[Abstract] Objective To investigate Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) needle aspiration puncture sensitivity, error prone and lymphoma in fine needle aspiration cytology diagnosis. Fine-needle aspiration cytology diagnosis of 318 patients with HL and NHL histopathologic findings contrast. Results lymphoma sensitivity of 95.6%, a sensitivity of 93.7% for HL, NHL sensitivity of 96.1%. 69 cases of HL the misdiagnosed as NHL3 cases reactive hyperplasia. NHL easy to confuse with HL and small cell tumors, including small cell carcinoma, atypical carcinoid, embryonal rhabdomyosarcoma. 249 patients with NHL, six cases of misdiagnosis of HL, including two cases of diffuse large B, 2 cases of wealth to the T B-cell lymphoma, one follicular center type 1 cases of anaplastic large cell. The immunocytochemistry results pathology results were consistent. Conclusion needle aspiration cytology to make an accurate diagnosis of lymphoma, but it should be done multi-needle aspiration to make specimens satisfaction, and in conjunction with the clinical data, immunocytochemistry as adjunct lymphoma cytological diagnosis.
Key words fine-needle aspiration cytology; Hodgkin’s lymphoma; non-Hodgkin’s lymphoma; immunocytochemistry
Fine-needle aspiration cytology (FNAC) used in the diagnosis of malignant lymphoma and literature is very common in foreign countries [1 3], it is not only for Hodgkin lymphoma (HL) and non-Hodgkin’s lymphoma (NHL ) to make an accurate diagnosis, but also part of the NHL parting. Clinical surface lymph nodes should be the first choice for fine needle aspiration cytology of this is simple, fast, and diagnosis of the economy, little pain to exclude inflammatory lesions (including tuberculosis), resulting in unnecessary surgery. This paper summarizes FNAC sensitivity of lymphoma, lymphoma morphological characteristics and easy to produce in the cytologic diagnosis of errors.
1 Materials and methods
1.1 collected in January 1993 to January 2006 in our hospital outpatient visits do FNAC and needle aspiration specimens satisfaction can make 318 cases of diagnosed cases, have histopathological results control, 13 cases of immune cells by thin layer smear chemical, cytological diagnosis of lymphoma or suspected lymphoma. The patient’s age between 6 to 80 years old, with a median age of 41 years old. Parts of needle aspiration in the neck, collarbone, armpit, groin, mediastinal and retroperitoneal lymph nodes.
1.2 mass surface skin followed by disinfection with iodine, ethanol, fixed tumor of the left index finger and middle finger, right hand penetrate the tumor center area with 10ml disposable syringe, needle 7-8 extract the negative pressure to draw tissue. Aspirate do conventional smears a surplus the specimens washed into Cytolyt fixative, to remove blood cells, do flakes 1. Two smears were fixed in 95% ethanol the 15min, HE staining.
1.3 cytological diagnosis is mainly divided into the following types of lymphocytes background see the typical R S cells, diagnosed with Hodgkin’s lymphoma; see some scattered in the background, only lymphocytes did not see the typical R S cells single-core, multi-core nuclear atypical cells with prominent nucleoli, suspected of Hodgkin’s lymphoma. Scattered in a large number of consistent size shaped lymphoid-derived cell, the diagnosis of non-Hodgkin’s lymphoma; smear mature lymphocytes and Shaped lymphocytes suspected non-Hodgkin’s lymphoma.
Cytological diagnosis of 318 cases of lymphoma, as shown in Table 1. Table 1 cytological and histological diagnosis results compare
Cell diagnostic results patients% tissue pathology consistent inconsistency the sensitivity HL3811.933593.7 suspected HL319.7229NHL17555.51611496.1 suspect as NHL7422.95123 total cases 31,810,026,651
Cytologic diagnosis of HL, inconsistent with the histopathologic results five cases are NHL histopathology results are shown two cases of diffuse large B-wealth to the T’s B-cell lymphoma, one follicular center type, 1 case of large anaplastic cells. Suspected cytology HL, and tissue pathology inconsistent nine cases of pathological results suggest that: three cases of metastatic carcinoma; 2 cases of NHL patients with diffuse large B-B-cell lymphoma of wealth to the T; 2 cases of necrotizing lymphadenitis ; cases of spindle cell sarcoma; cases of reactive hyperplasia. Cytological diagnosis of 14 cases of NHL, inconsistent pathological: 5 patients with small cell carcinoma; 4 metastatic poorly differentiated carcinoma; 2 cases of embryonal rhabdomyosarcoma; cases of ganglion neuroblastoma; cases of HL, nodular sclerosis ; cases of atypical carcinoid tumor. Suspected cytology the NHL and pathological consistent 23 cases: five cases of lymphadenitis; six cases of poorly differentiated carcinoma; 5 patients with small cell carcinoma; 2 cases of HL mixed; cases of immunoblastic lymphadenopathy; cases of primitive neuroectodermal ectodermal tumor; malignant thymoma; cases of malignant fibrous histiocytoma; patients with carotid body tumor.
