Ramteke Prashant, Chitragar Sanjeev, Singh Ashok, Mallick Saumyaranjan, Mathur Sandeep R, Jain Deepali, Iyer Venkateswaran K
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, Andaman and Nicobar Islands Institute of Medical Sciences, Andaman and Nicobar, India.
J Cytol. 2018 Jan-Mar;35(1):37-40. doi: 10.4103/JOC.JOC_211_16.
Anaplastic large-cell lymphoma (ALCL) is a rare subtype of non-Hodgkin's lymphoma (NHL) characterized by the presence of unusual giant cells. It is a CD30+lymphoma of T-cells lineage, which shows anaplastic lymphoma kinase-nucleophosmin (ALK-NPM) rearrangement. ALCL on fine needle aspiration cytology (FNAC) shows unusually large and bizarre tumor cells.
All aspirates seen over a 6-year period from November 2009 to November 2015 in which a diagnosis of ALCL or Hodgkin's lymphoma (HL) with bizarre giant cells were suspected on cytomorphology were prospectively selected. Twenty such aspirates were subjected to CD-30 and ALK-1 immunocytochemistry (ICC). Subsequent biopsy was available in all cases.
Out of 20 cases, seven cases, suspected to be ALCL on FNAC, were confirmed on biopsy. ALK-1 was positive in both cytology and biopsy of 6/7 of these. Two cases suspected to be ALCL on cytomorphology were HL (1) and diffuse large B-cell lymphoma (DLBCL) (1) on biopsy, both of which were ALK-1 negative on cytology. Eight cases of HL and three cases of large-cell NHL, which were all ALK negative on cytology, were confirmed on biopsy.
ICC for ALK and CD30 is useful in aspiration cytodiagnosis of ALCL. One CD30 positive DLBCL and one ALK negative ALCL showed concordant results of ICC on cytology and histology.
间变性大细胞淋巴瘤（ALCL）是非霍奇金淋巴瘤（NHL）的一种罕见亚型，其特征是存在异常巨大细胞。它是一种T细胞系的CD30+淋巴瘤，表现为间变性淋巴瘤激酶-核磷蛋白（ALK-NPM）重排。细针穿刺细胞学检查（FNAC）中的ALCL显示出异常大且形态怪异的肿瘤细胞。
前瞻性选择2009年11月至2015年11月这6年期间所有在细胞形态学上怀疑诊断为ALCL或伴有怪异巨细胞的霍奇金淋巴瘤（HL）的穿刺样本。对其中20个这样的穿刺样本进行CD-30和ALK-1免疫细胞化学（ICC）检测。所有病例均有后续活检结果。
20例病例中，FNAC怀疑为ALCL的7例经活检得以确诊。其中6/7的病例在细胞学和活检中ALK-1均为阳性。细胞学形态学上怀疑为ALCL的2例病例，活检结果分别为HL（1例）和弥漫性大B细胞淋巴瘤（DLBCL）（1例），二者在细胞学上ALK-1均为阴性。8例HL和3例大细胞NHL在细胞学上ALK均为阴性，经活检得以确诊。
ALK和CD30的ICC检测在ALCL的穿刺细胞诊断中有用。1例CD30阳性的DLBCL和1例ALK阴性的ALCL在细胞学和组织学上ICC检测结果一致。
