Is this Lymphocyte Normal Reactive Malignant?

Is this Lymphocyte Normal Reactive Malignant?

Steve Marionneaux

September 16, 2017

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From CAP Survey

Lymphocyte correctly identified by 96.8% of participants.

Number of Responses 228 74 29 22 7

Percent of Labs 63.0% 20.4% 8.0% 6.1% 1.9%

Cell type or finding Plasma cell Hairy cell Nucleated red cell Reactive/Atypical lymphocyte Normal lymphocyte

Number of Responses 295 67 22 9 4

Percent of Laboratories 73.8% 16.8% 5.5% 2.3% 1.0%

Cell Identified Lymphoma/S?zary cell Atypical lymphocyte

Monocyte Segmented neutrophil

Normal lymphocyte

Study Which Evaluated Consistency with Morphologic Evaluation of Lymphocytes

157 hospitals were sent a set of 56

photomicrographs from a 3 year old orthopedic

patient

Asked technologists to differentiate between normal lymphocytes, atypical, plasma cells, prolymphocytes, blasts

For 7 cells (normal) there was >90% agreement. No agreement was seen

with the other 49 images

114 labs responded with 671 individuals participating

van der Meer, W. et al. The divergent morphological classification of variant lymphocytes in blood smears. J Clin Pathol. 2007;60:838-839

Normal

Normal or Atypical

Normal or plasma cell

Normal or atypical or prolymphocyte

Normal or atypical or plasma cell

Normal or Atypical or prolymphocyte or plasma cell

Normal or Atypical or prolymphocyte or blast

Normal or Atypical or prolymphocyte or plasma cell or blast

van der Meer, W. et al. The divergent morphological classification of variant lymphocytes in blood smears. J Clin Pathol. 2007;60:838-839

The Divergent Morphological Classification of Variant Lymphocytes in Blood Smears

Summary of author's conclusions:

? Morphology of lymphocytes is complex; unfortunately a uniform definition of abnormal lymphocytes is lacking

? Confusing terminology is used: variant, atypical, etc ? Proving clinical information at bench should lead to a

better interpretation of morphology ? Recognition of abnormal lymphs can contribute to rapid

diagnosis of various conditions

Today's talk will address these issues and hopefully provide useful information on how to recognize and classify the various forms of lymphoid cells that can be encountered on peripheral blood smears

van der Meer, W. et al. The divergent morphological classification of variant lymphocytes in blood smears. J Clin Pathol. 2007;60:838-839

Consider sample age

Storage artifacts in lymphocytes

? Hyperchromatic cells ? Vacuolated ? Smudged or necrobiotic ? Nuclear membrane breakage,

nucleoplasm leaks mimicking ? Cytoplasmic inclusions ? Nuclear lobes ? Cytoplasmic blebbing or projections

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