Intravascular Lymphoma: an Unusual Diagnostic Outcome of an Incidentally Detected Adrenal Mass

ObjectiveTo describe a rare diagnosis of intravascular lymphoma in a patient presenting with an incidentally discovered adrenal mass.MethodsWe describe the patient’s clinical history and the findings from biochemical evaluation, radiologic studies, and surgical pathology and review the relevant literature.ResultsA 43-year-old woman developed sudden onset of flank pain associated with a flushing sensation and presented to the emergency department where computed tomography showed a 5-cm left adrenal mass. She had normal electrolytes, and serum and urinary test results were negative for pheochromocytoma. A 24-hour urinary cortisol level was minimally elevated, and the midnight salivary cortisol value was within the reference range. Magnetic resonance imaging revealed a 6.5 × 5.8-cm left adrenal lesion that demonstrated moderate T2-weighted signal and gradual delayed enhancement with no drop in signal on out-of-phase images. Since the lesion lacked high intensity and the biochemical testing results did not suggest a pheochromocytoma, it was deemed likely that the mass was a malignant lesion of the left adrenal gland. A laparoscopic left adrenalectomy was performed. Morphologic and immunohistochemical findings were consistent with a large B-cell lymphoma, which by virtue of its near exclusive distribution in vascular spaces, was consistent with the diagnosis of intravascular large B-cell lymphoma.ConclusionIntravascular large B-cell lymphoma should be included in the differential diagnosis of an incidentally detected adrenal mass even though the diagnosis is rare. (Endocr Pract. 2008;14:884-888)     

Prognostic factors in primary diffuse large B-cell lymphoma of adrenal gland treated with rituximab- CHOP chemotherapy from the Consortium for Improving Survival of Lymphoma (CISL)

ABSTRACT: BACKGROUND: The objective of this study was to identify prognostic factors for survival in patients with primary diffuse large B-cell lymphoma (DLBCL) of the adrenal gland. METHODS: Thirty one patients diagnosed with primary adrenal DLBCL from 14 Korean institutions and treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) were analyzed. RESULTS: Complete remission (CR) and overall response rate after R-CHOP chemotherapy were 54.8% and 87.0%. The 2-year estimates of overall survival (OS) and progression-free survival (PFS) were 68.3% and 51.1%. In patients achieving CR, significant prolongations of OS (P = 0.029) and PFS (P = 0.005) were observed. Ann Arbor stage had no influence on OS. There was no significant difference in OS between patients with unilateral involvement of adrenal gland and those with bilateral involvement. When staging was modified to include bilateral adrenal involvement as one extranodal site, early stage (I or II) significantly correlated with longer OS (P = 0.021) and PFS (P <0.001). CONCLUSIONS: Contrary to prior reports, our data suggests that outcomes of primary adrenal DLBCL are encouraging using a regimen of R-CHOP, and that achieving CR after R-CHOP is predictive of survival. Likewise, our modified staging system may have prognostic value.     

Comparative findings of lymphocytic thyroiditis and thyroid lymphoma

OBJECTIVE: To compare the cytologic features of histologically proven lymphocytic (Hashimoto's) thyroiditis (Hashimoto's thyroitidis) and primary thyroid lymphomas (TL). STUDY DESIGN: Clinical histories, smears (stained with Diff-Quik, Papanicolaou stain or hematoxylin and eosin [HE]) and surgical specimens (HE slides) were reviewed in 25 cases of lymphocytic thyroiditis and 12 of thyroid lymphomas. RESULTS: Surgical specimens of thyroiditis were obtained for other medical reasons: goiter and compressive symptomatology in 21 cases and neoplasms in 4 (2 papillary carcinomas, 1 follicular carcinoma and 1 oncocytic adenoma). Seven cases were primary lymphomas, and 5 were secondary. Histologically there were 6 large B-cell lymphomas, 2 mantle cell lymphomas, 1 Burkitt lymphoma, 2 mucosal-associated lymphoid tissue lymphomas in blastic transformation and 1 of unknown type. Sensitivity for the diagnosis was 67.5% for HT and 92.3% for lymphoma. CONCLUSION: A heterogeneous population of small and large lymphocytes was the most frequent pattern in both diseases. The presence of a monotonous population of large lymphocytes or, more rarely, of small cells indicates a probable TL. Plasma cells favor HT. Other techniques are mandatory for the differentiation of cases with inconclusive diagnoses.     

