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Fine needle aspiration of lymphoblastic lymphoma. A multiparameter diagnostic approach
J C Jacobs1, R L Katz, N Shabb
1Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Insights
Fine needle aspiration (FNA) biopsies are effective for diagnosing lymphoblastic lymphoma (LBL). These minimally invasive samples provide sufficient cellular material for comprehensive immunologic and genetic analysis, aiding accurate disease characterization.
Area of Science:
- Hematopathology
- Oncology
- Cytopathology
Background:
- Lymphoblastic lymphoma (LBL) diagnosis traditionally relies on surgical biopsies.
- Accurate immunophenotypic and genotypic characterization is crucial for LBL subtyping and treatment.
Purpose of the Study:
- To evaluate the adequacy of fine needle aspiration (FNA) biopsies for diagnosing and characterizing lymphoblastic lymphoma (LBL).
- To assess the utility of FNA in obviating the need for surgical biopsies in LBL cases.
Main Methods:
- Review of 16 fine needle aspiration (FNA) biopsies from LBL cases (12 initial diagnosis, 4 relapse).
- Analysis of cellular aspirates using immunologic, DNA/RNA flow cytometry, and gene rearrangement studies.
- Cytologic evaluation of cell morphology, including nuclear features, nucleoli, and mitotic activity.
Main Results:
- FNA readily yielded sufficient cellular material for comprehensive analysis.
- Cytology revealed intermediate-sized cells with fine chromatin and frequent mitoses.
- Immunophenotyping showed a predominantly T-cell phenotype (14/16 cases), with one precursor B-cell and one biphenotypic case.
- Terminal deoxynucleotidyl transferase (TdT) positivity was observed in 79% of cases.
- Flow cytometry indicated diploid DNA content (87%), intermediate proliferation, and intermediate RNA index.
- Gene rearrangement studies confirmed T-cell receptor (TCR) gene rearrangements in T-cell LBL and identified bigenotypic rearrangements in some cases.
Conclusions:
- Fine needle aspiration (FNA) biopsies are adequate for accurate diagnosis and characterization of lymphoblastic lymphoma (LBL).
- FNA can potentially replace surgical biopsy for LBL diagnosis, reducing patient morbidity.
- Comprehensive immunophenotypic and genotypic analysis is feasible on FNA samples, aiding in LBL subclassification.
Abstract:
Sixteen fine needle aspiration (FNA) biopsies of lymphoblastic lymphoma (LBL) that were used to either initially diagnose disease (12) or document relapse (4) were reviewed. Cellular aspirates (2 x 10(7) cells) were readily obtained for immunologic, DNA/RNA flow cytometric and immunoglobulin and/or T-cell receptor gene rearrangement studies. Cytologically, aspirates were characterized by intermediate-sized cells (9.5-18.5 microns) with fine nuclear chromatin, small, inconspicuous nucleoli, irregular nuclear contours and scant basophilic cytoplasm. Frequent mitotic figures were seen (1-14 figures per 1,000 cells). Fourteen cases demonstrated a T-cell phenotype with considerable phenotypic variability. One case demonstrated a precursor B-cell phenotype, and another demonstrated biphenotypic expression with both T-cell and myeloid differentiation. Eleven of 14 cases (79%) were positive for terminal deoxynucleotidyl transferase. Thirteen of 15 cases (87%) manifested diploid DNA content by flow cytometric analysis and were characterized by intermediate proliferative activity (S+G2M 12.7 +/- 8.7% SD) and intermediate mean RNA index (1.3 +/- .5 SD). T beta gene rearrangements were demonstrated in four of five phenotypic T-cell LBL cases analyzed, with concomitant JH gene rearrangements observed in three cases, confirming that bigenotypic rearrangements characterize some T-cell LBLs. We conclude that FNA samples are adequate for accurate characterization of LBL and may obviate the need for surgical biopsy.
