Bhaker Poonam, Das Anirban, Rajwanshi Arvind, Gautam Upasana, Trehan Amita, Bansal Deepak, Varma Neelam, Srinivasan Radhika
Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Division of Hematology-Oncology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Cancer Cytopathol. 2015 Sep;123(9):557-65. doi: 10.1002/cncy.21584. Epub 2015 Aug 4.
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.
前体T淋巴细胞淋巴瘤（T-LBL）是一种罕见的淋巴瘤，临床上多见于儿童和青少年，表现为纵隔肿块迅速增大、呼吸困难以及颈部淋巴结肿大，需要快速诊断。本研究的目的是报告其细胞形态学和流式细胞免疫表型分析（FCI）的情况。
回顾性分析2011年至2013年诊断的所有T-LBL病例的临床资料、细胞形态学特征、FCI及细胞块免疫细胞化学（CB-ICC）结果。
评估了15例前体T-LBL病例（10例细针穿刺样本和5例胸腔/心包积液样本）。涂片显示淋巴细胞呈散在分布，核质比高，嗜碱性细胞质稀少。细胞核可见切迹、裂隙和压迹。染色质在小和中等大小的母细胞中浓缩，在较大母细胞中分散。核仁仅见于较大母细胞。手镜形细胞和有丝分裂情况不一。免疫表型分析方面，流式细胞术显示CD2阳性（15例中的15例）、表面CD3阳性（15例中的14例）、细胞质CD3阳性（15例中的15例）、末端脱氧核苷酸转移酶（TdT）阳性（15例中的8例）、CD5阳性（15例中的13例）、CD10阳性（15例中的7例）和人类白细胞抗原-D相关分子（HLA-DR）阳性（15例中的1例）。所有病例均观察到CD4/CD8双阳性，形成紧密聚集，这与皮质T-LBL亚型一致。CB-ICC显示出一致的CD3阳性/TdT阳性/CD20阴性表型。在7例流式细胞术检测TdT阴性的病例中，CB-ICC呈阳性。
结合细胞形态学和FCI能够在细针穿刺和积液细胞学标本上准确、快速地诊断T-LBL，从而无需进行活检。