Chronic stress and high sucrose intake cause distinctive morphometric effects in the adrenal glands of post-weaned rats

We investigated the effects of chronic stress combined with high sucrose intake on the morphology of the adrenal glands in young rats. Male Wistar rats were fed a standard chow diet and allocated into control (C; tap water), chronic restraint stress (St), 30% sucrose diet (S30) and 30% sucrose diet + chronic restraint stress (S30 + St) groups. St consisted of 1 h daily sessions, 5 days/week for 4 weeks. Chronic stress reduced the thickness of the zona glomerulosa (ZG) and zona fasciculata (ZF) in both right and left glands; the thickness of the zona reticularis (ZR) was increased in the right gland. Cell density was greater in the ZF and medulla of both right and left glands, whereas cell density increased in the ZR of only the left gland. The percentage of small cells was lower in the ZG, whereas more large cells were found in the left gland. A similar result was obtained for the ZF, ZR and medulla in both right and left glands. Chronic stress increased the area covered by blood vessels in the ZR of the right gland, but decreased the area in the ZR of the left gland. The area covered by blood vessels was reduced in the medulla of both right and left glands in rats subjected to chronic stress. Infiltration of immune cells was increased by chronic stress in all layers of the cortex of the left gland, but was reduced in the medulla of the right gland. A high sucrose diet reduced the thickness of the medulla in the left gland. Cell proliferation increased in the ZG of the right gland and the weight of the right adrenal gland increased. Reduced cell proliferation in the ZG of the left gland was associated with a reduction in the area covered by blood vessels. In addition, the area covered by blood vessels decreased in the medulla of both glands. Our findings demonstrate that exposure to chronic stress during early life causes morphometric changes in adrenal glands.     

Intraocular large B-cell lymphoma. A case report

BACKGROUND: Large cell lymphoma involving the vitreous humor is uncommon, and its diagnosis in the absence of central nervous system disease can be difficult. The major diagnostic difficulties with vitreous washings in the absence of ancillary studies are in the distinction of inflammatory lymphoid infiltrate from intraocular lymphoma or diagnosing lymphoma when only very few neoplastic cells are present. CASE: A 75-year-old, white male sought medical attention for bilateral blurred vision and decreased visual acuity of recent onset. A clinical diagnosis of bilateral uveitis to rule out primary intraocular lymphoma or an infectious process was made, and a right vitrectomy was performed. An unequivocal diagnosis of lymphoma could not be made due to the paucity of neoplastic cells on that specimen. Two months later smears from the Cytospin (Thermo Shandon, Pittsburgh, Pennsylvania, U.S.A.) prepared on the specimen from a left vitrectomy showed a greater number of large, pleomorphic cells. In addition, immunocytochemical staining confirmed the B-cell lineage of the neoplastic cells. Immunoglobulin gene rearrangement analysis performed by the polymerase chain reaction method on the frozen cell pellet from the left vitrectomy demonstrated the presence of a monoclonal B-cell population, confirming the diagnosis of large B-cell lymphoma. CONCLUSION: Vitreous cytology in conjunction with ancillary studies is a sensitive procedure in the diagnosis of intraocular lymphoma.     

