Presented at the 60th Annual Scientific Meeting of the American Society of Cytopathology 2012; November 2-4, 2012; Las Vegas, NV.
Fine-needle aspiration diagnosis of lymphomas with signet ring cell features
Potential pitfalls and solutions
Article first published online: 27 MAR 2013
Copyright © 2013 American Cancer Society
Volume 121, Issue 9, pages 525–532, September 2013
How to Cite
Wang, J., Katz, R. L., Stewart, J., Landon, G., Guo, M. and Gong, Y. (2013), Fine-needle aspiration diagnosis of lymphomas with signet ring cell features. Cancer Cytopathology, 121: 525–532. doi: 10.1002/cncy.21291
- Issue published online: 13 SEP 2013
- Article first published online: 27 MAR 2013
- Manuscript Accepted: 19 FEB 2013
- Manuscript Revised: 15 FEB 2013
- Manuscript Received: 29 JAN 2013
- signet ring;
- fine-needle aspiration
Lymphoma with signet ring cell features (LSF) is a rare morphologic variant of non-Hodgkin lymphoma. Although it has been well documented in the surgical pathology literature, to the best of the authors's knowledge, the features of LSF in fine-needle aspiration (FNA) samples have rarely been reported. An accurate cytologic diagnosis of LSF is of important therapeutic significance.
The authors retrospectively reviewed 7 FNA cases of LSF for cytologic features, ancillary studies, corresponding histologic findings, and the patients' clinical and radiologic information to illustrate the diagnostic clues and potential pitfalls.
The final diagnoses, based on a multidisciplinary approach, were follicular lymphoma (5 patients), large B-cell lymphoma of follicular center cell origin (1 patient), and low-grade B-cell lymphoma with plasmacytoid features (1 patient). FNAs were obtained from both lymph node and extranodal sites. Common cytologic features included various percentages of signet ring cells in a background of nonvacuolated lymphomatous cells, lymphoglandular bodies, and cytoplasmic rings. The majority of signet ring cells contained a single, large, clear intracytoplasmic vacuole that pushed the nucleus laterally whereas fewer cells contained ≥ 2 vacuoles that indented the nucleus into a scalloped or stellate configuration. These cells resemble, to some degree, other lesions with signet ring cell features. One of the diagnostic clues of LSF was the similarity in nuclear details between signet ring cells and surrounding nonvacuolated lymphoid cells.
Familiarity with cytologic features, correlation with clinical/radiologic information, and ancillary studies are important for an accurate diagnosis of LSF and for distinguishing it from other lesions with signet ring cell features in FNA samples. Cancer (Cancer Cytopathol) 2013;121:525-32. © 2013 American Cancer Society.