FNA based diagnosis of head and neck nodal lymphoma [Citomorfološka dijagnoza limfoma u području glave i vrata]

Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics

CD20 Positive Childhood B-non Hodgkin Lymphoma (B-NHL): Morphology, Immunophenotype and a Novel Treatment Approach: A Single Center Experience

Lymphomas represent the third most common group of cancers in childhood and adolescence, mature B non Hodgkin’s lymphoma (B-NHL) accounting for up to 60% of newly diagnosed patients. The diagnosis of specific entities of B-NHL is based on well-defined morphologic analysis, immunophenotyping, cytogenetics and molecular genetics, which determine the optimal treatment strategy. In adult population a major turning point in treatment of B-NHL has been achieved since rituximab, in combination with CHOP has improved the survival rate up to 19%. Rituximab is a chimeric monoclonal antibody that targets CD20, a transmembrane calcium channel expressed on normal and malignant B-cells that mediates cytotoxic, apoptotic and anti-proliferative effects. The effect of rituximab in pediatric population is still not well enough investigated. Based on morphology and immunophenotype of malignant cells, seven children with B-NHL in our institution were eligible for treatment with modified B-NHL-Berlin-Frankfurt-Münster (BFM)-95-based protocol with rituximab administered on day -5. The complete remission was achieved in all seven patients. Six patients are still in complete remission at least 12 months after having finished chemotherapy and one patient relapsed two months after the last cycle and subsequently died. Major adverse effects observed during treatment were prolonged B-cell depletion and myelosupression. Rituximab in combination with B-NHL-BFM-95 protocol was otherwise well tolerated and proved to be effective in children and adolescents with B-NHL. The number of our patients is too small and the follow-up of a larger group of patients will help in defining the role of rituximab in the treatment of childhood B-NHL

Apoptosis of Leukemic Cells: A Case Report

Transformation of leukemic cells is associated with delay in maturation and in apoptosis, and to altered responsiveness to growth factors. However, some studies have revealed that Fas (CD95/APO1) which mediates apoptotic signal and decrease of anti-apoptotic Bcl-2 are frequently observed in acute myeloid leukemia (AML) M4/M5 leukemic cells. The aim of the study was to compare cytomorphology and cytochemistry of bone marrow (BM) apoptotic leukemic cells to preserved peripheral blood (PB) leukemic cells in our patient, a 76-year-old man with AML-M5b treated at Zagreb University Hospital Center. BM and PB of the AL patient were analyzed after Pappenheim and cytochemical stainings, and leukemic cells were classified according to FAB and WHO classification. Analysis of PB revealed leukocytosis and 80–90% monocytic cells (46% monoblasts, 29% promonocytes and 11% monocytes). Only a few preserved monoblasts and promonocytes were found in BM, together with numerous morphologically altered cells with characteristic chromatin condensation and pyknosis of nucleus, as well as nuclear fragmentation and formation of apoptotic bodies. Thus, cytomorphology of PB leukemic cells pointed to proliferation of immature monocytic cells, and cytomorphology of BM to cell apoptosis. Cytochemistry of PB monocytic cells and BM apoptotic cells confirmed monocytic cell lineage because esterase was strongly positive in almost all BM apoptotic leukemic cells and PB leukemic cells, and esterase was completely inhibited with sodium fluoride. On the basis of these findings, AML-M5b was diagnosed in our patient. There are many possible explanations for our observation of BM leukemic cell apoptosis in a patient with AML-M5. The most reliable one is that apoptosis was induced ex vivo after BM aspiration in course of the air drying of BM specimen before staining. Mass BM leukemic cell apoptosis that was recorded in contrast to numerous preserved leukemic cells in PK could be probably connected to unfavorable ratio of relatively low concentration of cytokines in relation to high leukemic cell number in BM aspirated cytologic specimen