Extraneous cells of hepatic origin in adrenal fine needle aspiration as a diagnostic pitfall: a case report

BACKGROUND: The fine needle aspiration (FNA) cytologic evaluations of most adrenal lesions are straightforward. However, there are diagnostic pitfalls to be avoided. CASE: A 34-year-old, pregnant woman was discovered to have an asymptomatic, right upper abdominal mass on ultrasound examination. After delivery, computed tomography-guided FNA showed bland epithelial cells, and a diagnosis of adrenal cortical adenoma was made. However, subsequent resection showed a myelolipoma of the adrenal gland. CONCLUSION: This case illustrated 2 cytodiagnostic pitfalls in adrenal fine needle aspirates. First, the myeloid cells characteristic of a myelolipoma were not present in the FNA smears because a large portion of the lesion was composed of fibroadipose tissue. Second, extraneous, benign cells of hepatic origin were misinterpreted as adrenal cortical adenoma cells.     

Giant lamellar bodies in pulmonary MALT lymphoma. A case report

BACKGROUND: Giant lamellar bodies are laminated, scroll-like whorls seen within alveolar spaces and have been occasionally observed in sclerosing hemangioma of the lung. However, to the best of our knowledge, the cytologic findings of giant lamellar bodies have not been reported. We describe cytologic findings of giant lamellar bodies associated with pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. CASE: A 72-year-old male had a pulmonary mass measuring 2.0 x 1.4 x 1.5 cm. Cytologic smears imprinted from a cut surface of the resected mass revealed a large number of concentrically laminated structures, giant lamellar bodies, measuring 15-40 microns in diameter. Necrotic cellular remnants were occasionally observed in the center of the structures. In the background, small to medium-sized lymphoid cells and plasmacytoid cells were observed. Histologic diagnosis of the tumor was IgG, kappa type, MALT lymphoma. An aggregate of giant lamellar bodies was observed within entrapped, dilated alveolar spaces lined with hypertrophied, type II pneumocytes. Immunohistochemically, the giant lamellar bodies were positive for KL-6. CONCLUSION: Giant lamellar bodies may be derived from surfactant and necrotic type II pneumocytes and may be observed cytologically in cases of pulmonary MALT lymphoma.     

NK/T-cell lymphoma of bilateral adrenal glands in a patient with pyothorax

ABSTRACT: Primary lymphoma of adrenal glands is rare, and non-B-cell lymphoma associated with pyothorax is also very rare. Here we report the first autopsy case of non-B-cell lymphoma in bilateral adrenal glands of a 79-year-old woman with pyothorax who had an aggressive clinical course. Immunohistochemically, tumor cells showed CD3+, CD45RO+, CD5-, CD7-, CD4-, CD8-, CD10-, CD20-, CD30-, CD79a-, CD138-, CD56-, granzyme B-, TIA-1+ and ALK-. In addition, tumor cells were strongly EBER1-positive by in situ hybridization. In genomic DNA of tumor cells, T-cell receptor rearrangements were not detected by southern blotting. We finally diagnosed this case as extranodal NK/T-cell lymphoma (nasal type).Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8050621197741854.     

Hyaluronan synthesis by anaplastic large cell lymphoma with massive lymphomatous effusion. A case report

BACKGROUND: Hyaluronan (HA) synthesis is frequently observed in malignant mesothelioma cells, whereas it is rarely found in lymphoma cells. Previous studies have reported that a high HA concentration in the serum was related to poor prognosis in lymphomas, although the mechanism was not elucidated. We recently encountered a case of anaplastic large cell lymphoma with an HA-rich, massive, lymphomatous effusion. Several studies were performed to clarify the character of this unusual lymphoma and to observe whether the lymphoma cells synthesized HA. CASE: A 59-year-old female was admitted with abdominal pain. Radiologic studies revealed a pleural effusion and paraaortic lymph node swelling. A biopsied specimen was compatible with anaplastic large cell lymphoma. Detailed cytologic observations revealed that the lymphoma cells in the pleural effusion had alcian blue-positive, productive material in the prominent Golgi area and microvillous structures on the surface. Further studies found that most of the lymphoma cells had HA-binding protein and expressed CD44 antigen, a receptor for HA. In addition, the HA concentration in the supernatant of the primary culture cells was extremely high and increased time dependently. CONCLUSION: These observations suggest that the lymphoma cells synthesized and released HA. Interactions of the released HA and CD44 on the surface might play an important role in the peculiar serosal growth of lymphoma cells.     

