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Pleural fluid cytology of Hodgkin's disease: cytomorphologic features and the value of immunohistochemical studies.
Olson PR, Silverman JF, Powers CN.
Department of Pathology, Medical College of Pennsylvania/Hahnemann University, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. [email protected]
Two cases in which Hodgkin's disease (HD) was cytologically diagnosed in pleural effusions are presented. The presence of Reed-Sternberg (R-S) cells was confirmed by positive staining for both CD15 and CD30, and negative staining for leukocyte common antigen. In addition, the differential diagnosis of HD in effusion cytology is presented, including look-alikes of R-S cells that can potentially lead to an incorrect diagnosis. To the best of our knowledge, we believe this is only the second cytologic report of HD diagnosed in a pleural effusion using immunohistochemistry to confirm the diagnosis. Copyright 2000 Wiley-Liss, Inc.
Publication Types:
PMID: 10613967 [PubMed - indexed for MEDLINE]
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Utility of CD15, CD30 & CD45 in the immunohistochemical diagnosis of Hodgkin's disease by antigen retrieval method.
Arici DS, Aker H, Gungor M.
Department of Pathology, School of Medicine, Cumhuriyet University, Sivas/Turkey.
The utility of staining Reed-Sternberg (RS) cells with CD30, CD15 and CD45 as a diagnostic aid in Hodgkin's disease (HD) and the value of microwave citrate antigen retrieval (AR) method in improving the results of immunohistochemical (IHC) studies were evaluated. Histological and immunohistological studies were carried out on 21 patients with HD seen from January 1987 to December 1996 in the Pathology Department of the Cumhuriyet University, School of Medicine. Avidin biotin peroxidase complex (ABC) was used in IHC study as a method for detection of RS cells. Monoclonal antibodies CD30, CD15 and CD45 were applied on formalin fixed paraffin embedded tissue sections. In order to enhance the immunoreactivity, microwave citrate AR method and proteolytic pretreatment were used. The reactivity of RS cells and staining patterns were determined. In 14 (70%) of the 20 patients, RS cells stained positively with CD30, in 16 (80%) CD15 staining was positive and only 1 (5%) was positively stained with CD45. A combination of cytoplasmic with cell surface staining was common with CD30, while paranuclear deposit with cell surface and cytoplasmic staining was common with CD15. In conclusion, to facilitate the detection of RS cells in formalin fixed paraffin embedded tissues, the application of a panel of markers appears to be necessary. Also AR method seems to be helpful in obtaining optimal results on formalin fixed paraffin embedded tissue.
PMID: 10489740 [PubMed - indexed for MEDLINE]
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Malignant pleural effusion in Hodgkin's lymphoma. Report of a case with immunoperoxidase studies.
Peterson IM, Raible M.
Department of Pathology, Truman Medical Center/Affiliated Hospital, University of Missouri-Kansas City School of Medicine.
The cytologic and histopathologic findings in a patient with Hodgkin's lymphoma, mixed cellularity type, and a malignant pleural effusion are presented. The consistency of staining with a battery of immunoperoxidase monoclonal antibody stains, including leukocyte common antigen, Leu-M1, UCHL1 and L26, was examined on sections of formalin-fixed lymph nodes and alcohol-fixed pleural fluid cell blocks. In addition, these same tissues were stained with carcinoembryonic antigen, B72.3, cytokeratin and epithelial membrane antigen immunoperoxidase antibodies to differentiate the tumor cells from reactive mesothelial cells and adenocarcinoma cells. The results on the pleural fluid specimens were consistent with what is known of the immunohistochemical staining properties of Hodgkin's lymphoma cells in lymph nodes.
Publication Types:
PMID: 1710403 [PubMed - indexed for MEDLINE]
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Sternberg-Reed-like cells in a pleural effusion secondary to pulmonary emboli with infarction: a cytological observation.
Irwin RS, Saunders RL Jr, Isaac PC, Marcus JB, Corrao WM.
Cells resembling Sternberg-Reed cells were observed in a pleural effusion that was caused by pulmonary embolus with infarction. Although Hodgkin's disease was suggested on the basis of abnormal pleural fluid cytological preparations, the subsequent evaluation and clinical course did not support that diagnosis. We conclude that first, the cytological diagnosis of Hodgkin's disease should only be made when Sternberg-Reed-like cells are seen in association with a compatible clinical and cytological picture, and second, the cytological diagnosis of Hodgkin's disease or other malignancy should be made with caution in cases in which pulmonary infarction is present.
