Color Atlas of Hematology - Practical Microscopic and Clinical ...

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182Cytology of Organ Biopsies and ExudatesNon-Hodgkin LymphomaSince the CBC is the first step in any lymph node diagnosis, lymph node biopsyis unnecessary in many cases of non-Hodgkin lymphoma (p. 70), becausethe most common form of this group of diseases, chronic lymphadenosis,can always be diagnosed on the basis of the leukemic findings of theCBC.However, when enlarged lymph nodes are found in one or more regionswithout symptoms of reactive disease, and the blood analysis fails to showsigns of leukemia, lymph node biopsy is indicated.The relatively monotonous lymph node cytology in non-Hodgkin lymphomasand tumor metastases mean that histological differentiation isrequired.In contrast to Hodgkin disease, with its conspicuous giant cell forms(p. 177), non-Hodgkin lymphomas display a monotonous picture withoutany signs of a reactive process (p. 70). Clinically, it is enough to distinguishbetween small cell forms (which have a relatively good prognosis) andlarge cell forms (which have a poorer prognosis) to begin with. For a moredetailed classification, see page 70 f.Histological analysis may be omitted only when its final results wouldnot be expected to add to the intermediate cytological findings in terms ofconsequences for treatment.Metastases of Solid Tumors in Lymph Nodes orSubcutaneous TissueWhen hard nodules are found that are circumscribed in location, biopsyshows aggregates of polymorphous cells with mostly undifferentiated nucleiand a coarse reticular structure of the chromatin (perhaps with welldefinednucleoli or nuclear vacuoles), and the lymphatic cells cannot beclassified, there is urgent suspicion of metastasis from a malignant solidtumor, i.e. from a carcinoma in a variety of possible locations or a softtissue sarcoma.As a rule, the next step is the search for a possible primary tumor. If this isfound, lymph node resection becomes unnecessary.If no primary tumor is found, lymph node histology is indicated. The histologicalfindings can provide certain clues about the etiology and also helpsin the difficult differential diagnosis versus blastic non-Hodgkin lymphoma.
In cases of non-Hodgkin lymphoma and tumor metastases, atentative diagnosis is possible on the basis of the lymph nodecytologyabcdeFig. 65 Non-Hodgkin lymphoma and tumor metastases. a Lymph node cytologyshowing small cells with relatively wide cytoplasm (arrow 1) in addition to lymphocytes.There are scattered blasts with wide cytoplasm (arrow 2): lymphoplasmacyticimmunocytoma. b Lymph node cytology showing exclusively large blastoidcells with a large central nucleolus (arrow). This usually indicates large-cell non-Hodgkin lymphoma (in this case immunoblastic). c–e Metastatic disease from:c uterine carcinoma, d small-cell bronchial carcinoma, and e leiomyosarcoma.183
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iiiColor Atlas of HematologyPractic
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vPrefaceOur Current EditionAlthough
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viiContentsPhysiology and Pathophys
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ContentsixAcute Lymphoblastic Leuke
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2Physiology and Pathophysiology of
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Normal Cells of the Blood andHemato
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Normally erythropoiesis takes place
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34Normal Cells of the Blood and Hem
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Advancing nuclear contraction and s
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Note the granulations, inclusions,
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Abnormalities of the White Cell Ser
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Predominance of Mononuclear Round t
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During lymphatic reactive states, v
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Extreme transformation of lymphocyt
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Monotonous proliferation of small l
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Atypical lymphocytes are not part o
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Deep nuclear indentation suggests f
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Cytoplasmic processes the main feat
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Plasmacytoma cannot be diagnosed wi
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Atypias and differential diagnoses
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Bone marrow diagnosis is indicated
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Conspicuously large numbers of mono
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Fundamental characteristic of acute
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The diagnosis of acute leukemia is
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Acute leukemias may also derive fro
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New WHO classification: AML with dy
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The cells in acute lymphocytic leuk
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In unexplained anemia and/or leukoc
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The classification of myelodysplasi
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Prevalence of Polynuclear (Segmente
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Predominance of the granulocytic li
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Prevalence of Polynuclear (Segmente
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Left shift as far as myeloblasts, p
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Bone marrow analysis is not obligat
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In the course of chronic myeloid le
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Enlarged spleen and presence of imm
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Eosinophilia and basophilia are usu
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Erythrocyte and ThrombocyteAbnormal
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Hypochromic Anemias129Insufficient
Page 141 and 142: Hypochromic Anemias131BSGIron Ferri
Page 143 and 144: Small, hemoglobin-poor erythrocytes
Page 145 and 146: Hypochromic erythrocytes of very va
Page 147 and 148: Hypochromic Anemias137Hypochromic S
Page 149 and 150: Hypochromic anemia without iron def
Page 151 and 152: Consistently elevated “young” e
Page 153 and 154: Distribution pattern and shape of e
Page 155 and 156: Conspicuous erythrocyte morphology
Page 157 and 158: Unexplained decrease in cell counts
Page 159 and 160: Hypochromic Anemias149Differential
Page 161 and 162: Thrombocytopenia with leukocytosis
Page 163 and 164: Conspicuous large erythrocytes sugg
Page 165 and 166: In older patients, myelodysplastic
Page 167 and 168: Small inclusions are usually a sign
Page 169 and 170: PlasmodiumfalciparumPlasmodiumvivax
Page 171 and 172: Conspicuous erythrocyte inclusions
Page 173 and 174: Bone marrow analysis contributes to
Page 175 and 176: Thrombocytes: increases, reductions
Page 177 and 178: Thrombocytes: increases, reductions
Page 179 and 180: Variant forms of thrombocyte and me
Page 181 and 182: Thrombocyte proliferation with larg
Page 183 and 184: Cytology of Organ Biopsiesand Exuda
Page 185 and 186: Lymph Node Cytology175Anamnesis- su
Page 187 and 188: Reactive lymph node hyperplasia and
Page 189 and 190: Lymph Node Cytology179Contact witha
Page 191: Epithelioid cells dominate the lymp
Page 195 and 196: Accessible cysts (e.g., branchial c
Page 197 and 198: Tumor cells can be identified in pl
Page 199 and 200: Viral, bacterial, and malignant men
Page 201 and 202: 191IndexAActinomycosis 179Addison d
Page 203 and 204: Index193Disseminated intravascularc
Page 205 and 206: Index195blast crisis 120-121bone ma
Page 207 and 208: Index197in hemolytic anemia 140orth
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