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Fine Needle Aspiration Cytology of Malignant Lymphomas – From Diagnosis to Classification and Prognosis

Fine needle aspiration (FNA) cytology is safe and simple technique in the assessment of patients with enlarged lymph node, especially in diagnosis of malignant lymphomas. When lymphoma is cytologically verified on initial testing, it should be followed by lymph node biopsy and histopathologic analysis. In case of relapse, determination of disease dissemination and detection of minimal residual disease, cytologic sample supplemented with ancillary technologies is adequate to make the diagnosis. The algorithms for the diagnosis of enlarged lymph node include FNA as the first diagnostic method, followed by the ancillary technologies is associated with lower risk than operative procedure, especially in immunocompromised patients (e.g. HIV positive), while the risk of infection for medical staff performing the procedure is also reduced. Unfortunately, patients with benign lymphadenopathy continue to be quite frequently referred for surgical extirpation and histopathologic diagnosis as the first differential diagnostic option. Malignant lymphomas are a heterogeneous group of monoclonal neoplastic diseases that originate from the immune system. Various types of non-Hodgkin’s lymphoma may have similar morphology with great variations in the origin, immunophenotype and other biological characteristics. The most widely used ancillary technologies in the diagnosis of lymphoma include immunocytochemistry on smears and/or flow cytometry, polymerase chain reaction (PCR), cytogenetics [conventional and/or fluorescent in situ hybridization (FISH)], and kinetic methods (DNA cytometry) from FNA samples. FNA sample can be used in for all these analyses and, depending on the clinical findings, can be obtained on initial FNA or later, after in the first cytological report the suspicion of lymphoma was raised. Immunocytochemistry plays a major role in the diagnosis and subtyping of malignant lymphomas, and also in the differential diagnosis of lymphomas vs. poorly differentiated tumors of another cell origin (metastatic tumors in lymph node). Flow cytometry as a fast, objective and quantitative multiparametric method, helps in differentiating reactive hyperplasias and malignant lymphomas by determining the lymphatic cell clonality (light kappa/lambda chain restriction) and in lymphoma subtyping by determining the degree of lymphatic cell differentiation as well as for quantitation of malignant cells. Very useful is information on rearrangement of the immunoglobulin heavy or light chain gene or T lymphocyte receptor gene, suggesting the lymphatic cell B or T clonality, that is the diagnosis of malignant lymphoma. It is determined by molecular diagnosis using PCR. Chromosomal aberrations can be identified by conventional cytogenetics, PCR, or FISH, that are highly relevant in the diagnosis, subclassification and prognostic assessment of lymphoma. In malignant lymphomas, cell kinetics has shown to be related with histologic type as well as with the clinical behavior. DNA cytometry can also be used in both diagnostic and prognostic value in various types of lymphomas. Cell proliferation rate measured as S-phase is closely associated with histologic grading in non-Hodgkin’s lymphoma, and it has independent prognostic value. Cytomorphology with ancillary technology play an important role in differential diagnosis, classification, and prognosis of malignant lymphoma.

Malignant lympomas; diagnosis; clasiffication; prognosis

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