Publication Types:
PMID: 579969 [PubMed - indexed for MEDLINE]
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Cerebral spinal fluid involvement by Hodgkin's disease diagnosed by CSF cytology and immunocytochemistry.
Perez-Jaffe LA, Salhany KE, Green RJ, Griffin T, Stadtmauer EA, Gupta PK.
Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
A 39-yr-old man with stage IV Hodgkin's disease (HD) involving bone marrow was being evaluated for autologous bone marrow transplantation when he developed diplopia, prompting a lumbar puncture tap for cerebral spinal fluid (CSF) examination. Cytologic examination of the CSF revealed numerous Reed-Sternberg (RS) cells in a polymorphous inflammatory background of small lymphocytes, monocytes, rare plasma cells, and eosinophils. However, magnetic resonance imaging (MRI) studies of the brain and spinal cord failed to reveal evidence of leptomeningeal disease or intracranial masses. Repeat CSF examination again demonstrated cytologic evidence of HD. Immunocytochemical stains established that the RS cells and mononuclear Hodgkin's cells were positive for CD30 and CD20 but negative for CD15; this phenotype was identical to that of RS cells in the initial diagnostic bone marrow biopsy, confirming CSF involvement by HD. The patient was treated with intrathecal methotrexate, 15 mg, 6 days after his bone marrow transplant. After treatment, all subsequent CSF cytology specimens were negative for tumor. In this case of disseminated HD, cytologic examination allowed for early detection of CNS involvement by lymphoma prior to development of radiographically detectable lesions.
Publication Types:
PMID: 10204105 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration cytology of Hodgkin disease: a study of 89 cases with emphasis on false-negative cases.
Chhieng DC, Cangiarella JF, Symmans WF, Cohen JM.
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35249-6823, USA. [email protected]
INTRODUCTION. Although the cytologic features of Hodgkin disease (HD) has been well described, HD accounts for most of the false-negative fine-needle aspiration (FNA) biopsies of malignant lymphomas. In this study, the authors examined the factors contributing to a false-negative diagnosis of HD. METHODS: Eighty-nine cases from 72 patients (23 females and 49 males) with HD evaluated by FNA were identified between 1990 and 1999. The patients' ages ranged from 5 to 90 years (median, 38 years). Eighty-five FNAs were from lymph nodes, and 4 were from extranodal sites. Histologic correlation was available for all patients. RESULTS: Based on the original cytologic diagnosis, 43 (48.3%) cases had a positive diagnosis of HD, 20 (22.5%) suspicious or atypical diagnosis, 13 (14.6%) a benign diagnosis (false-negative cases), and 10 (11.2%) were nondiagnostic. Three (3.4%) additional cases had a malignant diagnosis other than HD. After review, three false-negative cases were reclassified as HD and seven as atypical lymphoid proliferation. Three of these 10 cases also showed conspicuous collections of histiocytes mimicking poorly formed granulomas. In those "atypical" cases, only rare Reed-Sternberg (R-S) cells variants were identified. No R-S cells or its variants were identified in the remaining three false-negative cases; subsequent excisional biopsy showed partial involvement of the lymph node by HD in two cases. Among the nondiagnostic cases, nine cases showed considerable fibrosis in the resected lymph node. In addition, six cases were performed without on-site assessment. CONCLUSIONS: The cytologic diagnosis of HD can be challenging when classic R-S cells are absent. Contributing factors for a false-negative diagnosis include obscuring reactive inflammatory cells, fibrosis of the involved lymph nodes, partial involvement of the lymph node by HD, sampling error, and misinterpretation. On-site assessment significantly minimizes the false-negative diagnostic rate. Furthermore, additional material can be obtained for ancillary studies. Cancer (Cancer Cytopathol) Copyright 2001 American Cancer Society.
PMID: 11241266 [PubMed - indexed for MEDLINE]
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Comparison of Papanicolaou's and Wright-Giemsa stains in the examination of body fluids for Hodgkin's disease.
Wilson MS, Theil KS, Goodwin RA, Brandt JT.
Department of Pathology, Ohio State University, Columbus 43210.