Lymphoepithelioid cell lymphoma (Lennert's lymphoma). Report of a case with fine needle aspiration cytology

BACKGROUND: Lymphoepithelioid cell lymphoma (LCL) is a rare morphologic variant of peripheral T-cell lymphoma. Although their histopathologic and immunohistochemical findings are well known, the cytopathologic features have not been well documented. This report describes the fine needle aspiration cytology (FNAC) findings of a case of LCL. CASE: A 75-year-old woman presented with cervical, supraclavicular, axillary and mediastinal lymphadenopathy. FNAC of a cervical lymph node was performed. The smears contained a polymorphous infiltrate formed by abundant histiocytes disposed singly or in clusters, small and medium-sized to large atypical lymphoid cells and reactive cells, including eosinophils and plasma cells. Isolated capillary-sized vessels also were observed. Histopathologic and immunohistochemical examination confirmed the diagnosis of Lennert's lymphoma. CONCLUSION: Although histopathologic and immunohistochemical studies were required for a definitive diagnosis, the findings of FNAC in this case appeared distinctive and suggested the possibility of LCL.     

Anaplastic large cell lymphoma of the mediastinum diagnosed by transbronchial scratch cytology. A case report

BACKGROUND: Anaplastic large cell lymphoma (ALCL) is a subtype of non-Hodgkin's lymphoma characterized by CD30 antigen-positive, large neoplastic cells. We describe a case of ALCL suggested by cytologic examination of the tumor cells obtained from bronchial scratch preparations. CASE: A 26-year-old woman had had a dry cough since November 1996. Chest radiography in May 1997 revealed an abnormal shadow in the mediastinum extending to the pulmonary hilar region. The patient was hospitalized in June 1997. Computed tomography revealed a neoplastic lesion in the anterior mediastinum invading the right lung. Transbronchial scratch cytology revealed large, atypical lymphoid cells expressing CD30 and CD3 on immunocytochemical examination. A transcutaneous mediastinal biopsy was performed and a diagnosis of ALCL made. CONCLUSION: Differentiation from Hodgkin's disease was the most difficult point in this case. Detailed cytologic observation and CD3-positive immunocytology led to the correct diagnosis. The cell transfer technique of Sherman et al was very useful for immunocytologic staining. Thus, transbronchial scratch cytology was an especially valuable and effective procedure in this case.     

Primary central nervous system plasmablastic lymphoma presenting in human immunodeficiency virus-negative but Epstein-Barr virus-positive patient: A case report

ABSTRACT: We report a 32-year-old Outer Mongolian man, with plasmablastic lymphoma (PBL) primarily occured in the central nervous system and diagnosed by surgical resection. This patient appeared headache and Magnetic resonance imaging (MRI) showed multiple lesions in the right cerebral hemisphere including the right frontal-parietal lobe and right basal ganglia and the left cerebellum, he was diagnosed as lymphoma by stereotactic biopsy in January 2009 in local hospital, and was given radiotherapy 33 times after the biopsy. The patient was admitted to The Military General Hospital of Beijing PLA., Beijing, P.R. China on March 9th, 2011, with chief complaints of right limbs convulsioned suddenly, then fell down and lose of his consciousness, then awoke after 4 to 5 minutes, with symptoms of angulus oris numbness and the right upper limb powerless ten days ago. MRI of the brain revealed a well-defined hyperdense and enhancing mass in the left frontalparietal lobe, the meninges are closely related, there was extensive peritumoural edema noted with pressure effects, as evident by effacement of the left lateral ventricles and a 0.5 cm shift of the midline to the right side. Surgical resection showed markedly atypical, large singly dispersed or cohesive proliferation of plasmacytoid cells with frequent abnormal mitoses and binucleation, some neoplastic cells were large with round or oval nuclei and showed coarse chromatin and smaller or unapparent nucleoli, some neoplastic cells with prominent nucleoli, apoptosis and necrosis were often presented. Immunohistochemistry staining and gene rearrangement together with other supportive investigation confirmed the diagnosis of primary central nervous system plasmablastic lymphoma. A month later, he was started on chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, leurocristime and prednisone) for a week. Other supportive treatment was provided for symptomatic epilepsy. The patient regained muscle strength in both upper limbs and right lower limb and the symptomatic epilepsy was controlled after two weeks. Then the patient was discharged. Follow-up data shows the patient to be alive eleven months after discharge. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1649317674697046.     

