The Monotonous Small-Cell Pattern

  • Stefan E. Pambuccian
  • Ricardo H. Bardales
Part of the Essentials in Cytopathology book series (EICP, volume 10)


Small lymphocytes measure <12 μm in diameter, equivalent to the size of a histiocyte nucleus, a segmented neutrophil, or 1.5 to 2 times the size of an erythrocyte. The presence of a monotonous proliferation of small lymphoid cells in an enlarged round and rubbery lymph node is abnormal, and the cytologic findings should be correlated with the clinical scenario. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and the resolving or quiescent phase of a reactive lymphoid hyperplasia are the main and most common entities considered in the differential diagnosis and must be distinguished from other neoplastic and non-neoplastic processes. The following is a list of entities showing the monotonous small-cell pattern. The cytologic description is based on Romanovsky-stained, air-dried smears. We use the WHO classification and nomenclature for lymphoid neoplasms unless otherwise is noted.


Hodgkin Lymphoma Follicular Dendritic Cell Castleman Disease Follicular Dendritic Cell Sarcoma Reactive Lymphoid Hyperplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. Bonato M, Pittaluga S et al (1998) Lymph node histology in typical and atypical chronic lymphocytic leukemia. Am J Surg Pathol 22(1):49–56PubMedCrossRefGoogle Scholar
  2. Caraway N P, Thomas E et al (2008) Chromosomal abnormalities detected by multicolor fluorescence in situ hybridization in fine-needle aspirates from patients with small lymphocytic lymphoma are useful for predicting survival. Cancer 114(5):315–322PubMedCrossRefGoogle Scholar
  3. Deschenes M, Michel RP et al (2008) Fine-needle aspiration cytology of Castleman disease: case report with review of the literature. Diagn Cytopathol 36(12):904–908PubMedCrossRefGoogle Scholar
  4. Diehl V, Sextro M et al (1999) Clinical presentation, course, and prognostic factors in lymphocyte-predominant Hodgkin’s disease and lymphocyte-rich classical Hodgkin’s disease: report from the European Task Force on Lymphoma Project on Lymphocyte-Predominant Hodgkin’s Disease. J Clin Oncol 17(3):776–783PubMedGoogle Scholar
  5. Dong HY, Harris NL et al (2001) Fine-needle aspiration biopsy in the diagnosis and classification of primary and recurrent lymphoma: a retrospective analysis of the utility of cytomorphology and flow cytometry. Mod Pathol 14(5):472–481PubMedCrossRefGoogle Scholar
  6. Fan Z, Natkunam Y et al (2003) Characterization of variant patterns of nodular lymphocyte predominant hodgkin lymphoma with immunohistologic and clinical correlation. Am J Surg Pathol 27(10):1346–1356PubMedCrossRefGoogle Scholar
  7. Harris NL, Jaffe ES et al (1999) World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 17(12):3835–3849PubMedGoogle Scholar
  8. Hoyer JD, Ross CW et al (1995) True T-cell chronic lymphocytic leukemia: a morphologic and immunophenotypic study of 25 cases. Blood 86(3):1163–1169PubMedGoogle Scholar
  9. Kardos TF, Vinson JH et al (1986) Hodgkins disease: diagnosis by fine-needle aspiration biopsy. Analysis of cytologic criteria from a selected series. Am J Clin Pathol 86(3):286–291PubMedGoogle Scholar
  10. Keller AR, Hochholzer L et al (1972) Hyaline-vascular and plasma-cell types of giant lymph node hyperplasia of the mediastinum and other locations. Cancer 29(3):670–683PubMedCrossRefGoogle Scholar
  11. Koo CH, Rappaport H et al (1989) Imprint cytology of non-Hodgkin’s lymphomas based on a study of 212 immunologically characterized cases: correlation of touch imprints with tissue sections. Hum Pathol 20(12 Suppl 1):1–137PubMedCrossRefGoogle Scholar
  12. Lim MS, Beaty M et al (2002) T-cell/histiocyte-rich large B-cell lymphoma: a heterogeneous entity with derivation from germinal center B cells. Am J Surg Pathol 26(11):1458–1466PubMedCrossRefGoogle Scholar
  13. Lin P, Bueso-Ramos C et al (2003) Waldenstrom macroglobulinemia involving extramedullary sites: morphologic and immunophenotypic findings in 44 patients. Am J Surg Pathol 27(8):1104–1113PubMedCrossRefGoogle Scholar
  14. Meyer L, Gibbons D et al (1999) Fine-needle aspiration findings in Castleman’s disease. Diagn Cytopathol 21(1):57–60PubMedCrossRefGoogle Scholar
  15. Morton LM, Wang SS et al (2006) Lymphoma incidence patterns by WHO subtype in the United States, 1992–2001. Blood 107(1):265–276PubMedCrossRefGoogle Scholar
  16. Shin HJ, Caraway NP et al (2003) Cytomorphologic spectrum of small lymphocytic lymphoma in patients with an accelerated clinical course. Cancer 99(5):293–300PubMedCrossRefGoogle Scholar
  17. Stani J (1987) Cytologic diagnosis of reactive lymphadenopathy in fine needle aspiration biopsy specimens. Acta Cytol 31(1):8–13PubMedGoogle Scholar
  18. Stewart CJ, Duncan JA et al (1998) Fine needle aspiration cytology diagnosis of malignant lymphoma and reactive lymphoid hyperplasia. J Clin Pathol 51(3):197–203PubMedCrossRefGoogle Scholar
  19. Tani E, Johansson B et al (1998) T-cell-rich B-cell lymphoma: fine-needle aspiration cytology and immunocytochemistry. Diagn Cytopathol 18(1):1–4PubMedCrossRefGoogle Scholar
  20. Tong TR, Lee KC et al (2002) T-cell/histiocyte-rich diffuse large B-cell lymphoma. Report of a case diagnosed by fine needle aspiration biopsy with immunohistochemical and molecular pathologic correlation. Acta Cytol 46(5):893–898PubMedCrossRefGoogle Scholar
  21. Zhang JR, Raza AS et al (2006) Fine-needle aspiration diagnosis of Hodgkin lymphoma using current WHO classification – re-evaluation of cases from 1999–2004 with new proposals. Diagn Cytopathol 34(6):397–402PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Lab. Medicine & PathologyUniversity of MinnesotaMinneapolisUSA
  2. 2.Outpatient Pathology AssociatesSacramentoUSA

Personalised recommendations