We reviewed 36 body fluid specimens from 18 patients with Hodgkin's disease (HD) to characterize the cytologic features of HD as seen in Wright-Giemsa (WG)-stained cytocentrifuge preparations, and to compare diagnostic agreement between WG- and Papanicolaou-stained samples. Slides were examined independently by two pathologists without knowledge of the original diagnosis, and were classified as either positive, inconclusive, or negative for malignant cells. There was diagnostic agreement between both methods in 35 (97%) of 36 samples. Features in cytocentrifuged WG-stained specimens that were most helpful in recognizing HD included mirror image nuclei in typical Reed-Sternberg cells and an axis of symmetry in polylobate Reed-Sternberg variants, with even distribution of the nuclear material within the cytoplasm.
Publication Types:
PMID: 2454090 [PubMed - indexed for MEDLINE]
Comment in:
Value of fine needle aspiration cytology in the initial diagnosis of Hodgkin's disease. Analysis of 188 cases with an emphasis on diagnostic pitfalls.
Jimenez-Heffernan JA, Vicandi B, Lopez-Ferrer P, Hardisson D, Viguer JM.
Department of Pathology, University Hospital La Paz, Paseo de la Castellana 261, Madrid-28046, Spain.
OBJECTIVE: To evaluate the diagnostic accuracy and pitfalls of fine needle aspiration (FNA) cytology in the initial evaluation of Hodgkin's disease (HD) and to assess the influence of the pathologist's experience by comparing the results during two periods. STUDY DESIGN: A total of 170 cytodiagnoses of HD were reviewed and compared with those on the final histopathologic report. Thirty-three cases of HD with a previous, different cytologic diagnosis were also selected. In all the cases under study, FNA was performed as part of the initial diagnostic approach. From a practical perspective, diagnostic errors were divided into major or minor according to the consequences on patient management. RESULTS: Fifteen cytologic diagnoses of HD were followed by a different histologic diagnosis after lymph node biopsy. In 33 cases of HD an erroneous cytologic diagnosis was given prior to biopsy. The sensitivity of the series was 82.4% (86.1% excluding nonrepresentative cases). The positive predictive value reached 91.2%. Sensitivity varied from 79.3% in the first period (1982-1990) to 84.9% in the second (1991-1999) (83.3% and 88.2%, respectively, excluding nonrepresentative cases). Similarly, the positive predictive value increased from 89% to 92.8%. Diagnostic errors with important consequences for patient management diminished from 14 in the first period to 5 in the second. CONCLUSION: Cytology offers a rapid and accurate approach not only for the diagnosis of recurrent HD but also for its initial recognition. These results increase the capacity of FNA as a first-level diagnostic technique in the screening of lymphadenopathies.
Publication Types:
PMID: 11393058 [PubMed - indexed for MEDLINE]
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Fine needle aspiration cytodiagnosis of Hodgkin's disease and its subtypes. I. Scope and limitations.
Das DK, Gupta SK, Datta BN, Sharma SC.
Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
The fine needle aspiration (FNA) smears and paraffin-embedded sections from 89 cases with a cytologic and histologic diagnosis of Hodgkin's disease (HD) and 27 cases with minor or major cytohistologic discrepancies were reviewed. The accuracy of the initial cytologic study was found to be 91.8% for diagnosing HD and 58.1% for classifying its subtypes. Following review, 87 of the 89 agreement cases remained classified as HD. Of the 27 cases with initial cytohistologic discrepancies, 12 were classified as HD and 10 were categorized as lymphocytic or non-Hodgkin's lymphoma by both cytology and histology upon review. Following review, the accuracy of FNA cytology for the diagnosis of HD improved to 98.0%, with 71.4% correct subtyping. The greatest limitation of cytologic subtyping was in cases of nodular sclerotic HD: only 3 of 17 cases could be subtyped even after review. The cytomorphologic features of the HD subtypes are described, and the difficulties encountered in the cytodiagnosis of HD are discussed at length. The results of this study indicate that FNA cytology is a useful tool not only for the diagnosis of HD, but also for its subtyping.
PMID: 2343687 [PubMed - indexed for MEDLINE]
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Sources of discrepancies in the diagnosis of Hodgkin's disease by fine needle aspiration.
Daskalopoulou D, Tamiolakis D, Tsousis S, Apostolikas N, Markidou S.
