Adachi Sumiyo, Yamazaki Kazuto, Liang Shan-Guang, Ishida Yasuo
Department of Surgical Pathology, Chiba Medical Center, Teikyo University, Ichihara, Japan.
Department of Obstetrics and Gynecology, Chiba Medical Center, Teikyo University, Ichihara, Japan.
J Cytol. 2015 Jul-Sep;32(3):181-3. doi: 10.4103/0970-9371.168845.
We report a rare case of a 69-year-old woman in whom diffuse large B-cell lymphoma (DLBCL) originated from the uterus and involved the urinary bladder. The cervical smears of the case mostly consisted of discohesive atypical round cells, which were highly suggestive of lymphoma; however, in voided urine smears, a majority of the cells formed large aggregates of degenerated cells, mimicking those of urothelial carcinoma (UC). The smears also represented some small loose clusters, in which tumor cells formed short chains with nuclear molding, mimicking those of small cell carcinoma. The cytodiagnosis got definitive when we identified the atypical cells that showed CD20+/CD3-/cytokeratin-/NSE- immunophenotype. These are of particular concern as they may have misleading similarities to other epithelial neoplasms when examining lymphoma involving the urinary bladder. Accordingly, this case highlights the importance of immunocytochemistry to rule out malignant lymphoma when encountering large and/or small loose clusters of atypical round cells on urinary cytology.
我们报告了一例罕见病例，一名69岁女性，弥漫性大B细胞淋巴瘤（DLBCL）起源于子宫并累及膀胱。该病例的宫颈涂片主要由散在的非典型圆形细胞组成，高度提示淋巴瘤；然而，在排尿后的尿液涂片中，大多数细胞形成了大量变性细胞聚集体，类似尿路上皮癌（UC）。涂片还显示出一些小的松散细胞团，其中肿瘤细胞形成具有核模的短链，类似小细胞癌。当我们鉴定出显示CD20+/CD3-/细胞角蛋白-/NSE-免疫表型的非典型细胞时，细胞诊断得以明确。这些特别值得关注，因为在检查累及膀胱的淋巴瘤时，它们可能与其他上皮性肿瘤有误导性的相似之处。因此，该病例突出了免疫细胞化学在尿液细胞学检查中遇到大量和/或小的松散非典型圆形细胞团时排除恶性淋巴瘤的重要性。
