Fine needle aspiration cytology (FNAC) revealed many small to medium lymphocytes, a few large lymphocytes with mild nuclear atypia and increased chromatin and a few tingible
In addition, they have diminished or absent mantle zones, often do not include tingible
body macrophages, and do not show polarized light and dark zones.
Permanent pathology and flow cytometry immunophenotyping analysis identified the tumor as a high-grade B-cell lymphoma with Burkitt morphology composed of intermediate-size malignant cells in a diffuse pattern with numerous tingible
bodies creating a "starry sky" appearance (figure 2).
An aspirate showing evidence of polymorphic population of lymphoid cells along with histiocytes and tingible
body macrophages and plasma cells, (eosinophils, polymorphs, variable) were taken as suggestive of non-specific reactive lymphadenitis.
Follicular center cells, histiocytes (including tingible
body macrophages), and lymphohistiocytic aggregates were not found.
The residual lymph node showed reactive germinal centers and tingible
body macrophages, but no hemophagocytosis (Figure 1).
Some lymphoid follicles had a monotonous appearance of their germinal centres, being composed predominately of centrocytes and only a few centroblasts and lacked tingible
Cohen, "Impaired apoptotic cell clearance in the Germinal center by Mer-deficient tingible
body macrophages leads to enhanced antibody-forming cell and Germinal center responses," The Journal of Immunology, vol.
The tumor tissue contained tingible
body macrophages with nuclear debris.
In addition, tingible
body macrophages contain "ingested nuclear debris, which represents lymphocytes that have been selected to be destroyed in reactive follicles.
The morphology of follicular lymphoma is classically described as an effacement of normal lymph node architecture by back-to-back neoplastic follicles that show attenuated mantle zones, loss of polarization, and absence of tingible
body macrophages that are usually present in nonneoplastic follicles (Figure 1, A through C).
Usually, D-FL appears as several well-circumscribed germinal centers packed together with centrocytes and few, if any, centroblasts with no visible tingible
body macrophages and without mantle zones.