Postmortem Diagnosis of Hodgkin Lymphoma: An Issue Regarding to Fine Needle Aspiration Biopsy
ZG Pan, WJ Hunter, CS Deng. Creighton University Medical Center, Omaha, NE
Background: Fine needle aspiration biopsies (FNAB) are increasingly being used in diagnosis of lymphoma. These procedures are rapid, minimally invasive, well tolerated, and cost effective. The accuracy of diagnosing Hodgkin lymphoma by FNAB varies widely but has improved over time. We here describe a case of systemic Hodgkin lymphoma with repeated inconclusive premortem FNAB.
Design: A 75-year-old male presented with anemia and splenomegaly. CT scan revealed multiple mass lesions in the lung and liver, mediastinal hilar lymphadenopathy, and splenomegaly. A systemic metastatic tumor was suspected. Repeated FNAB of the liver masses showed prominent necrosis and inflammatory reaction. Rare atypical cells were noted, but immunostains failed to prove the nature of these cells. The patient died several months later.
Results: Grossly (Figure 1), prominent lymphadenopathy was noted in the mesentery and pulmonary hilar regions. Multiple mass lesions were present in the lungs and liver. The spleen was enlarged (495 grams) with a nodular cut surface. Microscopically (Figure 2), the masses in the lung and liver revealed prominent necrosis and inflammatory reaction. Occasional large atypical cells were noted with one or multiple irregular nuclei and large red nucleoli. These atypical cells were positive for CD79a, PAX5 and CD30, weakly positive for CD15, but negative for CD3 and ALK1. These tumor cells were also positive for EBER in situ hybridization. The tumor also involved spleen, multiple lymph nodes, adrenal gland, vertebral body, and pituitary body.
Conclusions: FNAB in diagnosis of Hodgkin lymphoma can result in false-negative results, owing to many factors, including extensive fibrosis and necrosis, sparse or absent Reed-Sternberg cells, and misinterpretation of RS cells as reactive atypia. Therefore, in cases with high suspicion for lymphoma or other malignancy, a tissue biopsy may be indicated if FNAB is inconclusive.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 18, Wednesday Morning