[Non-Hodgkin's lymphoma. Cytology and cytochemistry].

Abstract

Imprints of lymph nodes and tumor specimens from 442 patients with non-Hodgkin's lymphoma (NHL) were evaluated cytologically and cytochemically. With the exception of hairy cell leukemia, special forms of peripheral pleomorphic T-cell lymphoma, and lymph node plasmacytoma, all types of NHL of the Kiel classification were included in this study. The investigations were performed on slides stained with Pappenheim (May-Grünwald-Giemsa) or conventional cytochemical techniques for substrate and enzyme demonstration, such as periodic acid Schiff (PAS), neutral and acid non-specific alphanaphthyl acetate esterase, and acid and alkaline phosphatase. In certain cases further techniques for substrate and enzyme demonstration, including myeloperoxidase and naphthol AS-D chloroacetate esterase, were used. We combined the cytologic and cytochemical evaluation with an attempt to diagnose the type of lymphoma on imprints without prior knowledge of the histologic findings or clinical data, in other words, blind. At the same time, we attempted to distinguish the NHL from reactive lymph node lesions, nonlymphoid malignant tumors, and systemic diseases. For this purpose, 75 cases of lymphadenitis and 33 cases of nonlymphoid neoplasia were mixed with the NHL for a blind test. In the following we will summarize the results pertaining to the NHL only. Chronic lymphocytic leukemia of B type (B-CLL; n = 75) was cytologically characterized by the presence of so-called prolymphocytes and paraimmunoblasts and a predominance of lymphocytes. In our opinion, there are four main variants of B-CLL: small-cell ("mature") CLL, a type in which prolymphocytes are plentiful ("immature" CLL), LP immunocytoma-like ("basophilic") CLL, and a type of CLL with centrocyte-like lymphocytes ("B2-CLL"). B-CLL had no cytochemical profile of its own. The reproducibility of the diagnosis on imprints was 80%. In prolymphocytic leukemia of B type (B-PLL; n = 1) prolymphocytes and blast cells were plentiful. In the case studied, acid phosphatase activity was moderately strong (evident as granules distributed in a semicircular fashion and focally accumulated). In the blind test we diagnosed it only descriptively as an "acid phosphatase-rich lymphoma of low-grade malignancy with a high prolymphocyte and blast cell content". Chronic lymphocytic leukemia of T type (T-CLL) and prolymphocytic leukemia of T type (T-PLL) could not be distinguished with certainty in sections or imprints. There was also no strict delineation between T-CLL and T-PLL in blood smears. The T-CLL and T-PLL cases we evaluated (n = 4) belonged to the so-called helper cell type.(ABSTRACT TRUNCATED AT 400 WORDS)