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Case Reports
. 2012:9:5.
doi: 10.4103/1742-6413.93280. Epub 2012 Feb 24.

Two smalls in one: Coincident small cell carcinoma and small lymphocytic lymphoma in a lymph node diagnosed by fine-needle aspiration biopsy

Alaa Afify  1 , Shweta Das, Chen Mingyi
Affiliations
Case Reports

Two smalls in one: Coincident small cell carcinoma and small lymphocytic lymphoma in a lymph node diagnosed by fine-needle aspiration biopsy

Alaa Afify et al. Cytojournal. 2012.

Abstract

Background: B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma (CLL / SLL) is one of the most common lymphoproliferative disorders in western countries. Patients with SLL / CLL are at increased risk of site-specific secondary cancers. We present a unique case of a 71-year-old male, with a history of SLL / CLL, who presented with pulmonary symptoms and a mediastinal mass. Fine needle aspiration (FNA) of the mediastinal lymph node revealed synchronous SLL / CLL and small cell carcinoma (SCC).

Materials and methods: The patient underwent a computed tomography (CT) scan of the chest and endobronchial ultrasound-guided transbronchial fine needle aspiration of the mediastinal lymph node (4R). The sample was submitted for cytopathology, immunohistochemical stains, and flow cytometry evaluation.

Results: Fine needle aspiration of the mediastinal lymph node revealed neoplastic cells, in clusters and singly, with cytological features suggestive of small cell carcinoma. The immunohistochemistry results confirmed this diagnosis. Small-to-medium, mature-appearing lymphocytes were also present in the background. Flow cytometry analysis revealed that these lymphocytes possessed an immunophenotype consistent with CLL / SLL.

Conclusions: This case illustrates the importance of a pathologist's awareness of the possibility of concurrent lymphoma and metastatic carcinoma in a lymph node. When evaluating lymph nodes, pathologists must strive to identify both foreign cells and subtle lymphoid changes. As demonstrated by our case, ancillary techniques (such as immunohistochemistry and flow cytometry) can be critical to making a complete and accurate diagnosis. The diagnosis of small cell carcinoma in the enlarged lymph node, primarily harboring CLL / SLL, is of critical importance for decision-making and treatment purposes, in addition to having a significant adverse impact on the overall survival.

Keywords: FNA; Small cell carcinoma; lymphoma.

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Figures

Figure 1
Figure 1
CT image of chest showing right hilar mass and enlarged mediastinal lymph nodes
Figure 2
Figure 2
FNA smear (PAP stain) showing malignant cells in clusters and numerous lymphocytes in the background
Figure 3
Figure 3
Cell block tissue section showing small cell carcinoma (upper left corner) and lymphocytes (lower right corner)
Figure 4a
Figure 4a
Cell block tissue section showing small cell carcinoma positive for synaptophysin
Figure 4b
Figure 4b
Cell block tissue section showing small cell carcinoma negative for CD45 (arrows) and numerous lymphocytes positive for CD45
See this image and copyright information in PMC

References

    1. Henne T, Schmahl D. Occurrence of second primary malignancies in man-a second look. Cancer Treat Rev. 1985;12:77–94. - PubMed
    1. Hemminki K, Lenner P, Sundquist J, Bermejo JL. Risk of subsequent solid tumors after non-Hodgkin's lymphoma: Effect of diagnostic age and time since diagnosis. J Clin Oncol. 2008;26:1850–7. - PubMed
    1. Royle JA, Baade PD, Joske D, Girschik J, Fritschi L. Second cancer incidence and cancer mortality among chronic lymphocytic leukaemia patients: a population-based study. Br J Cancer. 2011;105:1076–81. - PMC - PubMed
    1. Morton LM, Curtis RE, Linet MS, Bluhm EC, Tucker MA, Caporaso N, et al. Second malignancy risks after non-Hodgkin's lymphoma and chronic lymphocytic leukemia: differences by lymphoma subtype. J Clin Oncol. 2010;28:4935–44. - PMC - PubMed
    1. El Demellawy D, Ross C, Sur M, Alowami S. Synchronously diagnosed lymph nodal collision tumor of malignant melanoma and chonic lymphocytic leukemia/small lymphocytic lymphoma: case report. Diagn Pathol. 2007;2:34. - PMC - PubMed

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