CD-30(Ki-1)-positive anaplastic large cell lymphoma in a pleural effusion. A case report with diagnosis by cytomorphologic and immunocytochemical studies.

BACKGROUND: Reports on cytodiagnosis of Ki-1-positive anaplastic large cell lymphoma (ALCL) are rare. This report describes one such case diagnosed by cytologic examination of a pleural effusion and confirmed by immunocytochemistry. CASE: An 87-year-old male presented with breathlessness, fever and a cough. Computed tomographic scan of the thorax showed a small, right, pleura-based nodule with infiltration of the immediate surroundings in addition to a massive, right-sided pleural effusion. Cytologic examination of pleural fluid revealed a heterogeneous population of cells comprising small mature lymphocytes, and numerous medium and large atypical lymphoid cells having frequent nuclear irregularity. Occasional very large cells resembling Reed-Sternberg cells or multinucleated cells with a horseshoe or wreathlike arrangement of nuclei (doughnut cells) were also present. Cytomorphology was suggestive of Ki-1 anaplastic large cell lymphoma (ALCL). Immunocytochemistry revealed intense positivity for CD-30, positivity for LCA and EMA in a variable number of cells and a negative result for cytokeratin except for occasional cells. CONCLUSION: Cytologic examination of pleural fluid can serve as a useful tool for the initial diagnosis of Ki-1-positive ALCL.     

Cushing's syndrome due to unilateral adrenal nodular hyperplasia with incomplete inhibition of the contralateral gland

A 57-year-old woman was demonstrated to be affected by adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome. Computed-axial tomography of the abdomen demonstrated an expansion of the left adrenal. In apparent contrast with these findings, adrenal scintigraphy demonstrated radiocholesterol uptake also by the right gland. At surgery, the left adrenal was found to be hard and enlarged and was excised, while the right gland was found of normal appearance and left in place. Histologic examination of the excised gland demonstrated nodular hyperplasia. Early after surgery, plasma cortisol returned to normal values with a normal circadian rhythm and complete inhibition by low dose dexamethasone; the response of plasma cortisol to ACTH was normal. The patient represents a rare case of unilateral adrenal nodular hyperplasia. Radiocholesterol uptake by the contralateral gland and early recovery from adrenal atrophy after surgery are exceptional findings and suggest incomplete inhibition of endogenous ACTH.     

ACTH-induced ultrastructural changes in the zona fasciculata of the hamster adrenal cortex. Are intraadrenal thrombi regulators of corticosteroid secretion?

