Lymph node cytology

Dr Raheela
 FNC evaluation of LN
Look at cell groups:
are there immature lymphoid cells?
macrophage-lymphoid complexes?
epithelioid cells?
metastatic cells?

Identify the stroma and vascular structures.

Evaluate nuclear atypia, but be aware that most NHL cells are a clonal
expansion of the corresponding non-lymphomatous cytotypes.

Compare cytological findings with ICC and/or FC, FISH and molecular data,
if available, to confirm the clonality or identify specific translocations.
• B-CELL NEOPLASMS
– Precursor B cell neoplasm
• Precursor B-lymphoblastic leukemia/lymphoma
• Precursor B-cell acute lymphoblastic leukemia
– Mature (peripheral) B-cell neoplasms
• B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma
(SLL/CLL)
• B-cell prolymphocytic leukemia Lymphoplasmacytic lymphoma (LPCL)
• Splenic marginal zone B-cell lymphoma (with/without villous
lymphocytes)
• Hairy cell leukemia
• Plasma cell myeloma/plasmacytoma
• Extranodal marginal zone B-cell lymphoma of MALT type (MALT)
• Nodal marginal zone B-cell lymphoma (with/without
monocytoid Bcells) (MZL)
• Follicular lymphoma (FL)
• Mantle-cell lymphoma (MCL)
• Diffuse large B-cell lymphoma (DLBCL)
• Burkitt lymphoma/Burkitt cell leukemia (BL)
• T-CELL AND NK-CELL NEOPLASMS
– Precursor T-cell neoplasm
• Precursor T-lymphoblastic lymphoma/leukemia
• Precursor T-cell acute lymphoblastic leukemia
– Mature (peripheral) T-cell neoplasms
• T-cell prolymphocytic leukemia
• T-cell granular lymphocytic leukemia
• NK-cell lymphomaleukemia (NKL)
• Adult T-cell lymphoma/leukemia (HTLV-1 positive)
• Extranodal NK/T-cell lymphoma, nasal type
• Enteropathy-type T-cell lymphoma
• Hepatosplenic gamma-delta T-cell lymphoma
• Subcutaneous panniculities-like T-cell lymphoma
• Mycosis fungoides/Sezarysyndrome
• Anaplastic large-cell lymphoma, T/null cell, primary cutaneous type
• Peripheral T-cell lymphoma, not otherwise characterized (PTL)
• Angioimmunoblastic T-cell lymphoma
• Anaplastic large-cell lymphoma, T/null cell, primary systemic type
 Non-specific hyperplasia
• FNC of most of lymph node enlargements shows a variable mixture
of normal cell type constituents. Vascular structures and
phagocyting histiocytes may be present, conferring a polymorphous
appearance to the smear. When a lymphadenopathy is determined
by the expansion of the follicular centres, the smears show
numerous centrocytes and centroblasts intermingled with small
mature lymphocytes, plasma cells and immunoblasts.

• In cases of interfollicular expansion the smears show a prevalence

of mature lymphocytes, plasma cells and immunoblasts; epithelioid
cells may also be present. In both cases, more monomorphous
smears pose the problem of the differential diagnosis with NHL. FC
and PCR may help in differential diagnosis. In immunodeficy
syndromes and autoimmune diseases FC may occasional show light
chains restrictions in a small percentage of the cells. In these cases,
as well as in all doubtful cases, histological control should be
performed.
• Differential diagnosis: follicular lymphoma (see NHL).
Salivary epithelial cells