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- right arm mass FNA
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This is a 58-year-old man with a history of mantle cell lymphoma, now he has a right arm mass. The FNA was done. What's your diagnosis? Are you going to do more studies?
This should be a easy case, but does bring an interesting topic to discuss: what's the role of FNA in the diagnosis of lymphoproliferative disorder?
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本帖最后由 于 2009-10-07 19:29:00 编辑
Fine-needle aspiration (FNA) has an important role in the diagnosis of lymphoproliferative disorder(LPD). . A multiparametric method, including cytology, flow cytometry (FCM), PCR, and FISH, may be available to evaluate in the diagnosis of lymphoma by FNA.
Cytomorphologic features include cell-size, hypercellularity with discohesive cells with round nuclei, nucleoli, mitoses, and karyorrhexis.
FCM analysis demonstrates a monoclonal pattern of immunoglobulin light chain expression. FNA coupled with FCM analysis appears to be highly accurate in the diagnosis of lymphomas. FCM immunophenotyping has an important role in the diagnostic work up of FNA specimens obtained from lymphoid lesions. Immunophenotyping is an essential component in the diagnostic work-up of LPD. As compared to immunohistochemistry, FCM immunophenotyping is rapid, quantitative and a more objective technique.
Molecular genetic analyses have been predicted to improve the diagnostic accuracy of FNA of lymphoma. PCR and FISH have been used for the diagnosis of B-cell non-Hodgkin lymphoma by FNA. In fact, gene rearrangements can be detected by PCR and FISH.
- 王军臣
海上明月：You did a wonderful summary on the approach of using FNA for lymphoproliferative disorder. Basically, FNA combined with other tests (Flow, FISH, etc.) can be used to diagnose lymphoma, it is even more accurate for monitor recuurent lymphomas. But, it has its limitation, for example, some T-cell lymphomas can be very difficult or impossible on FNA.
This case the flow cytometry of the arm mass FNA showed the exact phenotype of this patient's previous mantle cell lymphoma.
| 以下是引用陈隆文博士在2009-10-9 22:03:00的发言：
海上明月：You did a wonderful summary on the approach of using FNA for lymphoproliferative disorder. Basically, FNA combined with other tests (Flow, FISH, etc.) can be used to diagnose lymphoma, it is even more accurate for monitor recuurent lymphomas. But, it has its limitation, for example, some T-cell lymphomas can be very difficult or impossible on FNA. This case the flow cytometry of the arm mass FNA showed the exact phenotype of this patient's previous mantle cell lymphoma. |
陈隆文博士说：
海上明月：你就细针吸（FNA）诊断淋巴细胞增生性疾病做了精彩的概括。FNA结合其他的检测方法（如流式细胞术分析（FCM）和FISH等），基本上可用于诊断淋巴瘤，甚至能更准确监测淋巴瘤的复发。但它有其局限性，例如一些 T 细胞淋巴瘤的FNA标本是很难或不能以这类方法做出诊断的。而本例臂部肿块的FNA若采用FCM分析，是可检出该患者先前发生的套细胞淋巴瘤那样的确切表型的。
- 王军臣
