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Diagnosis of B-cell non-hodgkin lymphomas with small-/intermediate-sized cells in cytopathology
Joerg Schwock1, William R Geddie
1Division of Anatomical Pathology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto General Hospital, Room E11-219, Toronto, ON, Canada M5G 2C4.
Insights
Diagnosing small B-cell non-Hodgkin lymphomas via fine needle sampling can be challenging due to overlapping features. This review details key cytologic characteristics to improve accuracy in diagnosing these lymphomas and reactive conditions.
Area of Science:
- Cytopathology
- Hematopathology
- Oncology
Background:
- Fine needle sampling is a valuable tool for lymphadenopathy assessment.
- Cytologic diagnosis of small B-cell non-Hodgkin lymphomas presents significant challenges due to morphologic overlap.
- Ancillary testing aids diagnosis but requires careful interpretation within clinical and morphological context.
Purpose of the Study:
- To review and highlight key cytologic features of five common B-cell non-Hodgkin lymphomas.
- To differentiate these lymphomas from each other and from reactive lymphoid hyperplasia.
- To guide the selection of ancillary tests for accurate lymphoma diagnosis.
Main Methods:
- Review of cytomorphologic characteristics of specific B-cell non-Hodgkin lymphomas.
- Comparison of cytologic features between lymphoma entities and reactive lymphoid hyperplasia.
- Identification of common diagnostic pitfalls in cytological assessment.
Main Results:
- Detailed summary of pertinent cytomorphologic features for marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and lymphoplasmacytic lymphoma.
- Contrasting features to facilitate differentiation.
- Highlighting areas of potential diagnostic confusion.
Conclusions:
- Accurate cytologic assessment of B-cell non-Hodgkin lymphomas requires recognizing specific morphologic features.
- Understanding these features is crucial for selecting appropriate ancillary tests and avoiding misdiagnosis.
- This review aims to enhance diagnostic accuracy in cytological evaluation of lymphadenopathy.
Abstract:
Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy. The cytologic diagnosis of B-cell non-Hodgkin lymphomas composed of small-/intermediate-sized cells, however, has been seen as an area of great difficulty even for experienced observers due to the morphologic overlap between lymphoma and reactive lymphadenopathies as well as between the lymphoma entities themselves. Although ancillary testing has improved diagnostic accuracy, the results from these tests must be interpreted within the morphological and clinical context to avoid misinterpretation. Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis. For these reasons, we here review the cytologic characteristics particular to five common B-cell non-Hodgkin lymphomas which typically cause the most diagnostic confusion based on cytological assessment alone: marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and lymphoplasmacytic lymphoma. We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls.
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