FNA Based Diagnosis of Head and Neck Nodal Lymphoma

Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics

Breast cancer : Clinical guidelines proposal

Prijedog kliničke smjernice “Rak dojke” izraðen je u okviru projekta reforme zdravstva na traženje Ministarstva zdravstva Republike Hrvatske, a izradila ga je Stručna grupa HLZ-a Hrvatskoga senološkog društva u sastavu: prof. dr. sc. Ivan Drinković, Poliklinika za radiologiju i ultrazvučnu dijagnostiku, Zagreb, Paula Podolski, dr. med., KBC Zagreb, Mladen Stanec, dr. med., Klinika za tumore, Zagreb, a na temelju smjernica: Scottish Intercollegiate Guidelines Network “Breast cancer”, New Zeland Guidelines Group “Guidelines for the Surgical Management of Breast Cancer”, te Canadian Medical Association “Questions and answers on breast cancer-A guide for women and their physicians”.Proposal for guidelines for the women breast cancer was made as a part of health reform project on demand of Ministery of Health, Republic of Croatia.It was made by Croatian Senology Society Working Group (Ivan Drinković,MD, PhD). Guidelines are based on: Scottish Intercollegiate Guidelines Network “Breast cancer”, New Zeland Guidelines Group “Guidelines for the Surgical Management of Breast Cancer” and Canadian Medical Association “Questions and answers on breast cancer · A guide for women and their physicians”. ”Guideline for clinical practice is systematicaly made documentation wich purpouse is to help physicians and patients to make decisions about clinical aproach to particulary clinical questions” (CEBM-Oxford

FNA Based Diagnosis of Head and Neck Nodal Lymphoma

Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics

Cytomorphologic diagnostics of acute myeloid leukemia – the World Health Organization classification

Klasifikacija tumora hematopoetskog i limfocitnog tkiva prema Svjetskoj zdravstvenoj organizaciji (engl. World Health Organization; WHO) objedinila je podatke dobivene citomorfološkim, citokemijskim, imunofenotipskim, citogenetičkim i molekularnim analizama s kliničkim obilježjima pojedinih mijeloidnih novotvorina i uvrstila ih u dijagnostički algoritam kojim se pojedini entiteti definiraju. Osnovu dijagnoze čini citomorfološko određivanje postotka blasta unutar 200 stanica u razmazu periferne krvi ili 500 stanica u koštanoj srži bojenim prema May-Gruenwald Giemsi (MGG), gdje se nalaz više od 20 % blasta smatra akutnom leukemijom. Uz citomorfološku analizu konačna dijagnoza postavlja se uz nalaze imunofenotipizacije, citogenetike i molekularne dijagnostike, a početak liječenja temelji se na procjeni kliničkih parametara progresije bolesti.World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues incorporates morphologic, cytochemical, immunophenotypic, genetic and clinical informations into diagnostic algorithms for myeloid neoplasms. Cytomorphologic assessment of more than 20% blasts from 200-cell leukocyte differential counts of the peripheral blood smear and 500-cell differential counts of all cells in the bone marrow aspirate stained with May-Gruenwald Giemsa (MGG), is considered to be an acute leukemia. Along with cytomorphologic findings, the diagnosis is established with immunophenotypic, genetic and molecular findings, but clinical factors must be taken into consideration when deciding the onset of therapy

Morfološke i citogenetičke promjene, razina ekspresije WT1 te duplikacija gena FLT3 u novootkrivenim akutnim mijeloičnim leukemijama sa znacima mijelodisplazije [Morphologic and cytogenetic alterations, level of WT1 expression, and duplication of FLT3 gene in de novo acute myeloid leukaemia with myelodysplasia-related changes]

AML with myelodysplasia related-changes (AML-MRC) is considered as high-risk leukaemia. AML-MRC is associated with higher age and unfavorable cytogenetics. FLT3 gene mutations occur in one third of patients with AML. It is unknown weather they are linked to AML-MRC. The WT1 gene can act both as a tumor-suppressor gene and an oncogene. The aim of this study was to set scoring criteria for dysgranulocytopoiesis, dyseryhrocytopoiesis and dysmegakaryocytopoiesis, to compare morphologic alterations with cytogenetic abnormalities, to asses the expression of WT1 and frequency of FLT3-ITD and relate them to morphologic alterations and cytogenetic abnormalities in patients with AML-MRC. No association between severe dysplastic changes and unfavorable karyotypes was found. Scoring dysplastic changes has not been demonstrated to be a good predictor of cytogenetic abnormalities. Positive correlation between trilineage dysplasia and overexpression of WT1 gene was found. No relationship was found between severe morphological alterations and FLT3-ITD mutation or between FLT3-ITD and unfavorable cytogenetics. The hypothesis that morphologic alterations in de novo diagnosed AML with myelodysplasia related-changes are stronger in patients with unfavorable cytogenetics, FLT3- ITD mutation and overexpression of the WT1 gene was not confirmed

