Zhang Jue-Rong, Raza Anwar S, Greaves Timothy S, Cobb Camilla J
Department of Pathology, Cytopathology Division, LAC/USC Medical Center, Los Angeles, California 90033, USA.
Diagn Cytopathol. 2006 Jun;34(6):397-402. doi: 10.1002/dc.20439.
With the advent of modern therapy, the differences in prognoses and treatment regimens among different subtypes of Hodgkin lymphoma (HL) have largely vanished. Stage and the presence of systemic symptoms are much more important than histologic subtypes as predictive factors. The current (2001) WHO classification markedly de-emphasizes spatial relationships as critical to the diagnosis of lymphoma and emphasizes cell morphology, immunophenotype, genetic features, and clinical information to define the disease states. This classification, thus, greatly enhances the capability of fine-needle aspiration (FNA) to accurately diagnose HL. We searched all the FNA cases in our institute in years 1999 through 2004 and found 42 cases, for which 13 were primarily diagnosed (31.0%), 2 were recurrent (4.8%), 5 were highly suspicious (11.9%), and 22 were suspicious (52.3%) for HL. On follow-up tissue biopsy, all the primarily diagnosed, recurrent, and highly suspicious cases were confirmed to be HL (100% agreement). For the 22 suspicious cases, 13 were HL (59.1%), 5 were other lymphomas (22.8%), 1 was lymphoma unclassifiable (4.5%), and 3 were reactive processes (13.6%). The effect of immunostains on the diagnosis of HL was examined, and its importance was emphasized. Analysis of demographic data and the distribution of HL subtypes demonstrate that the study sample is representative of the general HL patient population. On the basis of these results, we propose: (1) If the FNA diagnosis of HL is confirmed both by morphology and immunostains, no further tissue confirmation, subclassification and grading is necessary, and appropriate treatment regimens should follow. (2) The nodular lymphocyte predominant HL and classical HL can be differentiated by adequate immunostaining. (3) If a definitive diagnosis cannot be achieved by FNA, a second FNA or a tissue biopsy should be recommended.
随着现代治疗方法的出现，霍奇金淋巴瘤（HL）不同亚型之间的预后和治疗方案差异已基本消失。分期和全身症状的存在作为预测因素比组织学亚型更为重要。当前（2001年）世界卫生组织分类显著淡化了空间关系对淋巴瘤诊断的关键性，而是强调细胞形态、免疫表型、基因特征和临床信息来定义疾病状态。因此，这种分类极大地提高了细针穿刺抽吸（FNA）准确诊断HL的能力。我们检索了1999年至2004年我院所有FNA病例，共发现42例，其中13例初步诊断为HL（31.0%），2例为复发病例（4.8%），5例高度可疑（11.9%），22例可疑（52.3%）为HL。在后续组织活检中，所有初步诊断、复发和高度可疑病例均确诊为HL（一致性为100%）。对于22例可疑病例，13例为HL（59.1%），5例为其他淋巴瘤（22.8%），1例为无法分类的淋巴瘤（4.5%），3例为反应性病变（13.6%）。研究了免疫染色对HL诊断的作用，并强调了其重要性。对人口统计学数据和HL亚型分布的分析表明，研究样本代表了一般HL患者群体。基于这些结果，我们建议：（1）如果FNA对HL的诊断通过形态学和免疫染色得到证实，则无需进一步的组织确认、亚分类和分级，应采用适当的治疗方案。（2）结节性淋巴细胞为主型HL和经典型HL可通过充分的免疫染色进行鉴别。（3）如果FNA无法做出明确诊断，应建议再次FNA或组织活检。