Correlated stereological and functional studies were performed on the effect of massive ACTH doses on adrenal cortex of the female hamster. ACTH resulted in a marked increase in adrenal gland weight at day 6 of treatment followed by a drop at day 9. Stereology showed significant enlargement of the zona fasciculata (ZF) cells with the highest value at day 6 and subsequent drop at day 9 of treatment. This hypertrophy was due to a notable increase in the volume of mitochondrial, SER, Golgi apparatus and lipid droplet compartments. Cortisol secretion by adrenal slices and homogenates was also highest at day 6 of ACTH administration and notably lower at day 9. At day 6 of ACTH treatment in outer ZF thrombi were seen. In their vicinity the subendothelial space was dilated and endothelial cells dissociated from the basal lamina. Numerous erythrocytes were also visible among dissociated ZF cells. At day 9 of experiment in outer part of ZF numerous spaces devoid of parenchymal cells appeared. The earlier authors considered the "empty spaces" or "holes" in hyperstimulated adrenal cortex as a sign of holocrine secretion of steroid hormones. The present findings enable us to introduce a new hypothesis on the development of these spaces. In our opinion in hyperstimulated adrenal cortex numerous thrombi may be formed leading thus to the degeneration of adrenocortical cells. Thus, the appearance of the "empty spaces" or "holes" in the gland is not connected with the holocrine secretion but with the regulation of the number of secretory cells in adrenal cortex by the thrombi-dependent mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immunocytochemical localization of the endogenous vasoactive peptide apelin to human vascular and endocardial endothelial cells

Apelin, the proposed endogenous peptide ligand of the novel G-protein-coupled receptor APJ, has been shown to possess potent vasodilator and positive inotropic effects in rats and humans in vivo. However, in humans, no endogenous source of apelin has been reported. Therefore, based on the presence of APJ and mRNA encoding apelin in human tissues, we investigated the expression of apelin in fresh-frozen human tissue from right atrium, left ventricle, lung, kidney, adrenal and large conduit vessels using immunocytochemistry. Apelin-like immunoreactivity (apelin-LI) was detected in vascular endothelial cells lining blood vessels in the human heart, kidney, adrenal gland and lung and in endothelial cells of large conduit vessels. Apelin-LI was also present in endocardial endothelial cells lining recesses of the right atrium. Apelin-LI was not present or below the level of detection in cardiomyocytes, Purkinje's cells, pulmonary or renal epithelial cells, secretory cells of the adrenal gland, vascular smooth muscle cells, adipocytes, nerves and connective tissue. The restricted presence of apelin-LI in endothelial cells suggests that endothelial apelin may play a role as a locally secreted cardiovascular mediator acting on APJ receptors present on the vascular smooth muscle and on cardiac myocytes to regulate vascular tone and cardiac contractility.     

Immunocytochemical study of malignant lymphoma in serous effusions

OBJECTIVE: To cytologically evaluate a large series of serous effusions associated with malignant lymphoma (ML), identify the immunoreaction patterns of the cells from selected positive cases and to investigate the correlation of cytomorphology with tissue section diagnosis. STUDY DESIGN: From 1966 to 1990, a review of the files of the Department of Anatomic Pathology, A. C. Camargo Hospital, disclosed 4,297 cases of serous effusions, 256 of which were associated with ML. Cytopathologically positive cases were selected for immunocytochemical study. All paraffin sections stained with hematoxylin and eosin were reviewed to confirm the malignancy of the cases. Immunostaining was performed on both cytocentrifuge slides previously stained with Papanicolaou stain and new sections of the biopsy samples using the immunoperoxidase method and avidin-biotin complex with monoclonal mouse antihuman B-cell marker L-26 and monoclonal (mouse) antihuman T-cell marker UCHL-1. RESULTS: Immunocytochemical reactions were performed in 54 cases: 22 were pan-B positive and 10 pan-T positive; 24 cases showed no reactivity for either monoclonal antibody. Immunohistochemical reactions were performed in 24 available cases: 15 were pan-B positive and pan-T positive; 3 cases showed no reactivity for either monoclonal antibody. Cytohistoimmunoreactions were similar in 11 pan-B positive cases and 2 pan-T positive cases. Three cases were negative for both markers, 4 cases were pan-T positive in tissue samples and negative in cytocentrifuge smears, 3 cases were pan-B positive in tissue and negative on cytology and 3 cases were negative for both markers in both tissue and cytologic specimens. CONCLUSION: Cytology is an effective method of evaluating serous effusions associated with malignant lymphoma: no false positive diagnosis was observed in this series. Immunophenotyping of lymphoid cells is useful to classify and confirm the cytologic diagnosis.     

