Review Article

Diagnosis of B-Cell Non-Hodgkin Lymphomas with Small-/Intermediate-Sized Cells in Cytopathology

Table 1

Summary of the cytologic features of B-cell non-Hodgkin lymphomas with small-/intermediate-sized cells.

GrossLow PowerHigh Power

SmearCompositionAggregatesCell SizeNucleiNucleoliChromatinCytoplasmMitotic activityPlasma/-cytoid CellsMast CellsOther Cells

RLH Large and small aggregatesPolymorphicLHA and FCF are key featuresSmall to intermediateN/AN/AN/AN/APresentPresentPresentComplete spectrum
MZL Large and small aggregatesPolymorphicLHA and FCF possibleIntermediateSmooth to mildly irregularInconspicuous to largeOpen to clumpedConspi-cuous, abundant in monocytoid formsLowPresentPresentLarge activated cells, histiocytes, immunoblasts
FL Grade 1/2 Numerous small aggregatesMonomorphic to dimorphic (grades 1-2)Repetitive FCF commonIntermediateIrregular, bilobed or “divided” nuclei commonInconspicuousOpen to clumpedScantLowAbsentPresentCentroblasts
MCL Vague aggregatesMarkedly monomorphicVague aggregates (FCF/LHA possible in mantle zone pattern)Intermediate (small and large cell variants occur)Subtly irregularInconspicuous to largeDispersed to clumpedVariable, moderatePossibleAbsent/ RareInfrequentScattered EH present, PLC and PIB absent
SLL/CLL Vague aggregatesMonomorphicVague aggregates (proliferation centers)SmallSmoothAbsent/In-conspicuousCoarse -clumpedScantLowInfrequentInfrequentPLC, PIB, smudge cells, rarely RS cells
LPLVague aggregatesMono-, rarely polymorphicRare/ Absent aggregatesSmallSmooth, possible Dutcher bodiesAbsent/In-conspicuousCoarse–clumped, “cart-wheel”Scant to plasma-cytoid, Russell bodiesLowCommonPresent, often frequentPLC and PIB absent

CB: centroblasts, EH: epithelioid histiocytes, FCF: follicle center fragments, FDC: follicular dendritic cell, FL: follicular lymphoma, LHA: lymphohistiocytic aggregate, LPL: lymphoplasmacytic lymphoma, MCL: mantle cell lymphoma, MZL: marginal zone lymphoma, PLC: prolymphocytes, PIB: paraimmunoblasts, RLH: reactive lymphoid hyperplasia, RS: Reed-Sternberg, SLL/CLL: small lymphocytic lymphoma/chronic lymphocytic leukemia; N/A: not applicable.