Huma Fatima, Chung Ho Chang, Rajuta Kanhere, Edward G Bernacki.
Fine needle aspiration of Signet ring cell Lymphoma of diffuse large B-Cell type: A case report with diagnostic pitfalls.
Int J Pathol Jan ;5(2):79-82.

Signet ring cell lymphoma is a diagnostic challenge for cytological evaluation because the lesional cells can appear artefactual, or can be confused with other neoplasms. We report a case of signet ring cell lymphoma of diffuse large B-cell type in a 51-year old male. The abundance of vacuolated cells, with signet cell morphology, in cytological smears aspirated from enlarged sub-mandibular lymph node raised strong suspicion of metastatic neoplasm especially adenocarcinoma . However the vacuolated cells were only positive for Leukocyte Common Antigen (LCA) and B-cell markers confirming lymphoid origin of the signet cells. Flow cytometery and electron microscopy confirmed the diagnosis. An excisional biopsy specimen was subsequently received which showed similar morphologic feature. We concluded that signet ring morphology is a non-specific change which can occur in any neoplasm including both B and T cell lymphoma, carcinoma of various origin, melanoma and even sarcoma. Therefore it is important to obtain additional material for appropriate ancillary studies, such as immunohistochemistry, flow cytometery and electron microscopy (EM), when confronted with such an ambiguous aspirate.

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