Renal lymphoma. The diagnostic and therapeutic roles of fine-needle aspiration.
This study focused on 19 patients with renal lymphoma (RL) from whom 20 initial (1 patient with fine-needle aspiration [FNA] specimens of masses in both kidneys) and 1 repeated FNA specimen were obtained. Of the 19 patients, 10 had secondary RL, 8 primary RL, and 1 transplant RL. The FNA samples were studied by smears (all cases), tissues (11), phenotyping by immunostaining (13) or flow cytometry (4), and gene rearrangement (3). The final diagnoses included 1 T-cell lymphoma and 18 B-cell lymphomas. Of the 20 original specimens, 14 were reported as positive for lymphoma, 3 suggestive of lymphoma, 1 positive for transitional cell carcinoma, and 2 unsatisfactory. The follow-up specimen showed reactive changes. Tissue correlation, available in 11 cases, confirmed a positive cytodiagnosis (7), provided a final diagnosis in the cytologically inconclusive cases (3), or revised the misdiagnosis of transitional cell carcinoma from smears (1). The phenotyping elucidated the B vs T lineage of the lymphoma in all tested cases, confirmed the positive cytodiagnosis in 10 cases, confirmed the reactive cytodiagnosis in 1 case, and helped achieve a conclusive diagnosis in 2 cases suggestive of lymphoma. Gene rearrangement studies showed light chain restriction in the 2 tested cases. FNA has an essential role in treatment planning for RL. Although FNA usually is diagnostically conclusive, a high index of suspicion and awareness of atypical or misleading cytomorphologic features are important for a correct interpretation, especially for primary RL. Ancillary testing is essential for the diagnosis in problematic cases and lays the foundation for the differential diagnosis.
Truong
L D
LD
Department of Pathology, Baylor College of Medicine, Houston, TX, USA.
Caraway
N
N
Ngo
T
T
Laucirica
R
R
Katz
R
R
Ramzy
I
I
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002648:Child; D005260:Female; D015321:Gene Rearrangement; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology*; D016399:Lymphoma, T-Cell / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D014057:Tomography, X-Ray Computed