CYTOLOGICAL APPROACH TO THE DIAGNOSIS OF LYMPHOPROLIFERATIVE PROCESSES OF THE ORAL CAVITY

Primary non-Hodgkin lymphoma of the oral cavity (OCL), represent less than 3% of all the NHL. pNHL may be clinically indistinguishable from other tumoral and non-tumoral lesions of the same area and the microscopical diagnoses may be hampered by the morphological overlap with reactive processes. An accurate pre-operative diagnosis should be mandatory because of the difficulties of a surgical biopsy and of a complete excision of the corresponding lesions. Fine needle cytology (FNC) has been successfully utilized in the preoperative diagnosis of oral cavity masses and NHL as well. The aim of this study has been to review the cytopathological features of a series of OCL. Materials and Methods:The series accounts for 10 cytological cases of OCL; one case of myeloma and one of florid lymphoid reactive hyperplasia were added to the series too. Corresponding lesions were from palatal soft tissue (2 cases); palatal bone (4 cases); floor of the mouth (1 case), vestibules (2 cases) and gums (3 cases). In all the cases, a traditional FNC was performed, in 7 cases, a second FNC was performed to prepare additional smears for immunocytochemistry (ICC) (2 cases), using antibodies CD3 and CD20 or suspended in PBS and used for flow cytometry (FC) in 5 cases. Cytological diagnoses were rendered on the basis of cytological features only (5 cases), or combined to ICC (2 cases) and/or FC (5 cases). All the diagnoses were histologically controlled. Results: Clinical presentation was generally represented by sub-mucosal masses which bulged in the oral cavity. In all the cases cytological smears showed a monomorphous lymphoid cell population; corresponding cells had nuclear atypia (enlargement, dispersed chromatin, membrane irregularity and 109 poster presentations Downloaded by: International Academy of Cytology 85.18.242.249 - 6/20/2013 1:42:07 PM large nucleoli) in 6 cases and more bland appearance in the 5 cases. One case showed a proliferation of atypical plasma-cells including binucleated and immature cells. Cytological diagnoses were suspect NHL in 7 cases including a case subsequently diagnosed as reactive hyperplasia. OCL was diagnosed in 4 cases and myeloma in 1 case. All the lesions were histologically diagnosed as NHL in 10 cases, myeloma (1) and florid lymphoid reactive hyperplasia (1). Conclusion: The cytological diagnosis of OCL is generally difficult, nonetheless a preoperative cytological diagnosis should be advisable to differentiate the corresponding masses from other tumoral and nontumoral processes, to avoid unnecessary extensive surgery and to sped up the therapeutic procedures