Cytology of extranodal Ki-1 anaplastic large cell lymphoma.

Ki-1-positive anaplastic large-cell lymphoma (ALCL) is an uncommon neoplasm which may present with extranodal as well as nodal disease. By definition, the tumor cells are immunoreactive for Ki-1 or Ber-H2 antigen (CD30). There have been few published cytologic descriptions of this lymphoma, or of its detection in extranodal sites. We describe the cytologic findings in five cases of extranodal Ki-1 lymphoma. Cytologic findings in all five cases were similar and consisted of a heterogeneous population of lymphocytes and bizarre, pleomorphic tumor cells. These cells were characterized by generous amounts of vacuolated, basophilic cytoplasm, eccentric, multilobulated nuclei with some showing "wreath-like" configurations. Some nuclei contained huge nucleoli simulating Reed-Sternberg cells. All cases showed the characteristic surface membrane and cytoplasmic paranuclear dot-like staining for CD30. Our findings indicate that fine-needle aspiration and exfoliative cytology have a useful role in the diagnosis of Ki-1 ALCL in extranodal sites. Furthermore, effusions containing anaplastic cells suspicious for lymphoma, particularly in AIDS patients, should be immunostained with antibodies to CD30.

Fine needle aspiration biopsy diagnosis of tuberculous lymphadenitis in patients with and without the acquired immune deficiency syndrome.

All Bellevue Hospital cases from a recent 27-month period whose fine needle aspiration (FNA) samples of cervical or supraclavicular masses showed acute and/or granulomatous inflammation were reviewed. The 30 patients included 8 with the acquired immune deficiency syndrome (AIDS), 3 with the AIDS-related complex (ARC), 2 with AIDS risk factors and 17 without known risk factors for AIDS. Of these, mycobacterial infections had been diagnosed in 22 patients: 18 by cultures positive for Mycobacterium tuberculosis and 4 by positive staining for acid-fast bacilli. In addition to the presence of neutrophils, two criteria for the diagnosis of mycobacterial infection were identified on the routinely stained FNA smears: caseous material and granulomas. Caseous material was the most sensitive and specific criterion. Granulomas were often present in patients with mycobacterial infection, but were also occasionally present in patients with other processes. The differences in cytologic specimens between AIDS and non-AIDS patients are discussed. The findings suggest that FNA is a safe and sensitive technique for the diagnosis of mycobacterial lymphadenitis in AIDS patients and that purulent aspirates from appropriate patient populations should prompt the use of special stains and cultures to rule out mycobacterial infection.

Fine needle aspiration biopsy of cystic benign lymphoepithelial lesion of the parotid gland in patients at risk for the acquired immune deficiency syndrome.

Cystic benign lymphoepithelial lesion (BLL), a previously rare lesion of the parotid gland consisting of marked lymphoid hyperplasia with accompanying squamous-lined cysts, has recently been described in patients with the acquired immune deficiency syndrome (AIDS) or AIDS risk factors. Thirteen fine needle aspiration (FNA) samples of parotid gland masses from patients with AIDS (one case), AIDS risk factors (five cases) or denial of AIDS risk factors (two cases) and a histopathologic diagnosis of BLL were examined. The FNA features that correlated best with the histopathologic findings were (1) a heterogeneous lymphoid population, (2) scattered single and/or clustered foamy macrophages and (3) superficial and/or anucleated squamous cells. Most aspirates showed some combination of these three components. The differential diagnostic considerations, the clinical and radiologic correlations and the relationship of this lesion to HIV infection are discussed. Patients with parotid masses whose aspirates consist of some combination of squamous cells, lymphocytes and foamy macrophages should be questioned for possible AIDS risk factors.

IgM monoclonal gammopathy/Waldenström's macroglobulinemia: a morphological and immunophenotypic study of the bone marrow.

The presence of a monoclonal paraprotein in the serum or urine raises the possibility of myeloma or lymphoma/leukemia. Yet, in a significant proportion of individuals with serum paraproteins, particularly those with low levels of paraprotein, clinical and routine bone marrow evaluation is not diagnostic of an underlying neoplasm. The purpose of this study was to define the pathologic basis for macroglobulinemia in patients whose routine bone marrow biopsies were not diagnostic of a lymphoplasmacytic neoplasm. We used immunofluorescence microscopy and flow cytometry of cell suspensions prepared from aspirated marrow, as well as immunohistochemistry of core biopsies, to perform immunopathologic evaluations of the bone marrow from 16 such patients. Seven individuals without a monoclonal serum paraprotein, who were similarly studied, served as controls. Our data indicate that 13 of the 16 patients with monoclonal serum IgM paraproteins whose routine bone marrow biopsies were normal or showed nondiagnostic changes morphologically had a dispersed monotypic B lineage population of concordant immunoglobulin heavy and light chain type in the bone marrow. The immunophenotype of these cells spanned the range from mature B cell to plasmacytoid B cell to plasma cell. In four of these 13 patients a diagnosis of lymphoplasmacytic lymphoma could be made on the basis of greater than or equal to 20% monoclonal B lineage cells among bone marrow mononuclear cells.

Extranodal noncutaneous lymphoid hyperplasias represent a continuous spectrum of B-cell neoplasia: demonstration by molecular genetic analysis.

We investigated 16 lymphoid proliferations occurring in the ocular adnexa, salivary glands, breast, and thyroid gland and satisfying the histopathologic and immunophenotypic criteria of benign lymphoid hyperplasia for the presence of clonal rearrangements of the antigen receptor, c-myc, bcl-1, and bcl-2 genes and Epstein-Barr virus (EBV) DNA sequences. Each of these 16 extranodal, noncutaneous lymphoid neoplasms exhibited clonal immunoglobulin heavy and/or light chain and lacked T-cell receptor (TCR) beta-chain gene rearrangements. The patterns of immunoglobulin gene rearrangements included solitary and multiple barely perceptible to faint bands, solitary clear and definite bands, and solitary high-intensity bands superimposed on a background of multiple less-intense bands. Three ocular adnexal lymphoid neoplasms exhibited bcl-1 or bcl-2 gene rearrangements. None of the 16 lymphoid neoplasms contained EBV DNA sequences. Two patients developed a histopathologically confirmed malignant lymphoma in an extranodal site. None of the remaining 14 patients developed additional lymphoid neoplasms during a mean follow-up period of 30 months, despite conservative therapy. These results demonstrate that extranodal, noncutaneous lymphoid neoplasms meeting the histopathologic and immunophenotypic criteria for benign lymphoid hyperplasia frequently contain occult monoclonal and oligoclonal B-cell populations representing a continuous and progressive spectrum of B-cell neoplasia up to and including malignant lymphoma.

Cystic parotid lesions in patients at risk for the acquired immunodeficiency syndrome.

Twenty-three patients at risk for the acquired immunodeficiency syndrome presented with cystic lesions of the parotid gland. Fourteen patients had unilateral parotid cysts and nine had bilateral enlargement. Ten patients were positive for antibodies to the human immunodeficiency virus (HIV), three were negative for antibodies to the human immunodeficiency virus, and ten refused testing. Fine-needle aspiration cytology and computed tomography were helpful in making the diagnosis of benign lymphoepithelial cyst. Superficial parotidectomy confirmed the diagnosis. Concurrent malignancy (Kaposi's sarcoma) was diagnosed in one patient from a parotid specimen. Follow-up has ranged from four months to five years.