Gross Findings in Lymphadenectomy Specimens: Diagnosis and Differentiation of Malignant Lymphoma

Abstract

In the diagnosis of malignant lymphoma (ML), lymphadenectomy specimens are separated as needed for histological diagnosis, flow cytometry, and various genetic analyses after determining the suitability of the specimens from gross findings. We investigated gross findings for cut surfaces of lymphadenectomy specimens. Of the 57 patients who underwent lymphadenectomies, 7 were diagnosed with reactive lymphoid hyperplasia (RLH), 19 with follicular lymphoma (FL), 20 with diffuse large B-cell lymphoma (DLBCL), and 11 with Hodgkin lymphoma (HL). The gross findings for fresh, unfixed lymph node specimens with the maximum cut surface were evaluated in terms of color homogeneity, unevenness of cut surface, aspect ratio, presence of internal nodules, and capsular disruption. After this evaluation, a histological diagnosis was performed. In a comparison of color homogeneity, significantly more cases in the ML group (30/50 [60.0%]) were homogeneous than in the RLH group (1/7 [14.2%]) (P = 0.039). Capsular disruption was not observed in the RLH group, whereas it was found in 42/50 (84.0%) cases in the ML group (P = 0.001). The internal nodules between the FL group (17/19 [89.5%]) and HL group (9/11 [81.8%]) occurred more frequently than those of the DLBCL group (11/20 [55.0%]) (P = 0.039). Moreover, the internal nodules tended to be smaller in FL and HL than in DLBCL (P = 0.007). The color homogeneity and capsular disruption findings were important in differentiating ML from RLH, and the presence and size of the internal nodules were important in differentiating the ML subtypes.