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FLOW CYTOMETRY IN EVALUATION OF EXTRANODAL LYMPHOMA PRESENTING AT UNUSUAL LOCATIONS COMPARED TO NODAL LYMPHOMAS
Author(s):
Pallavi Prakhar
,
Pallavi Prakhar
Affiliations:
Pathology,Lady Hardinge Medical College, New Delhi, India,New Delhi,India
Monisha Choudhury
,
Monisha Choudhury
Affiliations:
Pathology,Lady Hardinge Medical College, New Delhi,India
Sunita Sharma
Sunita Sharma
Affiliations:
Pathology,Lady Hardinge Medical College,New Delhi,India
(Abstract release date: 05/18/17) EHA Library. Prakhar P. 05/18/17; 182789; PB2075
Pallavi Prakhar
Pallavi Prakhar
Contributions
PDF Abstract
Abstract

Abstract: PB2075

Type: Publication Only

Background
: Immunophenotyping is a fundamental step in the diagnosis of hematolymphoid neoplasms. Lymphomas arising at extranodal sites can present significant diagnostic challenges due to their morphological diversity. In recent years flow cytometry (FCM) has proven useful in the evaluation of nodal and extranodal lymphoproliferative disorders on samples obtained by surgical specimens or fine needle aspiration cytology (FNAC).

For years FNAC has been used for initial evaluation of suspected hematolymphoid neoplasms. Flow cytometry can additionally help in identifying B or T cell nature of neoplastic cells, clonality in case of B-cell neoplasms and any aberrant phenotype. The possibility of detecting CD20 status can help in initiating targeted therapy without undergoing tissue biopsy to do so. FNA cytology with Flow cytometry can serve as a replacement for open biopsy and may help in eliminating the need for more invasive procedures.
In this study FCM analysis on cytological specimens, including nodal and extranodal mass from GIT, Thyroid, Kidney, Breast, Tonsil, cerebrospinal fluid and ascitic fluid, was performed.

Aims

The aim of our study was to evaluate the efficacy of flow cytometer for the evaluation of extranodal and nodal lymphomas on 40 patients.

Methods
The currant study was prospectively conducted on 40 patients with a clinical suspicion of hematolymphoid neoplasms. Samples for flowcytometric immunophenotyping (FCI) were obtained by fine needle aspiration (FNA) or by tissue scraping along with samples for cytomorphological, histological and immunohistochemical (IHC) evaluation. Samples collected in Isotone were submitted for FCI on 5-color Beckman Coulter FC-500, using a set of mature and immature antigens markers for lymphoid cells. Results of FCI on cytological specimens along with cytological findings were compared with histological and IHC diagnosis.

Results
Flowcytometric immunophenotyping conducted on extranodal sites included total 10/40 (25%) cases out of which most common site was GIT (4 cases) followed by CNS (3 cases), Kidney (1 case), Thyroid (1 case), Breast (1 case), and Tonsil (1 case). Definite diagnosis using only FCI could be obtained in 25/40 (62.5%) cases in which 6/10 (60%) cases was conducted on exranodal and 19/30 (63%) cases on nodal tissue samples. The remaining 15 cases which could not be categorized by FCI included Hodgkin lymphoma (6 cases), inadequate cellularity (5 cases), Tuberculosis (2 cases), ALCL (1 case), Mantle cell lymphmoma (1 case) and Ewing’s/PNET (1 case). Combining FCI with cytological findings definite diagnosis could be found in 33/40 (82%) cases, compared to 38/40 (95%) cases by histological and IHC examination. As per World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues 2008 most common lymphoma at extranodal site was DLBCL followed by acute lymphoblastic leulemia/lymphoma. Whereas at nodal site most common lymphoma was DLBCL followed by Hodgkin’s lymphoma. The estimated diagnostic sensitivity of FCI alone was 60.5% with 50% specificity, similar for both extranodal and nodal tissue samples. Whereas after combing FCI with cytological findings sensitivity and specificity was found to be 78.4% and 100% respectively. Immunophenotyping of lymphoblastic leukemia/lymphoma by FCM on cytological specimens was found to be in 100% concordance with FCI on peripheral blood/bone marrow aspirates.

