Abstract
BackgroundPrimary intestinal follicular lymphoma (PI-FL) is a rare and indolent lymphoma and is challenging for diagnosis with endoscopic biopsy specimens. Whole slide imaging (WSI) has been increasingly used for assisting pathologic diagnosis, but not for lymphoma yet, probably because there are usually too many immunostained sections in a single case. In this study we attempted to identify morphological clues of PI-FL in the endoscopic biopsy specimens by measuring various parameters using WSI.MethodsWe retrospectively investigated 21 PI-FL cases, and scanned the HE sections from 17 of these cases with endoscopic biopsy specimens. Sections from 17 intestinal biopsies showing reactive lymphoid hyperplasia were scanned for comparison. The density and diameter of lymphoid follicles and the shortest distance of these follicles to the surface epithelia were measured on WSI. Comparisons of the aforementioned parameters were made between the neoplastic and reactive follicles.ResultsThe density of follicles was significantly higher in PI-FL than that of reactive hyperplasia (median 0.5 vs. 0.2/mm2; p < 0.01). Furthermore, the neoplastic follicles were significantly larger (median diameter 756.9 vs. 479.7 μm; p < 0.01). The shortest distance of follicles to the surface epithelia tended to be closer in PI-FL (104.7 vs. 177.8 μm, p = 0.056), but not statistically significant.ConclusionsIn this study we found that in PI-FL the density and diameter of lymphoid follicles as measured from WSI were significantly different from that of intestinal reactive lymphoid hyperplasia. When facing the diagnostic challenge between these two entities in routine practice, pathologists might be alerted by these morphological clues and request for immunohistochemistry for differential diagnosis.
Highlights
Primary intestinal follicular lymphoma (PI-Follicular lymphoma (FL)) is a rare and indolent lymphoma and is challenging for diagnosis with endoscopic biopsy specimens
Several studies have validated the accuracy of Whole slide imaging (WSI) in pathological diagnosis, suggesting that WSI can be used for routine practice, which has been realized in a Dutch academic pathology laboratory where the pathological diagnosis is fully digitalized [1,2,3,4]
Eleven Primary intestinal follicular lymphoma (PI-FL) patients were from Taichung Veterans General Hospital and ten patients were from Chi-Mei Medical Center
Summary
Primary intestinal follicular lymphoma (PI-FL) is a rare and indolent lymphoma and is challenging for diagnosis with endoscopic biopsy specimens. Whole slide imaging (WSI) has been increasingly used for assisting pathologic diagnosis, but not for lymphoma yet, probably because there are usually too many immunostained sections in a single case. Whole slide imaging (WSI), the scanning of conventional glass slides as digital files, has been increasingly employed by pathologists for assisting diagnosis, education, and research purposes. There is only one published report investigating the concordance rate between digital pathology and conventional microscopic histopathology and the researchers found that WSI was a reliable technology for lymphoma diagnosis [10]. Considering the uniqueness of PI-FL, thorough clinical, laboratory, endoscopic and radiologic workups to differentiate PI-FL from systemic nodal FL with secondary gastrointestinal (GI) tract involvement have been suggested [16]
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