Structure of the Cytological Report
In a properly drafted report, the cytopathologist not only describes cell morphology but also indicates the data from additional tests. It is mandatory to document the specific research method (e.g., immunocytochemical method or cell block technology — cell blocks) and the obtained result.
If automated computer assistants (automated screening systems) were used to evaluate the smear, this is also reflected in the document along with the results of machine analysis. In addition, the report may contain educational notes for the clinician — explanations with references to current clinical guidelines and recent scientific publications.
Cytogenetics and FISH Method
To search for prognostically important abnormalities, molecular cytogenetic testing is used — fluorescence in situ hybridization (FISH method). Plasma cells serve as the test material.
This test is indicated for all patients with newly diagnosed multiple myeloma, as well as at the first and second relapses of the disease (level of recommendation evidence C, reliability of evidence level 4). The spectrum of detected genetic aberrations includes:
- Assessment of ploidy.
- Chromosome 1 abnormalities.
- Deletion del 17p13.
- Translocations: t(4;14), t(14;16), t(6;14), t(11;14).
Bone Marrow Cytological Examination
Assessment of the cellular composition of bone marrow hematopoiesis is critically important to rule out hemoblastosis and bone marrow involvement by solid tumor metastases. The cytological specimen is obtained via sternal puncture followed by smear examination (myelogram).
Clinical note: sternal puncture is completely safe and can be performed even in patients with severe thrombocytopenia without prior transfusion preparation.
The resulting smear allows the detection of specific signs of pathology. For example, in aplastic anemia, the bone marrow aspirate is hypocellular, completely lacking megakaryocytes, but showing relative lymphocytosis. In patients with Waldenström macroglobulinemia, bone marrow cytological examination is prescribed during diagnosis or before antitumor therapy to detect lymphoplasmacytic infiltration (Level of Recommendation C, Level of Evidence 5).
Histology and Immunophenotyping
If cytological data are insufficient, patients with Waldenström macroglobulinemia undergo trephine biopsy to obtain a histological specimen. Next, pathomorphological examination of the biopsy material is performed using immunohistochemical methods and immunophenotyping of hematopoietic progenitor cells.
Tumor cells in Waldenström macroglobulinemia have a specific immunophenotype. They express immunoglobulins PIgM both intracellularly (cIgM) and on the surface (sIgM), with surface expression significantly prevailing.
| Expression | Markers |
|---|---|
| Pronounced | B-cell antigens: CD19, CD20, CD22, CD79a |
| Weakly positive | CD10 (may be completely absent), CD21, CD25, CD38, CDc |
| Uncharacteristic | CD5, CD23 (presence does not exclude the diagnosis) |
Diagnosis of Concomitant Amyloidosis
Patients with Waldenström macroglobulinemia may be suspected of having concomitant amyloidosis affecting the skin, gastrointestinal tract, kidneys, liver, or bone marrow. In such cases, pathomorphological examination of biopsies from the affected organs is indicated. Specific tissue staining with the Congo red dye is used to verify the diagnosis (Level of Recommendation C, Level of Evidence 4).
To memorize the pronounced expression of B-cell antigens in Waldenström macroglobulinemia, use the sequence: 19, 20, 22, and 79a. These are the main B-lymphocyte "passports" that always brightly light up during immunophenotyping.
Class and exam questions
Which cells serve as material for the FISH method in multiple myeloma?
Plasma cells are used for molecular cytogenetic testing via the FISH method.
Is it safe to perform a sternal puncture with low platelets?
Yes, sternal puncture is considered a safe procedure. It can be performed in patients with severe thrombocytopenia without prior transfusion preparation.
What does a myelogram look like in aplastic anemia?
The bone marrow smear shows poor cellular composition (hypocellular aspirate), complete absence of megakaryocytes, and relative lymphocytosis.
Does the presence of CD5 and CD23 rule out the diagnosis of Waldenström macroglobulinemia?
No. Although the expression of these markers is uncharacteristic for this disease, their presence is sometimes observed and is not a reason to rule out the diagnosis.
What else to study on this topic
- Levels of recommendation evidence and levels of proof reliability in oncohematology.
- Cell block technology in modern cytology.
- Principles of operation of automated cytological smear screening systems.
- Pathogenesis and clinical manifestations of concomitant amyloidosis.
- Differential diagnosis of Waldenström macroglobulinemia and multiple myeloma.
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