuM1). These specimens included 33 body cavity fluids (21 pleural, 8 ascitic and 4 pericardial), 22 cerebrospinal fluids (CSF) and 12 fine needle aspirates (4 brain, 1 adrenal, 2 liver, 1 kidney, 3 retroperitoneal masses and 1 lymph node). The marker studies confirmed the initial cytomorphologic diagnoses in 31 specimens and modified the final diagnoses in 16 specimens. Markers in 20 specimens were noncontributory due to low cellularity or technical difficulties. Two problems may limit the usefulness of these procedures. First, many of the CSF specimens contained too few cells for adequate processing. Second, the mesothelial cells from pleural specimens often stained with HLE1. Our findings indicate that marker studies are of value in the diagnosis of problematic cases presenting as undifferentiated tumors in cytopathology.