Case 2: Submandibular Neck FNAYes, this is a case of malignant lymphoma, high grade. The diagnossis of lymphoma on FNA is often challenging. In the case of high grade lymphomas, the diagnosis of malignancy is more straightforward, however, the distinction from other poorly differentiated neoplasms (carcinoma, melanoma, etc.) can be difficult. The presence of a discohesive population of cells (cytology slide 1), lymphoglandular bodies in the background (cytology slide 4), central prominent nucleoli and nuclear protrusions/knobs (cytology slides 2 & 3) all strongly suggest lymphoid origin. Further studies utilizing immunohistochemistry and flow cytometry may be necessary. ICC can be performed on cell block material when lymphoma is suspected. The best markers to use are CD4S (LCA-leukocyte common antigen), CD20 (B cell marker) and CD3 (T cell marker). The tissue sections show a nodular (slide 2) and diffuse (slide 3) infiltrate of large cells with high N/C ratios, prominent often central nucleoli and brisk mitosis activity. The tumor cells were positive for CD20 indicating B cell lineage.
Tissue Section Slide 1
Tissue Section Slide 2
Tissue Section Slide 3
Tissue Section Slide 4 |
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