The role of fine needle aspiration cytology in the diagnosis of lymphoma.

The accuracy of fine needle aspiration (FNA) cytology for the diagnosis of lymphoma and other hematolymphoid malignancies was investigated by a review of 158 FNA specimens from 143 patients. Patients included in the study had either a diagnosis of a hematolymphoid malignancy by FNA cytology or a biopsy diagnosis of lymphoma that was preceded by FNA cytology. Biopsy specimens were obtained from 85% of the patients. Of the 158 needle aspirates, 118 (75%) were diagnosed as lymphoma, 13 (8%) as suspicious of lymphoma, 8 (5%) as myelomas, 3 (2%) as leukemias, 12 (8%) as positive for malignancy and 4 (2%) as negative for malignancy. Two of the 118 needle aspirates diagnosed as lymphoma were false positives while 3 of 13 diagnosed as suspicious for lymphoma were found to be benign. Overall, there were four false negatives. Morphologic subclassification of the lymphomas, originally attempted for 60 needle aspirates, was identical to the histologic subclassification in 51 cases (85%). FNA cytology provided the initial diagnosis of a hematolymphoid malignancy in 51% of the cases and allowed the documentation of recurrent disease in 49%. The results demonstrate the usefulness of FNA cytology for the diagnosis and management of patients with lymphoma.

Benign lichenoid keratosis.

The microscopic spectrum of benign lichenoid keratosis (BLK) was studied by examination of 30 examples. BLK consists of a segment of hyperplastic epidermis accompanied by a lymphoid infiltrate in the papillary dermis. Although termed "lichen planus-like," saw-tooth acanthosis predominated in only seven lesions, whereas irregular acanthosis was widespread in 23. The infiltrate had both a band-like (lichenoid) and perivascular arrangement, but a lichenoid appearance predominated in only half the specimens. Liquefaction of the basal layer was widespread, and hydropic change often involved the midepidermis. Mild cytologic atypicality was present in each case, but other features of actinic keratosis were lacking. Changes of senile lentigo were observed adjacent to 17 lesions. Partial involution was present in several cases. BLK often is confused clinically with a variety of other cutaneous tumors. Nevertheless, the diagnosis usually can be made on histologic grounds alone when the history indicates a solitary lesion.

Cytoplasmic fibrils in plasma cells of a solitary myeloma.

A 56-year-old woman had solitary plasma-cell myeloma in the right humerus. Six weeks after local irradiation therapy, she died from pulmonary alveolar hemorrhage and bilateral pleural effusion with malignant plasma-cell infiltration of the right atrium. Ultrastructural studies of the plasma cells from the myocardium demonstrated large bundles of prominent, non-branching, solid cytoplasmic fibrils in many cells. Each fibril had a width of 66--132 A, periodicity of 30--60 A, and a beaded appearance. These features suggest that the fibrils may be protein material, possibly an immunoglobulin.