Angioimmunoblastic T-Cell Lymphoma Diagnosed From Serous Effusion by Integration of Cytologic Features and Ancillary Studies

• Published in: American journal of clinical pathology Vol. 159; no. 4; pp. 379 - 394
• Main Authors: Li, Jinnan, Zhu, Xianglan, Deng, Xueqin, Zhang, Wenyan, Jiang, Yong, Wan, Yin, Chen, Jie, Li, Cong, Liu, Weiping, Zhao, Sha, Su, Xueying
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 04.04.2023
• Subjects: Aged; Apoptosis; CD3 antigen; CD7 antigen; Cell surface; Cytochemistry; Cytoplasm; Diagnosis; Effusion; Epstein-Barr virus; Epstein-Barr Virus Infections - pathology; Flow cytometry; Gene rearrangement; Heavy chains; Herpesvirus 4, Human; Humans; Immunoblastic Lymphadenopathy - diagnosis; Immunoblastic Lymphadenopathy - pathology; Immunoglobulins; Inflammation; Lymphadenopathy; Lymphocytes; Lymphocytes B; Lymphocytes T; Lymphoma; Lymphoma, T-Cell, Peripheral - diagnosis; Lymphoma, T-Cell, Peripheral - pathology; Male; Middle Aged; Non-Hodgkin's lymphomas; RNA viruses; T cell receptors; T cells; T-cell lymphoma; T-Lymphocytes - pathology; Cytologic-histologic correlation; Serous effusion; Ancillary studies; AITL; Cytology
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqac170

Abstract Objectives To explore the approach to the diagnosis of malignant serous effusion (SE) caused by angioimmunoblastic T-cell lymphoma (AITL). Methods The clinical, cytomorphologic, immunophenotypic, and molecular features of 6 patients were summarized. Results Clinically, SE caused by AITL was predominant in middle-aged and older male patients with multiple SEs and lymphadenopathy. Cytomorphology showed small to medium-sized, irregular lymphocytes with clear cytoplasm and mixed with various inflammatory cells and apoptosis. Hodgkin/Reed-Sternberg–like cells were detected in 2 of 6 cases. Furthermore, 2 patterns of cytomorphology were described for the first time. Flow cytometry revealed abnormal T-cell populations with loss of surface CD3 (3/4 cases) and CD7 (3/4 cases). In addition, B-cell populations lacking surface immunoglobulin (Ig) were identified in 2 of 4 cases. Immunocytochemical staining revealed expression of at least 2 T follicular helper markers. Epstein-Barr virus–encoded RNA (EBER)–positive cells were demonstrated in 4 of 5 cases. Clonal T-cell receptor γ chain rearrangement was detected in 6 cases, and 3 of them had concomitant clonal immunoglobulin gene rearrangement. Moreover, 2 cases revealed discrepant findings regarding IgH/Igκ rearrangements in cytohistologic correlation. Conclusions This study broadens the morphologic spectrum of malignant SE caused by AITL and provides diagnostic criteria in routine practice.