Intravascular lymphoma and thyroid gland

Intravascular lymphoma (IVL) is a rare disease characterized by the proliferation of neoplastic cells in the small blood vessels that frequently goes undiagnosed until the time of autopsy. The neoplastic cells are usually of B-cell origin. The clinical course was examined to determine factors that would facilitate antemortem diagnosis. IVL is observed with clinical, histopathological and immunohystochemical methods. This is a unique case because the thyroid gland is a rare place for IVL. Accent is given on immunohystochemical methods and tissue biopsy in the differential diagnosis of IVL when nervous system and thyroid gland dysfunction occur This report indicates that micro-ecosystem of multinodular goitrous might influence the expression of chemokines and/or adhesion moleculs on endothelial and lymphoma cells, leading to heavy infiltration of thyroid gland. Concurrently, that may guide the physician to tissue biopsy facilitating antemortem diagnosis and institution of appropriate therapy.     

Human herpesvirus 8 in primary effusion lymphoma in an HIV-seronegative male. A case report

BACKGROUND: AIDS-related body cavity-based lymphoma, or primary effusion lymphoma (PEL), is a distinct clinicopathologic entity that occurs predominantly in immunosuppressed patients infected with human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus. Although it rarely occurs in human immunodeficiency virus (HIV)-negative patients, we report such a case here. CASE: A 74-year-old male, who was HIV and Epstein-Barr virus (EBV) negative, was admitted to the hospital with dyspnea and chest pain. Chest radiography and computed tomography showed right pleural effusion. Cytologic analysis of the pleural effusion revealed a high grade lymphoma with round nuclei, prominent nucleoli and abundant cytoplasm. Polymerase chain reaction performed on the pleural effusion was positive for HHV-8 and negative for EBV. On molecular studies, the immunoglobulin heavy and kappa light chains were rearranged. Flow cytometry revealed a hyperploid fraction with DNA index of 1.29 expressing CD30. Immunostaining for HHV-8 from a cell block was positive. Electron microscopy revealed lymphomalike cells, many in various stages of apoptosis, with large nucleoli and clusters of viruslike particles in the nucleoplasm. CONCLUSION: A firm diagnosis of PEL can be established by the examination of cells from the lymphomatous effusion by a combination of cytology, molecular genetics, phenotypic features, immunostaining and electron microscopy. To our knowledge, this is the first case in which immunostaining for anti-HHV-8 monoclonal antibodies was used to support the diagnosis.     

Multilobated large B-cell lymphoma diagnosed cytologically. A case report.

BACKGROUND: Fine needle aspiration (FNA) biopsy can be used to reliably classify most conditions involving lymph nodes or, at least, significantly reduce the differential diagnosis. CASE: A 70-year-old male presented with an ulcerated mass arising from the left tonsillar fossa and involving the anterior and posterior pillars. A biopsy of the tonsillar mass performed at an outside hospital was interpreted as a large cell undifferentiated carcinoma. Subsequently the patient developed systemic lymphadenopathy. A bone scan showed intense uptake within the medial tibial plateau of the left knee. FNA biopsy of the right axillary mass was interpreted at University of Cincinnati Medical College as a large cell lymphoma, multilobated type. Histologic and immunohistochemical studies of the lymph node confirmed the presence of multilobated B-cell lymphoma. Lymphoma chemotherapy was initially successful but was discontinued due to toxicity. The patient died two months after the initial cytologic diagnosis of lymphoma. CONCLUSION: Multilobated lymphomas are an unusual variant of non-Hodgkin's lymphomas (mostly B-cell type). Cytology and immunocytochemistry are useful diagnostic procedures that can help to diagnose this relatively uncommon type of lymphoma and significantly reduce the possibility of misdiagnosis.