FNA cytology of lymphomas: useless or useful? Edneia Tani
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1 FNA cytology of lymphomas: useless or useful? Edneia Tani Karolinska University Hospital Stockholm Sweden
2 FNAC LYMPH NODE First report:
3 FNAC LYMPH NODE Pioneers Sixten Franzén Lopez Cardoso
4
5
6 FNAC LYMPH NODE Zajicek (1974): 20% of cases of well differentiated lymphomas can not at present be recognized. Koss (1984): often possible and accurate, requires considerable caution and experience. Franzén (1983): there is no question that the diagnosis can be made with ease by FNA.
7 FNAC LYMPHOMAS PROBLEMS Cytomorphology: low grade lymphomas reactive high grade lymphomas metastasis Growth pattern
8 benign reactive x lymphoma
9 LYMPHOMA X CARCINOMA
10 FNAC LYMPH NODE Accepted for metastasis Not accepted for primary lymphomas but for recurrences and deep seated lymphomas
11 FNAC - LYMPHOMAS IMMUNOCYTOCHEMISTRY
12 Acta Cytol 1988 FNAC LYMPH NODE
13 FNAC LYMPHOMAS Classifications Cyto morphol Immuno Growth pattern Cyto genetics Kiel REAL WHO
14 FNAC LYMPHOMAS TODAY Quick stain cytomorphology Flow/immunocytochemistry Proliferation Cytogenetics
15 benign reactive x lymphoma
16 B T B T K L K L
17 lymphoma benign reactive
18 LYMPHOMA X CARCINOMA
19 LCA CK CD3 CD20 Cytokeratin
20 CARCINOMA LYMPHOMA
21 ENLARGED LYMPH NODE reactive hyperplasia lymphoma metastasis
22 27G 0.4 mm 23G 0.6 mm
23 Smear Cell suspension
24 FNA lymph node smears MGG, Pap Mib 1 ER, PR, AR cell susp cytospin (immuno, FISH) flow cytometry gene rearrangement bacteriology
25 Cell suspension cytospin immunostaining Cell concentration: 1 2 million cells/ml volume / cytospin: 100 ul 700 rpm 3 min air dried (up to 5 days) cold aceton fixed (10 min) three step alkaline phosphatase immunostaining technique
26
27
28 Four colour flow cytometry FITC PE PerCP alt. PE/Cy5/ APC Lambda kappa CD19 CD5 CD23 CD10 CD20 CD19 CD4 CD7 CD8 CD3 Bcl 2 CD10 CD3 CD19
29 Flow cytometry Lambda/ kappa/ CD19/ CD5 2. Gating on CD19/SSC and analysis of kappa/lambda Gate on CD19/SSC Reactive population Kappa:lambda 1,5 Lambda positive NHL
30 FNA lymph node ENLARGED LYMPH NODE Benign Unspecific reactive hyperplasia Specific infection Malignant lymphoma metastasis
31
32 CD3 kappa CD20 lambda
33
34 CD20 CD3
35 FNA lymph node ENLARGED LYMPH NODE Benign Unspecific reactive hyperplasia Specific infection Malignant lymphoma metastasis
36
37 Childhood suppurative lymphadenitis (non tuberculous mycobacterial lymphadenitis) Mycobacterium avium 7 (39%) Mycobacterium malmoense 4 (22%) Negative mycobact culture 7 (39%) Total: 18 cases
38
39 FNA lymph node ENLARGED LYMPH NODE Benign Unspecific reactive hyperplasia Specific infection Malignant lymphoma metastasis
40 FNA lymph node LYMPHOMAS Hodgkin s lymphoma Non Hodgkin s lymphoma T cell B cell
41
42 CD15 CD30
43 FNA lymph node LYMPHOMAS Hodgkin s lymphoma Non Hodgkin s lymphoma T cell B cell
44
45
46 CD3 kappa CD20 lambda
47 Lymphoma subclassification B cell lymphomas WHO Lymphoma subtype CD5 CD10 CD23 CD43 CLL lymphoplasmacytic +/ Mantel cell lymphoma + /+ +/ Follicular lymphoma + /+ Marginal zone
48 CD10 CD5 Mib 1
49
50 Lymphomas cytogenetics B cell tumors Small cell lymphocytic trisomy 12 Mantle cell t (11;14) Marginal zone trisomy 3 t(11;18) Follicular t (14;18) Burkitt/Burkitt like t (8;14), t (2;8) or t (8;22) T cell tumors Anaplastic large cell t (2;5)
51 Lymph node FNA: Mantel cell lymphoma?
52
53 Follicular lymphoma: Monoclonal kappa CD20+/CD10
54 26 year old HIV +
55 CD20 CD3 kappa lambda
56 Lymph node FNA: Burkitt like lymphoma?
57
58 CD20 CD4 CD3 C CD8
59
60
61 CD3 CD8 CD20 CD4
62
63 CD30 CD45
64 FNA lymph node ENLARGED LYMPH NODE Benign Unspecific reactive hyperplasia Specific infection Malignant lymphoma metastasis
65 Metastasis Carcinoma Squamous cell carcinoma Adenocarcinoma Poorly differentiated ca Undifferentiated ca Melanoma Sarcoma
66 Metastasis of adenocarcinoma
67 Metastasis of adenocarcinoma CK subtyping ER, PGR, AR TTF 1 CA125, CEA, CDX 2 PSA, PSAP Thyroglobulin, calcitonin Uroplakin CD10
68 CK subtyping CK7+ CK20+ urothelial, pancreas, ovarium (mucinous) CK7+ CK20 lung, breast, mesothel ovarium, endometrial CK7 CK20+ colon CK7 CK20 prostate, hepatoma, renal, squamous ca
69 CK7 CK20 TTF 1 adenocarcinoma
70 ER PGR
71 Enlarged lymph node: metastasis of adenocarcinoma
72 CK7 CK20 AR PSA
73 Metastasis Carcinoma Squamous cell carcinoma Adenocarcinoma Poorly differentiated ca Undifferentiated ca Melanoma Sarcoma
74 LCA CK
75 Metastasis Carcinoma Squamous cell carcinoma Adenocarcinoma Poorly differentiated ca Undifferentiated ca Melanoma Sarcoma
76
77 LCA HMB45
78 Metastasis Carcinoma Squamous cell carcinoma Adenocarcinoma Poorly differentiated ca Undifferentiated ca Melanoma Sarcoma
79 desm myoglob
80 FNA lymph node FINAL DIAGNOSIS cytomorphology immunocytochemistry cytogenetics clinical presentation
81 Cancer Lymphadenitis Lymphoma Sarcoma Melanoma Unclear Others Total Cancer Benign l. Lymph. Sarcoma Melanoma Unclear Others
82 How to succeed? Interested clinicians Surgical biopsy not the primary diagnostic technique Interested cytopathologists Training Quick staining triage Conferences (hemathologists, pathologists, cytologists, radiologists, oncologists )
83 FNA cytology of lymphomas: useless or useful? Edneia Tani Karolinska University Hospital Stockholm Sweden
84 FNA cytology of lymphomas: useful! Thank you for your attention!
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