The spectrum of coincident entities with small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) diagnosed by cytology

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Blank The spectrum of coincident entities with small lymphocytic

lymphoma/chronic lymphocytic leukemia (SLL/CLL) diagnosed by cytology.

HA Kastenbaum, WE Khalbuss, RE Felgar, R Stoller, and SE Monaco

Cytojournal, January 1, 2010; 7: 20.

Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh,

Pennsylvania, USA.

BACKGROUND: The cytologic diagnosis of Small lymphocytic lymphoma/chronic

lymphocytic leukemia (SLL/CLL) often relies on finding a small lymphoid

population with the characteristic immunoprofile by ancillary testing. There are

only a few reports of other processes identified with SLL/CLL. The aim of this

study was to review the fine needle aspiration (FNA) and touch prep (TP)

diagnoses of SLL/CLL in order to identify any coincident entities. MATERIALS AND

METHODS: We retrospectively reviewed all FNA and TP cytology cases between

January 2005 and May 2009 with a diagnosis of SLL/CLL to determine the presence

of any coincident process. RESULTS: We identified 29 cases, including 23 FNAs

and six TPs, from 23 patients. Ancillary studies were utilized in 97% of the

cases, including flow cytometry (FC, 79%), immunohistochemistry (IHC, 55%),

fluorescent in situ hybridization studies (24%) and special stains (7%).

Coincident entities were identified in nine cases (31%) and included seven (28%)

neoplastic entities (Hodgkin lymphoma [HL], adenocarcinoma, squamous cell

carcinoma, seminoma) and two (7%) non-neoplastic entities (infection and

immunoglobulin containing cells). Six cases (21%) suspicious for large cell

transformation were also identified. CONCLUSION: In our review of SLL/CLL,

coincident entities were present in 31% of the cases and included a spectrum of

non-neoplastic and neoplastic processes. FC was the most frequently utilized

ancillary test, but IHC provided important information by excluding a mantle

cell lymphoma or confirming a coincident process. Thus, cytomorphologic

evaluation in these patients is important due to the high risk of a coincident

process that may not be apparent by FC alone and may require clinical

management.

PMID: 20976208