Fine needle aspiration of signet-ring cell lymphoma - A case report with differential diagnostic considerations

BACKGROUND: Signet-ring cell lymphoma is an unusual morphologic variant of non-Hodgkin's lymphoma that, although well described histologically, is sca rcely mentioned in the cytology literature. Its main significance lies in i ts potential for diagnostic confusion with more common lesions containing s ignet-ring cells. CASE: A 50-year-old, white male presented with a two-month history of persi stent cervical lymphadenopathy and fatigue. Fine needle aspiration of a 2-c m, left,submandibular lymph node revealed classic signet-ring cells among s mall and large lymphoid cells. Also noted were multivacuolated cells. The b ackground of the smears showed many vacuolated structures analogous to the lymphoglandular bodies seen in lymphoid proliferations without signer-ring cells. CONCLUSION: The differential diagnosis of signet-ring cell lesions by fine needle aspiration includes signet-ring cell lymphoma, sinus histiocytosis a nd metastatic adenocarcinoma, liposarcoma and melanoma. When confronted wit h such an aspirate, additional material should be obtained for immunocytoch emical or flow cytometric analysis.