Soft tissue aspiration cytopathology of malignant lymphoma and leukemia.

BACKGROUND: Malignant lymphoma (ML) and leukemia infrequently involve soft tissue and, to the authors' knowledge few reports exist regarding the role of fine-needle aspiration biopsy (FNAB) in their diagnosis. In the current study, the authors report their experience with FNAB in patients with soft tissue ML and leukemia.

METHODS: All cases of ML, leukemia, or atypical lymphoid cells from soft tissue aspirates were reviewed. Masses from lymph node-rich sites, those adjacent to enlarged lymph nodes, or those associated with cutaneous lesions were excluded.

RESULTS: Twenty-one patients (male:female ratio of 1:1) who ranged in age from 10 months to 87 years (mean age, 51 years) were studied. Seven patients had superficial masses and 14 patients had deep soft tissue masses. Sites included the extremities (10 patients), trunk (8 patients), and head (3 patients). Cytologic diagnoses were ML (large cell [11 patients] and Hodgkin [1 patient]), acute leukemia (lymphoblastic [3 patients] and myelogenous [2 patients]), and atypical lymphoid cells (4 patients). Eight aspirates represented the initial diagnosis of ML, three were recurrent ML, four were recurrent leukemia, one was initial leukemia, and one ML aspirate was obtained concurrently with core needle biopsy. Four aspirates were diagnosed as atypical lymphoid cells. Three subsequently were diagnosed as ML and one aspirate was diagnosed as acute leukemia. All ML were of large B-cell type. One case of atypical lymphoid cells was found to be a mantle cell lymphoma. The leukemia cases were T-cell (two cases), pre-B-cell (two cases), and myelogenous (two cases). Immunophenotyping confirmed the cytology by flow cytometry (five cases), cytospin (three cases), and cell block (four cases). Immunophenotyping of eight cases was performed on tissue samples. In one case a cytopathologic diagnosis of ML reversed a prior tissue core biopsy diagnosis of liposarcoma. The specificity and sensitivity rates for a definitive diagnosis of ML or leukemia were 100% and 82%, respectively.

CONCLUSIONS: In the majority of cases, it is possible to determine a specific diagnosis and subtype of soft tissue ML or leukemia using FNAB. Cancer (Cancer Cytopathol)