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Marginal zone and mantle cell lymphomas: assessment of cytomorphology in subtyping small B-cell lymphomas
Bettina A Murphy1, Brenton A Meda, David H Buss
1University of Texas at Southwestern Medical Center, Dallas, Texas, USA.
Insights
Distinguishing mantle cell lymphoma (MCL) from marginal zone lymphoma (MZL) using fine-needle aspiration biopsy (FNAB) is challenging. While some features suggest one over the other, cytomorphology alone is insufficient for reliable diagnosis, necessitating ancillary studies.
Area of Science:
- Hematology
- Oncology
- Cytopathology
Background:
- Fine-needle aspiration biopsy (FNAB) is increasingly used for diagnosing malignant lymphomas.
- Cytomorphologic differentiation among small B-cell lymphomas, including mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL), presents diagnostic challenges.
Purpose of the Study:
- To compare the cytomorphologic features of MCL and MZL in FNAB specimens.
- To identify distinctive cytomorphologic attributes that can differentiate MCL from MZL.
Main Methods:
- Evaluation of cytomorphologic features in direct smears from seven immunophenotypically confirmed MCL and seven MZL aspirates.
- Analysis of specific features such as cellular population characteristics and presence of mitotic figures.
Main Results:
- Features favoring MCL included a monomorphic cellular population, irregular nuclear contours, and mitotic figures.
- A polymorphic cellular population was suggestive of MZL.
- Significant overlap in cytomorphologic features was observed between MCL and MZL.
Conclusions:
- Cytomorphology alone is insufficient for definitively distinguishing MCL from MZL in FNAB specimens.
- Ancillary studies, such as immunophenotyping, are essential for accurate diagnosis.
- While suggestive features exist, reliable differentiation requires a combination of morphology and additional diagnostic modalities.
Abstract:
The diagnosis of malignant lymphomas by fine-needle aspiration biopsy (FNAB) is increasing in utilization. The cytomorphologic distinction among the small B-cell lymphomas may be quite difficult. We are unaware of anyone who has compared directly mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL) in FNAB. Our major goal was to examine the cytomorphologic attributes of MCL and MZL and to look for features distinctive of or suggestive of either neoplasm. Seven immunophenotypic MCL and seven immunophenotypic MZL aspirates were evaluated for a number of cytomorphologic features in direct smears. Features favoring MCL include a relatively monomorphic cellular population, prominent nuclear membrane contour irregularities, and mitotic figures. Conversely, a polymorphic cellular population suggested MZL. However, due to extensive overlap of specific cytologic features, the two lymphomas cannot be definitively distinguished based solely on cytomorphology. Although there are cytomorphologic attributes suggestive of either MCL or MZL, considerable overlap exists. Based on an individual case basis, the distinction cannot be made reliably by morphology alone; ancillary studies, e.g., immunophenotyping, are essential.
