title: Fine-needle aspiration biopsy in diagnosis of follicular lymphoma: cytomorphologic and immunohistochemical analysis.
abstract: Follicular lymphoma is a relatively uncommon type of non-Hodgkin's lymphoma (NHL) thought to derive from follicular center cells. There are limitations to fine-needle aspiration in the diagnosis of follicular NHL, and very few studies are available on it. We describe here the cytomorphologic features of eight biopsy-proven cases of follicular NHLs and five biopsy-proven cases of intermediate-grade NHLs. Five cases of reactive lymphoid hyperplasia (RLH) diagnosed on cytology were also studied cytomorphologically. Image morphometry was done in follicular and intermediate-grade NHLs, immunocytochemistry was done in follicular and intermediate-grade NHLs, and immunocytochemistry for bcl-2 expression was studied in five cases of follicular NHLs. The aspirate smears of follicular NHL showed the presence of higher grades, many to abundant (++ to +++) monomorphic lymphoid aggregates, with an increased number of mast cells. Lymphohistiocytic tangles and tingeable body macrophages were not observed in any of the cases. Cytomorphologically, all the cases of intermediate-grade NHL showed a predominantly monomorphic population of lymphoid cells with absent or few grades (+) of lymphoid aggregates. Image morphometric data analysis of each cell parameter for follicular and intermediate-grade NHLs were found to be statistically insignificant (P > 0.05) and hence of little help in diagnosis of follicular vs. low-grade NHLs. Immunocytochemistry for bcl-2 expression in follicular NHL showed variable results, ranging from 0-90% (expressed as bcl-2 index). Certain characteristic cytomorphological features such as the presence of monomorphic lymphoid cell aggregates and an increased number of mast cells are soft indicators for the diagnosis of follicular NHL on aspiration smears. Immunocytochemistry for bcl-2 expression may be of help in cases with clinical and cytological suspicion of lymphoma. Image morphometry has a small role in this regard.
authors.affiliation: Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Uma Nahar
authors.initials: UN
authors.lastname: Saikia
authors.forename: Pranab
authors.initials: P
authors.lastname: Dey
authors.forename: Biman
authors.initials: B
authors.lastname: Saikia
authors.forename: Ashim
authors.initials: A
authors.lastname: Das
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002452:Cell Count; D005260:Female; D006801:Humans; D019044:Image Cytometry; D007150:Immunohistochemistry; D008224:Lymphoma, Follicular / Q000737:chemistry / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis; D019310:Pseudolymphoma / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D019253:Proto-Oncogene Proteins c-bcl-2