LYMPHOGLANDULAR BODIES

Lymphoglandular bodies (LGBs) are fragments of cytoplasm that are well-organized from different types of cells in lymphoid tissue. These various types of lymphatic tissue or lympho-glandular tissue include lymphnodes, tonsils, thymus, spleen and ectopic lympho-glandular tissue.[1,2]

They are round, pale, basophilic fragments that have smooth borders or projections in Giemsa stained cytologic sections. Their diameter varies between 2 and 7 μm.[1,2]

They were first identified as hyaline bodies by Downey and Weidenreich and Downey. These structures were named as “lymphoglandular bodies” (LGBs) by Soderstrom in 1966 and he regarded them to be specific for lymphoid tissue and lymphoid malignancies.[2]

They have been called by various other names like lymphoid globules, Soderstrom bodies, cytoplasmic fragments and lymphocytoid bodies.[3]

They are especially conspicuous in imprints and smears from needle biopsy. They are best appreciated in a Romanowsky-type stain, especially in Giemsa stains as round pale blue bodies with lacy internal structure measuring upto the size of a red blood cell.[4] They are distinguished from platelets by their pale, lightly basophilic color with smooth borders, occasional blebs and lack of granulation.[5]

They permit distinction of lymphomas from malignant tumors of other origin and recognition of ectopic lympho-glandular metaplasia. They occur more abundantly in smears of benign and malignant lymphoid disorders than in nonlymphoid round cell neoplasms. These cytoplasmic fragments are most numerous in B-cell lesions, but also occur in T-cell lesions and neoplasms of myeloid lineage. They are helpful in distinguishing lymphomas from other small round cell tumors like neuroblastoma, Ewing's sarcoma, retinoblastoma, Wilms tumor and embryonal rhabdomyosarcoma.[1,2] LGBs are also seen in some nonlymphoid malignancies namely small cell carcinoma of lungs, non-small cell carcinoma of lungs, ganglioneuroblastoma, melanoma, seminoma and undifferentiated sarcoma.[3,6]

LGBs are also seen in tissue sections mainly in efferent sinuses and in some areas of solid lympho-glandular parenchyma and should not be considered as artifacts. According to Murakami et al., LGBs are useful even in hematoxylin and eosin (H and E) stained histologic sections for differentiating malignant lymphomas from malignant nonlymphoid tumors, but their frequency is less as compared to that seen in cytology specimens.[3] Abundant LGBs, defined as >20 LGBs per high power field, are considered characteristic of lymphoid malignancies.[6] According to the study by Murakami et al., undifferentiated carcinoma, seminoma and multiple myeloma contain relatively abundant LGBs even in H and E-stained histologic sections.[3]

Thus detection of more than 20 lymphoglandular bodies per high power field even in H and E stained sections favors the diagnosis of hematolymphoid malignancies mainly lymphomas. Also, detection of loads of LGBs in H and E stained sections point towards a poorly differentiated carcinoma/sarcoma.

The presence of LGBs in the H and E stained histological sections in a case of multiple myeloma has been presented in this manuscript. A 55-year-old female patient presented with swelling in the right anterior maxillary region in relation to 11. The lesion was excised in toto and the histopathological examination showed sheets of noncohesive cells with eosinophilic cytoplasm and eccentrically placed nuclei representing plasma cell. Along with these cells, abundant round small basophilic to amphophilic bodies were seen dispersed in the connective tissue. Low-power view and the inset showing high power view of the lesion along with hand-drawn illustration of the same is presented in Figure 1. The H&E images of the lesion is presented in Figure 2.

Figure 1.

(a) Photomicrograph of the multiple myeloma case showingdysplastic plasma cells with eccentrically placed nuclei, lymphocytes, small blood capillaries and areas of fi brosis. Numerous round basophilic to amphophilic LBDs are seen scattered between these cells (H&E stain, ×100). Inset: High power view of the same (H&E stain, ×400). (b) Hand drawn illustration of the same

Figure 2.

(a and b) Photomicrograph of a case of multiple myeloma displaying dysplastic plasma cells with blood capillaries, areas of fi brosis and hyalinization. Admixed with the plasma cells are numerous pale basophilic to amphophilic round bodies which are homogenous cytoplasmic fragments or lymphoglandular bodies (LGBs) [hematoxylin and eosin (H&E) stain ×100]

Histopathological significance of LGBs:

• LGBs are seen in high grade malignancies

• Presence of LGBs is suggestive of a lympho-proliferative lesion or hematolymphoid malignancy

• Presence of more than 20 LGBs per high power field is strongly suggestive of lymphoid malignancies.