Table 1 shows that the sensitivity HL to 93.7%, NHL was 96.1%. The Lymphoma sensitivity of 95.6%.
Nine cases of NHL seen from Table 2, cytology and pathology diagnosis, LCA showed strong positive epithelial antigen the AE1/AE3-negative, suspect the NHL four cases, one cases of LCA +, the remaining three cases AE1/AE3 positive patients with small cell carcinoma ChroA +, NSE + + + the other cases CK8/18 positive, consider adenocarcinoma.
This study the sensitivity of lymphoma was 95.6%, slightly higher than the literature of 80% to 90%. Reported HL sensitivity of 30% to 92%, the NHL sensitivity of 80.3% . In this study, the sensitivity of HL and NHL were 93.7% and 96.1%, respectively, were higher than those reported in the literature, and tumor hospital case, has long been fixed to specialized cells pathologist needle aspiration operation and a wealth of diagnostic experience.
Because the the HL complex composition, the smear was a variety of forms, should find the typical R S cells in the diagnosis of HL. Cytological diagnosis of HL and suspected of the HL 69 cases, seven cases pathological diagnosis of NHL, including three cases of diffuse large B, 2 cases of B-cell lymphoma wealth to the T’s, one follicular center type, patients with large cell anaplastic. Diffuse large B lymphoma smear regraded, part of the tumor cells showed irregular nuclear shape, prominent nucleoli mistaken HL tumor cells. The other cases of smear to see little large cell degeneration nuclear, further sucked out of a sufficient large number of cells, may reduce this error diagnosis. Wealth to the B-cell lymphoma of the T-needle aspiration smears show a reactive T lymphocytes or tissue and a small amount of large B-cell components type an distinguish between of such NHL with lymphatic Table 213 cases Immunocytochemistry cells abatement HL is more difficult. In this study, this confused with the cases of two cases, the diagnosis of HL reasons mistakenly tissue cells or B cells diagnosis of the tumor cells of HL. Anaplastic large cell lymphoma sometimes with HL background reactive inflammatory cells, large cell flaky or cluster-like arrangement, but the large cells of HL mostly scattered single. Reviewing this study in anaplastic large cell lymphoma smear, see large cell flaky and tile-like, cell cytoplasm relatively wide. Two different primary tumor in the same case this study mistakenly suspected cases of spindle cell sarcoma as HL. Acosta et al  have also been reported in the same two cases of cervical lymph node metastases of medullary thyroid cancer cells and HL cells, and histologically. Needle aspiration small number of cancer cells in the smear and the scattered distribution misdiagnosed HL, careful observation of the visible cancer cells for more than two, three cells together, small cell cytoplasm is relatively wide, prominent nucleoli, HL-and single-core, dual-core, multi-core, tumor cells in a cell’s cytoplasm or different. Should also be noted that the tumor cells of HL easy to be confused with undifferentiated nasopharyngeal carcinoma cells, the two smear background .
The NHL and other small round malignant cell morphology was not typical of small cell carcinoma, ganglion neuroblastoma, embryonal rhabdomyosarcoma, atypical carcinoid, primitive neuroectodermal tumor cytology in difficult differential diagnosis, In addition to cell morphology should be combined with clinical and immunocytochemistry. 249 cases of NHL in this study, cytologic diagnosis and suspected cases of small cell carcinoma, 2 cases of embryonal rhabdomyosarcoma. Although sarcoma cells, the cytoplasm, eosinophilic cytoplasm, nucleus lobulated.
Immunocytochemistry of the 13 cases of thin smears are made after cytology, pathology results, 10 patients with pathologically NHL immunocytochemistry the LCA were positive, two cases of small cell carcinoma epithelial antigen were positive, in line with the pathological. The immunocytochemistry applied to cytology as a diagnostic aid.
The process of fine needle aspiration, fine needle aspiration parts of limitations prone to false negatives. Sometimes HL, NHL or metastatic cancer involving only the local lymph nodes, needle aspiration can not touch this area. In this study, diagnosis of five cases of lung metastases of poorly differentiated cancer cells the NHL or suspected cases of NHL, no epithelial cells in the smear. Accordingly, the lymph nodes of different regions of the multi-needle aspiration is necessary, this can reduce the appearance of false negative.