Cytology Department, Hellenic Anticancer Institute, Saint Savvas Hospital, Athens, Greece.
The aim of this study was to assess the value of Fine Needle Aspiration (FNA) Cytology in the diagnosis of Hodgkin's Disease (HD) and to identify the sources and nature of the inaccuracies related to this procedure. We retrospectively studied all cases cytologically diagnosed in our laboratory as HD during a five year period (1990-1994). We also traced cases in which FNA cytology failed to reveal HD and where a subsequent HD diagnosis was made by histology. Of the 99 cases studied, a histological report was available for 93. In 82 cases FNA was carried out as part of the initial evaluation. In the remaining 17 cases the diagnosis of HD was known and FNA was performed in order to confirm or exclude a relapse. The results included 4 false positive for HD, 5 false negative and 3 HD-suspicious cases (only one of which proved histologically to be HD while the remaining two were other neoplasms). The re-evaluation of the last 12 cases identified 3 different sources of error: a) Material adequacy criteria; b) Sampling techniques; c) Interpretation.
PMID: 9157825 [PubMed - indexed for MEDLINE]
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Ki-1-positive anaplastic large cell lymphoma initially diagnosed as Hodgkin's disease by fine needle aspiration (FNA) cytology.
Aljajeh IA, Das DK, Krajci D.
Unit of Histopathology, Farwaniya Hospital, Kuwait.
A 45-year-old male presented with a large mass in the left axilla. FNA cytology was interpreted as Hodgkin's disease (HD), lymphocyte depletion (LD) type, but histopathologic and immunohistochemical examination showed features of Ki-1-positive anaplastic large cell lymphoma. Unrepresentative sampling by the FNA from the tumour periphery resulted in a false impression of dual reactive and neoplastic cell populations, which together with the frequent Reed-Sternberg-like cells led to the initial erroneous impression of HD. Therefore, the cytologic diagnosis of HD, LD should be approached with caution.
Publication Types:
PMID: 8520002 [PubMed - indexed for MEDLINE]
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Hodgkin's disease: diagnostic accuracy of fine needle aspiration; a report based on 62 consecutive cases.
Fulciniti F, Vetrani A, Zeppa P, Giordano G, Marino M, De Rosa G, Palombini L.
Laboratory and Cytopathology Service, Faculty of Medicine and Surgery, University of Naples Federico II, Italy.
We report on our series of 62 cases occurring between January 1977 and December 1990, which were diagnosed as Hodgkin's disease by fine needle aspiration (FNA) samples. The overall accuracy of the cytological diagnosis was high, with only four incorrect diagnoses and a positive predictive value of 93.5%. The value of FNA as a first level diagnostic technique in the screening of lymphadenopathies is discussed, as well as the limitations and pitfalls of the cytological diagnosis.
PMID: 7948759 [PubMed - indexed for MEDLINE]
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Cytologic criteria for subclassification of Hodgkin's disease using fine-needle aspiration.
Moriarty AT, Banks ER, Bloch T.
Department of Pathology, Indiana University School of Medicine, Indianapolis.
Hodgkin's disease (HD) is increasingly being evaluated by fine-needle aspiration (FNA); however, criteria to subclassify HD into its four subtypes--nodular sclerosis (NS), mixed-cellularity (MC), lymphocyte-depleted (LD), and lymphocyte-predominant (LP)--has not been established. In order to evaluate criteria for subclassification, all FNA cases of HD obtained over a 5-yr period at Indiana University Medical Center that had confirmatory surgical biopsies were reviewed. The number of Reed-Sternberg (RS) cells was quantitated in each cytologic case and statistically analyzed by subgroup, using analysis of variance (ANOVA). LD had the highest mean (means) number of RS cells (means = 51) with NS and MC having similar means (means = 7 and 6, respectively). Only one case of LP was identified and therefore could not be analyzed statistically. Fibrosis and the presence of RS variants were qualitatively assessed and were not helpful in distinguishing the subtypes of HD. Although the quantitation of RS cells may be used to identify LD types of Hodgkin's disease, MC and NS cannot be separated reliably on this criterion alone. Although FNA can be used to diagnose HD, stage a patient, or assess efficacy of chemotherapy, subtyping of HD should still be done on histologic sections of excised lymph nodes.
PMID: 2776595 [PubMed - indexed for MEDLINE]
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