Al Shanqeety O, Mourad W A
Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Diagn Cytopathol. 2000 Dec;23(6):375-9. doi: 10.1002/1097-0339(200012)23:6<375::aid-dc2>3.0.co;2-1.
The diagnosis of T-cell lymphomas by fine-needle aspiration biopsies (FNAB) is extremely difficult. This is mainly due to the rarity of the disease, the morphologic similarity to reactive lymphadenopathy, and the difficulty in identifying abnormal T-cell antigen expression. We studied FNAB of histologically proven T-cell lymphomas in an attempt to identify the salient cytomorphologic features as well as the surface marker attributes of the disease. Twenty cases were reviewed. The smears were evaluated for overall cytologic pattern and percentage of abnormal cells. A critical review of flow cytometric (FCM) antigen expression of the lymphomas was also performed. There were 6 female and 14 male patients, with an age range of 9-84 yr (median, 36 yr). Fourteen cases (70%) showed polymorphous smears, and 6 cases (30%) showed monomorphous smears. Abnormal cells ranged from 10-100% (median, 60%). Abnormal T-cell antigen expression by FCM analysis was seen in 17 cases (85%). The most common aberrant T-cell antigen pattern was loss of 3 or more pan-T-cell antigens (n = 10). The most common individual T-cell antigen loss was that of CD7 (n = 10), followed by loss of CD5 (n = 5). There was also loss of CD4 and CD8 (n = 5), loss of CD5 and CD7 (n = 5), complete loss of CD3 (n = 4), coexpression of CD4 and CD8 (n = 1), and partial loss of CD3 (n = 1). CD56 was expressed in 2 cases. CD1a was tested in one case and was positive. CD4/CD8 ratio was elevated (>2.5) in 9 cases (53%), with a range of 3/1-57/1 (median, 12/1). TCR gene rearrangement using PCR was positive in 7 of 9 tested cases. Our findings suggest that the diagnosis of peripheral T-cell lymphomas can be achieved by FNAB in the majority of cases through close analysis of the morphology. This can be supported by a critical analysis of the phenotype using two or three-color flow cytometry with an attempt at identification of one or more abnormal T-cell antigen expression and/or loss. This can be supplemented by CD4/CD8 ratios and T-cell receptor gene rearrangement analysis.
通过细针穿刺活检（FNAB）诊断T细胞淋巴瘤极其困难。这主要是由于该疾病罕见、形态学上与反应性淋巴结病相似，以及难以识别异常T细胞抗原表达。我们研究了经组织学证实的T细胞淋巴瘤的FNAB，试图确定该疾病显著的细胞形态学特征以及表面标志物属性。回顾了20例病例。对涂片进行总体细胞学模式和异常细胞百分比评估。还对淋巴瘤的流式细胞术（FCM）抗原表达进行了严格审查。有6例女性和14例男性患者，年龄范围为9 - 84岁（中位数为36岁）。14例（70%）显示多形性涂片，6例（30%）显示单形性涂片。异常细胞范围为10% - 100%（中位数为60%）。通过FCM分析，17例（85%）出现异常T细胞抗原表达。最常见的异常T细胞抗原模式是3种或更多种泛T细胞抗原缺失（n = 10）。最常见的单个T细胞抗原缺失是CD7缺失（n = 10），其次是CD5缺失（n = 5）。也有CD4和CD8缺失（n = 5）、CD5和CD7缺失（n = 5）、CD3完全缺失（n = 4）、CD4和CD8共表达（n = 1）以及CD3部分缺失（n = 1）。2例表达CD56。1例检测CD1a呈阳性。9例（53%）的CD4/CD8比值升高（>2.5），范围为3/1 - 57/1（中位数为12/1）。9例检测病例中有7例通过聚合酶链反应（PCR）检测TCR基因重排呈阳性。我们的研究结果表明，在大多数情况下，通过仔细分析形态学，FNAB可实现外周T细胞淋巴瘤的诊断。这可以通过使用两色或三色流式细胞术对表型进行严格分析来支持，尝试识别一种或多种异常T细胞抗原表达和/或缺失。这可以通过CD4/CD8比值和T细胞受体基因重排分析来补充。
