Schwock Joerg, Geddie William R
Division of Anatomical Pathology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto General Hospital, Room E11-219, Toronto, ON, Canada M5G 2C4.
Patholog Res Int. 2012;2012:164934. doi: 10.1155/2012/164934. Epub 2012 May 27.
Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy. The cytologic diagnosis of B-cell non-Hodgkin lymphomas composed of small-/intermediate-sized cells, however, has been seen as an area of great difficulty even for experienced observers due to the morphologic overlap between lymphoma and reactive lymphadenopathies as well as between the lymphoma entities themselves. Although ancillary testing has improved diagnostic accuracy, the results from these tests must be interpreted within the morphological and clinical context to avoid misinterpretation. Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis. For these reasons, we here review the cytologic characteristics particular to five common B-cell non-Hodgkin lymphomas which typically cause the most diagnostic confusion based on cytological assessment alone: marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and lymphoplasmacytic lymphoma. We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls.
细针采样是一种快速、安全且可能具有成本效益的获取组织的方法，用于细胞形态学评估，旨在对临床上出现淋巴结病的患者进行初步分诊，在某些情况下还可进行完整诊断。然而，由小/中等大小细胞组成的B细胞非霍奇金淋巴瘤的细胞学诊断，即使对于经验丰富的观察者来说，也被视为一个极具难度的领域，这是因为淋巴瘤与反应性淋巴结病之间以及淋巴瘤实体本身之间存在形态学重叠。尽管辅助检测提高了诊断准确性，但这些检测结果必须在形态学和临床背景下进行解读，以避免错误解读。重要的是，识别特定的细胞学特征对于指导适当选择辅助检测至关重要，这些检测将证实或反驳初步诊断。出于这些原因，我们在此回顾五种常见的B细胞非霍奇金淋巴瘤的特定细胞学特征，这些淋巴瘤仅基于细胞学评估通常会导致最严重的诊断混淆：边缘区淋巴瘤、滤泡性淋巴瘤、套细胞淋巴瘤、慢性淋巴细胞白血病/小淋巴细胞淋巴瘤和淋巴浆细胞淋巴瘤。我们总结了每个实体以及反应性淋巴组织增生最相关的细胞形态学特征，将它们相互对比以促进识别，并突出常见的诊断陷阱。
