Cytological assessment of lymphoid tissues and cells in fine needle aspirates and fluid samples: Can we go beyond ”atypical lymphoid proliferation”?
Dr. Hyangmi Ko
Hyang Mi Ko, MD, PhD is a staff cytopathologist at the University Health Network and Assistant Professor at the University of Toronto. She graduated Chonnam National University Medical School in South Korea and trained in anatomic pathology and research fellowship at Chonnam University Hospital. She completed clinical cytology fellowship at University Health Network. She then has been practicing since 2011 at the University Health Network, with special interested in lymphoma cytology.
Dr. Joerg Schwock
Dr. Schwock completed studies at the University of Leipzig, Germany and the University of Toronto. He received RCPSC certification in Anatomical Pathology and diplomate status in Cytopathology. Dr. Schwock is cytopathologist at the University Health Network and assistant professor at the University of Toronto.
1 : Identify key cytomorphological patterns and cell types of lymphoid proliferations
2 : Develop an effective plan for the laboratory processing of lymphoid cytology specimens
3 : Select the most appropriate laboratory process for quantitatively limited samples
4 : Integrate morphology and ancillary tests results to formulate a diagnosis/differential diagnosis
5 : Provide sampling recommendations to ensure safe and timely clinical patient management
Pathologists performing the evaluation of cytologic specimens are frequently confronted with lymphoid samples that may or may not represent the disease process leading to the clinical presentation. Fine needle samples of superficial lesions and fluid specimens are generally obtained through simple, quick and inexpensive procedures regularly applied during the initial assessment of a newly identified mass, lymphadenopathy or fluid accumulation. Technical advances such as an increased use of minimally invasive sampling techniques (e.g. endobronchial/endoscopic ultrasound-guided fine-needle aspiration) have led to a greater number of quantitatively limited samples which arguably pose unique challenges for many laboratories charged with the handling of these specimens. Crucially, these samples often set the path for subsequent clinical investigations and in some circumstances will remain the only means of pathological assessment such as in patients who present with certain general health (e.g. elderly, significant comorbidity) or lesional characteristics (e.g. malignant effusion, deep visceral lesion, proximity to vital structures).
Accurate diagnosis and clinically actionable subclassification of lymphoproliferative disease requires a dedicated approach based on (1) high-quality technical preparations for morphologic assessment, (2) individualized sample triage for targeted ancillary testing (incl. immunohisto-/cytochemical, flow cytometric, cytogenetic, molecular studies) and (3) careful integration of cytomorphologic, clinical and ancillary data into a final diagnosis and clinically relevant report. Both on-site and laboratory-based rapid sample evaluation can be deployed at an early analytic stage to facilitate the efficient use of many small specimens (e.g. cerebrospinal fluid) with the goal to extract a maximum amount of clinically useful information.
Using a case-based approach, participants will have the opportunity to experience a wide spectrum of original cases from the course directors practice covering common and less common entities. A spectrum of both benign and neoplastic lymphoid proliferations will be demonstrated including the specific ancillary testing strategy applied. Potential alternatives for testing that may be sought out depending on available laboratory resources/infrastructure and differential diagnoses taken into consideration will be discussed. Cases requiring accelerated work-up (e.g. rapid progression, superior vena cava obstruction) or timely histopathological assessment (e.g. lymphoma transformation with heterogeneity in tumor grade or type, insufficient material to detect or characterize low frequency neoplastic cells, lymphoproliferative process with equivocal findings/clinically relevant differential diagnoses) are included.
Skills gained during this course will (1) minimize potentially unproductive, harmful and/or costly interventions (e.g. excisional biopsy of benign/reactive lymphoid proliferations) and (2) promote a “smart” use of health care resources directed towards patients who require timely and accurate assessment.