Conclusion

Flowcytometric immunophenotyping along with fine needle aspiration cytology offer a rapid, simple and minimally invasive procedure for the detection of hematolymphoid neoplastic cells in solid tissue especially at extranodal sites. Flow cytometry alone may not consistently provides a definite diagnosis of lymphoma subtypes but can be very helpful in diagnosing extranodal lymphoma and nodal lymphoblastic leukemia/lymphoma.
KEYWORDS: Flow cytometry, extranodal lymphoma

Session topic: 18. Non-Hodgkin & Hodgkin lymphoma - Biology

Keyword(s): flow cytometry, Extranodal lymphoma

Abstract: PB2075

Type: Publication Only

Background
: Immunophenotyping is a fundamental step in the diagnosis of hematolymphoid neoplasms. Lymphomas arising at extranodal sites can present significant diagnostic challenges due to their morphological diversity. In recent years flow cytometry (FCM) has proven useful in the evaluation of nodal and extranodal lymphoproliferative disorders on samples obtained by surgical specimens or fine needle aspiration cytology (FNAC).

For years FNAC has been used for initial evaluation of suspected hematolymphoid neoplasms. Flow cytometry can additionally help in identifying B or T cell nature of neoplastic cells, clonality in case of B-cell neoplasms and any aberrant phenotype. The possibility of detecting CD20 status can help in initiating targeted therapy without undergoing tissue biopsy to do so. FNA cytology with Flow cytometry can serve as a replacement for open biopsy and may help in eliminating the need for more invasive procedures.
In this study FCM analysis on cytological specimens, including nodal and extranodal mass from GIT, Thyroid, Kidney, Breast, Tonsil, cerebrospinal fluid and ascitic fluid, was performed.

Aims

The aim of our study was to evaluate the efficacy of flow cytometer for the evaluation of extranodal and nodal lymphomas on 40 patients.

Methods
The currant study was prospectively conducted on 40 patients with a clinical suspicion of hematolymphoid neoplasms. Samples for flowcytometric immunophenotyping (FCI) were obtained by fine needle aspiration (FNA) or by tissue scraping along with samples for cytomorphological, histological and immunohistochemical (IHC) evaluation. Samples collected in Isotone were submitted for FCI on 5-color Beckman Coulter FC-500, using a set of mature and immature antigens markers for lymphoid cells. Results of FCI on cytological specimens along with cytological findings were compared with histological and IHC diagnosis.

Results
Flowcytometric immunophenotyping conducted on extranodal sites included total 10/40 (25%) cases out of which most common site was GIT (4 cases) followed by CNS (3 cases), Kidney (1 case), Thyroid (1 case), Breast (1 case), and Tonsil (1 case). Definite diagnosis using only FCI could be obtained in 25/40 (62.5%) cases in which 6/10 (60%) cases was conducted on exranodal and 19/30 (63%) cases on nodal tissue samples. The remaining 15 cases which could not be categorized by FCI included Hodgkin lymphoma (6 cases), inadequate cellularity (5 cases), Tuberculosis (2 cases), ALCL (1 case), Mantle cell lymphmoma (1 case) and Ewing’s/PNET (1 case). Combining FCI with cytological findings definite diagnosis could be found in 33/40 (82%) cases, compared to 38/40 (95%) cases by histological and IHC examination. As per World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues 2008 most common lymphoma at extranodal site was DLBCL followed by acute lymphoblastic leulemia/lymphoma. Whereas at nodal site most common lymphoma was DLBCL followed by Hodgkin’s lymphoma. The estimated diagnostic sensitivity of FCI alone was 60.5% with 50% specificity, similar for both extranodal and nodal tissue samples. Whereas after combing FCI with cytological findings sensitivity and specificity was found to be 78.4% and 100% respectively. Immunophenotyping of lymphoblastic leukemia/lymphoma by FCM on cytological specimens was found to be in 100% concordance with FCI on peripheral blood/bone marrow aspirates.

Conclusion

Flowcytometric immunophenotyping along with fine needle aspiration cytology offer a rapid, simple and minimally invasive procedure for the detection of hematolymphoid neoplastic cells in solid tissue especially at extranodal sites. Flow cytometry alone may not consistently provides a definite diagnosis of lymphoma subtypes but can be very helpful in diagnosing extranodal lymphoma and nodal lymphoblastic leukemia/lymphoma.
KEYWORDS: Flow cytometry, extranodal lymphoma

Session topic: 18. Non-Hodgkin & Hodgkin lymphoma - Biology

Keyword(s): flow cytometry, Extranodal lymphoma

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