title: Fine-needle aspiration diagnosis of lymphomas with signet ring cell features: potential pitfalls and solutions.
abstract: BACKGROUND
  Lymphoma with signet ring cell features (LSF) is a rare morphologic variant of non-Hodgkin lymphoma. Although it has been well documented in the surgical pathology literature, to the best of the authors's knowledge, the features of LSF in fine-needle aspiration (FNA) samples have rarely been reported. An accurate cytologic diagnosis of LSF is of important therapeutic significance.
  
  
  METHODS
  The authors retrospectively reviewed 7 FNA cases of LSF for cytologic features, ancillary studies, corresponding histologic findings, and the patients' clinical and radiologic information to illustrate the diagnostic clues and potential pitfalls.
  
  
  RESULTS
  The final diagnoses, based on a multidisciplinary approach, were follicular lymphoma (5 patients), large B-cell lymphoma of follicular center cell origin (1 patient), and low-grade B-cell lymphoma with plasmacytoid features (1 patient). FNAs were obtained from both lymph node and extranodal sites. Common cytologic features included various percentages of signet ring cells in a background of nonvacuolated lymphomatous cells, lymphoglandular bodies, and cytoplasmic rings. The majority of signet ring cells contained a single, large, clear intracytoplasmic vacuole that pushed the nucleus laterally whereas fewer cells contained ≥ 2 vacuoles that indented the nucleus into a scalloped or stellate configuration. These cells resemble, to some degree, other lesions with signet ring cell features. One of the diagnostic clues of LSF was the similarity in nuclear details between signet ring cells and surrounding nonvacuolated lymphoid cells.
  
  
  CONCLUSIONS
  Familiarity with cytologic features, correlation with clinical/radiologic information, and ancillary studies are important for an accurate diagnosis of LSF and for distinguishing it from other lesions with signet ring cell features in FNA samples.
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jeff
authors.initials: J
authors.lastname: Wang
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Katz
authors.forename: John
authors.initials: J
authors.lastname: Stewart
authors.forename: Gene
authors.initials: G
authors.lastname: Landon
authors.forename: Ming
authors.initials: M
authors.lastname: Guo
authors.forename: Yun
authors.initials: Y
authors.lastname: Gong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis* / Q000601:surgery; D002467:Cell Nucleus / Q000473:pathology*; D003581:Cytodiagnosis; D003593:Cytoplasm / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008223:Lymphoma / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D012189:Retrospective Studies
keywords: aspiration; cytology; fine-needle aspiration; lymphoma; signet ring