CytoJournal 2006, 3:1 http://www.cytojournal.com/content/3/1/1
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ton Dickinson, San Jose Ca) which has a capacity for
eight-parameter detection, will offer an opportunity to
provide immunophenotyping on even smaller quantities
of neoplastic cells.
To the best of our knowledge, there have been only four
previous reports where FNA was performed in patients
with HCL (see table 1). In three of the four cases, a diag-
nosis of HCL was clinically suspected which helped estab-
lish the diagnosis of HCL on FNA samples . In one
unsuspected case of HCL, FNA did not prove to be as use-
ful in making a diagnosis of HCL .
Unlike percutaneous FNA, EUS-FNA obtains samples by
piercing the gastrointestinal tract mucosa. Rare fragments
of glandular epithelium were noted in the aspirates in the
present case; however, these did not pose any concern for
metastatic carcinoma. Glandular epithelium can often be
seen in the EUS-FNA samples, but their characteristic
honey-comb appearance and benign appearing cytologic
features are helpful in avoiding possible over-interpreta-
The patient in the present study was in complete remis-
sion with peripheral blood and differential counts
remaining within the reference range. The patient had
undergone splenectomy 19 years ago, and no parameters
suggestive of recurrent HCL were noted in this patient. A
recent review by Goodman, et al suggests that a complete
remission has been noted in 50–95% of patients follow-
ing 2-chlorodeoxyadenosine (2-Cda) therapy . In a
more recent study, 95% of 209 patients with HCL demon-
strated complete remission after 2-Cda treatment; the
median time of recurrence was 42 months . In the
present study, the patient was in remission for at least 4
years (48 months) following 2-Cda therapy and demon-
strated abdominal pain and intra-abdominal lymphaden-
opathy as the first manifestation of recurrent disease.
This case shows that a diagnosis of HCL can be accurately
rendered on small EUS-FNA samples. This study also
underscores the concept that the presence of a cytopathol-
ogist in the endoscopy suite is not only important to
assess the specimen adequacy, but also plays an important
role in obtaining additional samples for appropriate
ancillary studies to arrive at an accurate diagnosis.
All authors made substantial contributions to the intellec-
tual content and/or presentation of the manuscript. RM
(cytopathology fellow) is the first author, and she wrote
the manuscript under the guidance of NJ (cytopatholo-
gist) senior author who coordinated the writing of this
manuscript. VB (hematopathologist) and DJ (cytopathol-
ogist with expertise in hematopathology), helped with
immunophenotyping as well as developing the manu-
script. SV (endosonographer) performed EUS-FNA and
provided necessary clinical information for writing and
revising the manuscript. JPA (surgical oncologist) pro-
vided the necessary clinical information as well as follow
up and revised the manuscript.
Co-editors of CytoJournal Vinod B. Shidham, MD, FRCPath, FIAC and Bar-
bara F. Atkinson, MD thank: the academic editor Dr. Ruth Katz, MD, Pro-
fessor, Pathology, University of Texas MD Anderson Center Houston, TX,
United States email@example.com for organizing and completing the
peer-review process for this manuscript.
1. Stelow EB, Lai R, Bardales RH, Mallery S, Linzie BM, Crary G, Stanley
MW: Endoscopic ultrasound-guided fine-needle aspiration of
lymph nodes: the Hennepin County Medical Center experi-
ence. Diagn Cytopathol 2004, 30:301-306.
2. Jhala NC, Jhala DN, Chhieng DC, Eloubeidi MA, Eltoum IA: Endo-
scopic ultrasound-guided fine-needle aspiration. A
cytopathologist's perspective. Am J Clin Pathol 2003,
3. Hehn ST, Grogan TM, Miller TP: Utility of fine-needle aspiration
as a diagnostic technique in lymphoma. J Clin Oncol 2004,
4. Austin MR, Birdsong GG, Sidaway MK, Kaminsky DB, Cibas ES, Mody
DR, Moriarty AT, Rimm DR, Ehya H, Facik MS, et al.: Utility of Fine
needle aspiration as a diagnostic technique in lymphoma
(Letter to the Editor). The ASC Bulletin 2005, XLII:36-37.
5. Zeppa P, Marino G, Troncone G, Fulciniti F, De Renzo A, Picardi M,
Benincasa G, Rotoli B, Vetrani A, Palombini L: Fine-needle cytology
and flow cytometry immunophenotyping and subclassifica-
tion of non-Hodgkin lymphoma: a critical review of 307 cases
with technical suggestions. Cancer 2004, 102:55-65.
6. Beaty MW, Geisinger KR: Hodgkin lymphoma: flow me? Cytojour-
nal 2005, 2:13.
7. Hernandez OM, Oweity TM, Ibrahim SM: Is an increase in CD4/
CD8 T-cell ratio in lymph node fine needle aspiration helpful
for diagnosing Hodgkin lymphoma? A study of 85 lymph
node FNAs with increased CD4/CD8 ratio. Cytojournal 2005,
8. Yao JL, Cangiarella JF, Cohen JM, Chhieng DC: Fine-needle aspira-
tion biopsy of peripheral T-cell lymphomas. A cytologic and
immunophenotypic study of 33 cases. Cancer 2001, 93:151-159.
9. Ribeiro A, Vazquez-Sequeiros E, Wiersema LM, Wang KK, Clain JE,
Wiersema MJ: EUS-guided fine-needle aspiration combined
with flow cytometry and immunocytochemistry in the diag-
nosis of lymphoma. Gastrointest Endosc 2001, 53:485-491.
10. Galindo LM, Garcia FU, Hanau CA, Lessin SR, Jhala N, Bigler RD,
Vonderheid EC: Fine-needle aspiration biopsy in the evalua-
tion of lymphadenopathy associated with cutaneous T-cell
lymphoma (mycosis fungoides/Sezary syndrome). Am J Clin
Pathol 2000, 113:865-871.
11. Jhala NC, Jhala D, Eltoum I, Vickers SM, Wilcox CM, Chhieng DC,
Eloubeidi MA: Endoscopic ultrasound-guided fine-needle aspi-
ration biopsy: a powerful tool to obtain samples from small
lesions. Cancer 2004, 102:239-246.
12. Jhala D, Eloubeidi M, Chhieng DC, Frost A, Eltoum IA, Roberson J,
Jhala N: Fine needle aspiration biopsy of the islet cell tumor of
pancreas: a comparison between computerized axial tomog-
raphy and endoscopic ultrasound-guided fine needle aspira-
tion biopsy. Ann Diagn Pathol 2002, 6:106-112.
13. Goodman GR, Bethel KJ, Saven A: Hairy cell leukemia: an
update. Curr Opin Hematol 2003, 10:258-266.
14. Polliack A: Hairy cell leukemia: biology, clinical diagnosis, unu-
sual manifestations and associated disorders. Rev Clin Exp
Hematol 2002, 6:366-388. discussion 449–350