CD20 positive childhood B-non Hodgkin lymphoma (B-NHL): morphology, immunophenotype and a novel treatment approach: a single center experience [CD20 pozitivni B ne-Hodgkinovi limfoni u djece (B-NHL): morfologija, imunofenotipizacija i novija terapijska dostignuća: iskustva jednog centra]

Lymphomas represent the third most common group of cancers in childhood and adolescence, mature B non Hodgkin’s lymphoma (B-NHL) accounting for up to 60% of newly diagnosed patients. The diagnosis of specific entities of B-NHL is based on well-defined morphologic analysis, immunophenotyping, cytogenetics and molecular genetics, which determine the optimal treatment strategy. In adult population a major turning point in treatment of B-NHL has been achieved since rituximab, in combination with CHOP has improved the survival rate up to 19%. Rituximab is a chimeric monoclonal antibody that targets CD20, a transmembrane calcium channel expressed on normal and malignant B-cells that mediates cytotoxic, apoptotic and anti-proliferative effects. The effect of rituximab in pediatric population is still not well enough investigated. Based on morphology and immunophenotype of malignant cells, seven children with B-NHL in our institution were eligible for treatment with modified B-NHL-Berlin-Frankfurt-Münster (BFM)-95-based protocol with rituximab administered on day -5. The complete remission was achieved in all seven patients. Six patients are still in complete remission at least 12 months after having finished chemotherapy and one patient relapsed two months after the last cycle and subsequently died. Major adverse effects observed during treatment were prolonged B-cell depletion and myelosupression. Rituximab in combination with B-NHL-BFM-95 protocol was otherwise well tolerated and proved to be effective in children and adolescents with B-NHL. The number of our patients is too small and the follow-up of a larger group of patients will help in defining the role of rituximab in the treatment of childhood B-NHL

Apoptosis of leukemic cells: a case report [Apoptoza leukemijskih stanica - prikaz bolesnika]

Transformation of leukemic cells is associated with delay in maturation and in apoptosis, and to altered responsiveness to growth factors. However, some studies have revealed that Fas (CD95/APO1) which mediates apoptotic signal and decrease of anti-apoptotic Bcl-2 are frequently observed in acute myeloid leukemia (AML) M4/M5 leukemic cells. The aim of the study was to compare cytomorphology and cytochemistry of bone marrow (BM) apoptotic leukemic cells to preserved peripheral blood (PB) leukemic cells in our patient, a 76-year-old man with AML-M5b treated at Zagreb University Hospital Center. BM and PB of the AL patient were analyzed after Pappenheim and cytochemical stainings, and leukemic cells were classified according to FAB and WHO classification. Analysis of PB revealed leukocytosis and 80-90% monocytic cells (46% monoblasts, 29% promonocytes and 11% monocytes). Only a few preserved monoblasts and promonocytes were found in BM, together with numerous morphologically altered cells with characteristic chromatin condensation and pyknosis of nucleus, as well as nuclear fragmentation and formation of apoptotic bodies. Thus, cytomorphology of PB leukemic cells pointed to proliferation of immature monocytic cells, and cytomorphology of BM to cell apoptosis. Cytochemistry of PB monocytic cells and BM apoptotic cells confirmed monocytic cell lineage because esterase was strongly positive in almost all BM apoptotic leukemic cells and PB leukemic cells, and esterase was completely inhibited with sodium fluoride. On the basis of these findings, AML-M5b was diagnosed in our patient. There are many possible explanations for our observation of BM leukemic cell apoptosis in a patient with AML-M5. The most reliable one is that apoptosis was induced ex vivo after BM aspiration in course of the air drying of BM specimen before staining. Mass BM leukemic cell apoptosis that was recorded in contrast to numerous preserved leukemic cells in PK could be probably connected to unfavorable ratio of relatively low concentration of cytokines in relation to high leukemic cell number in BM aspirated cytologic specimen