Precursor T-lymphoblastic lymphoma: Speedy diagnosis in FNA and effusion cytology by morphology, immunochemistry, and flow cytometry.
运用细胞形态学、免疫化学及流式细胞术快速诊断FNA和积液细胞学中前驱T淋巴母细胞性淋巴瘤
Abstract
Precursor T-lymphoblastic lymphoma (T-LBL) is a rare lymphoma presenting clinically in children and adolescents with a rapidly enlarging mediastinal mass, dyspnea, and cervical lymphadenopathy requiring quick diagnosis. The objective of the current study was to report on the spectrum of cytomorphology and flow cytometric immunophenotyping (FCI).
The clinical profile, cytomorphological features, FCI, and cell block immunocytochemistry (CB-ICC) of all cases of T-LBL diagnosed from 2011 through 2013 were reviewed.
Fifteen cases of precursor T-LBL (10 fine-needle aspiration samples and 5 pleural/pericardial fluid samples) were evaluated. Smears demonstrated dispersed lymphoblasts, with a high nuclear:cytoplasmic ratio and scanty basophilic cytoplasm. Nuclei demonstrated notches, clefts, and indentations. The chromatin was condensed in small and intermediate-sized blasts and dispersed in larger blasts. Nucleoli were present only in the larger blasts. Hand mirror-shaped cells and mitoses were variable. With regard to immunophenotyping, flow cytometry demonstrated positivity for CD2 (15 of 15 cases), surface CD3 (14 of 15 cases), cytoplasmic CD3 (15 of 15 cases), terminal deoxynucleotidyl transferase (TdT) (8 of 15 cases), CD5 (13 of 15 cases), CD10 (7 of 15 cases), and human leukocyte antigen-D related (HLA-DR) (1 of 15 cases). Dual CD4/CD8 positivity was observed in all cases forming a tight cluster, which is consistent with the cortical T-LBL subtype. CB-ICC demonstrated a uniform CD3-positive/TdT-positive/CD20-negative phenotype. In 7 cases in which TdT was negative by flow cytometry, CB-ICC was positive.
Combining cytomorphology and FCI enables the accurate and rapid diagnosis of T-LBL on fine-needle aspiration and effusion cytology specimens, thereby obviating the need for a biopsy. Cancer (Cancer Cytopathol) 2015;123:557-565. © 2015 American Cancer Society.
The clinical profile, cytomorphological features, FCI, and cell block immunocytochemistry (CB-ICC) of all cases of T-LBL diagnosed from 2011 through 2013 were reviewed.
Fifteen cases of precursor T-LBL (10 fine-needle aspiration samples and 5 pleural/pericardial fluid samples) were evaluated. Smears demonstrated dispersed lymphoblasts, with a high nuclear:cytoplasmic ratio and scanty basophilic cytoplasm. Nuclei demonstrated notches, clefts, and indentations. The chromatin was condensed in small and intermediate-sized blasts and dispersed in larger blasts. Nucleoli were present only in the larger blasts. Hand mirror-shaped cells and mitoses were variable. With regard to immunophenotyping, flow cytometry demonstrated positivity for CD2 (15 of 15 cases), surface CD3 (14 of 15 cases), cytoplasmic CD3 (15 of 15 cases), terminal deoxynucleotidyl transferase (TdT) (8 of 15 cases), CD5 (13 of 15 cases), CD10 (7 of 15 cases), and human leukocyte antigen-D related (HLA-DR) (1 of 15 cases). Dual CD4/CD8 positivity was observed in all cases forming a tight cluster, which is consistent with the cortical T-LBL subtype. CB-ICC demonstrated a uniform CD3-positive/TdT-positive/CD20-negative phenotype. In 7 cases in which TdT was negative by flow cytometry, CB-ICC was positive.
Combining cytomorphology and FCI enables the accurate and rapid diagnosis of T-LBL on fine-needle aspiration and effusion cytology specimens, thereby obviating the need for a biopsy. Cancer (Cancer Cytopathol) 2015;123:557-565. © 2015 American Cancer Society.
摘要
前驱T淋巴母细胞性淋巴瘤(T-LBL)是一种少见的淋巴瘤，好发于儿童和青少年，临床表现为快速增长的纵膈肿块、呼吸困难和颈部淋巴结肿大，需要快速做出诊断。本研究旨在报道其细胞形态学和流式细胞术免疫表型（FCI）谱系。本文复习了2011-2013年所有确诊为T-LBL病例的临床表现、细胞形态学特征、FCI和细胞块免疫细胞化学（CB-ICC）检测结果。
共评估了15例前驱T-LBL（10例细针穿刺标本和5例胸腔积液/心包积液标本）。细胞学涂片显示淋巴母细胞散在分布，核浆比高， 胞质稀少，嗜碱性。核显示核切迹、核裂、核凹痕。小至中等的淋巴母细胞染色质凝集，较大的淋巴母细胞染色质分散。仅较大的淋巴母细胞见核仁。镜影细胞及核分裂象多少不一。至于免疫表型，流式细胞术显示阳性的有：CD2（15/15)、CD3细胞膜(14/15)、CD3胞质(15/15)、TdT(8/15)、CD5(13/15)、CD10(7/15)以及人类白细胞抗原-DR(1/15)。肿瘤细胞团簇状紧密排列、皮质型T-LBL表现的所有病例显示CD4和CD8双阳性。CB-ICC显示免疫表型一致：CD3阳性、TdT阳性、CD20阴性。有7个病例，流式细胞术检测TdT阴性，而CB-ICC显示TdT阳性。
联合运用细胞形态学和FCI能准确并快速诊断细针穿刺和积液细胞学标本中的T-LBL，从而不需要活检。
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