BIA-ALCL diagnosis on CytoLyt fixed ThinPrep, cell block and immunohistochemistry

Area of Science:

• Oncology
• Hematopathology
• Cytopathology

Background:

• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma linked to breast implants, especially textured ones.
• Current diagnostic guidelines emphasize cytopathology, followed by CD30 immunohistochemistry (IHC) and flow cytometry (FC) for T-cell clonality.
• Existing literature on BIA-ALCL cytopathology primarily focuses on cytospins and smears, with limited data on ThinPrep preparations.

Observation:

• This case report describes the diagnosis of BIA-ALCL using ThinPrep and cell block preparations processed with CytoLyt.
• Microscopic examination of ThinPrep slides revealed numerous large, atypical lymphoid cells with irregular nuclei and prominent nucleoli.
• These cells were found in a background of inflammatory cells, macrophages, and granular debris.

Findings:

• Immunohistochemistry (IHC) confirmed TIA-1 and CD30 reactivity, along with other T-cell markers, in cells preserved in CytoLyt solution.
• The study details the specific antibodies utilized for IHC analysis in the BIA-ALCL diagnosis.
• Potential ThinPrep artifacts, such as cell size reduction and artifactual lymphoid aggregation, were noted.

Implications:

• This report validates ThinPrep and cell block methods for BIA-ALCL diagnosis, expanding cytopathological evaluation techniques.
• Accurate identification of BIA-ALCL requires careful consideration of cytomorphological features and IHC results.
• Pathologists must be aware of ThinPrep-induced cellular alterations to avoid misdiagnosis in both benign and reactive conditions.