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Cytomorphology and Ancillary Technologies in the Diagnosis, Classification and Prognosis of Malignant Lymphomas

Fine needle aspiration (FNA) cytology is safe and simple technique in the assessment of patients with malignant lymphomas. The most widely used ancillary technologies in the diagnosis of lymphoma include flow cytometry, immunocytochemistry, polymerase chain reaction (PCR), conventional cytogenetics and/or fluorescent in situ hybridization (FISH), and kinetic methods (DNA cytometry). FNA sample can be used in for all these analyses and, depending on the clinical picture, can be obtained on initial FNA or later, after in the first cytological report the suspicion of lymphoma was raised. Immunocytochemistry plays a major role in the diagnosis and subtyping of malignant lymphomas, and also in the differential diagnosis of lymphomas versus poorly differentiated tumors of another cell origin. In the latter, there are a number of cellular antigenes, and using the combinations of various antibodies, in most cases it can be determined whether it is a lymphoma or a nonlymphoid neoplasm of epithelial, neuroendocrine, histiocytic, smooth muscle, striated muscle, embryonal, etc. origin ; even, in some cases the organ of tumor origin can be determined. Flow cytometry helps in differentiating reactive hyperplasias and malignant lymphomas by determining the lymphatic cell clonality (light kappa/lambda chain restriction) and in lymphoma subtyping by determining the degree of lymphatic cell differentiation. Very useful is information on rearrangement of the immunoglobulin heavy or light chain gene or T lymphocyte receptor gene, suggesting the lymphatic cell B or T clonality, i.e. the diagnosis of malignant lymphoma. It is determined by molecular diagnosis using PCR. Chromosomal aberrations can be identified by conventional cytogenetics, PCR, or FISH, that are highly relevant in the diagnosis, subclassification and prognostic assessment of lymphoma. DNA cytometry can also be used in both diagnostic and prognostic value in various types of lymphomas. On primary diagnostic, relapse, determination of disease dissemination and detection of minimal residual disease, cytologic sample supplemented with ancillary technologies is adequate to make the diagnosis, classification and prognosis in many cases of lymphoma.

Cytomorphology; ancillary technologies; malignant lymphomas

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