Lymphoma: Difference between revisions
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*[[Lymph node]] | *[[Lymph node]] | ||
*[[Tumor]] | *[[Tumor]] | ||
*[[Tonsil]] | |||
==Gross processing== | ==Gross processing== | ||
[[File:Touch prep on a lymph node.jpg|thumb|220px|Making a "touch prep".]] | |||
Whenever there is a suspicion of lymphoma, perform the following before putting the specimen in formalin: | Whenever there is a suspicion of lymphoma, perform the following before putting the specimen in formalin: | ||
*Take a small sample for flow cytometry. | *Take a small sample for '''flow cytometry'''. | ||
*Make a touch prep: press a glass slide against the cut surface of the lymph node, apply cytologic fixative solution immediately and stain with H&E. | *Make a "'''touch prep'''": lightly press a glass slide against the cut surface of the lymph node, lift the glass slide, apply cytologic fixative solution immediately (to avoid drying artifacts) and stain with H&E. | ||
*Submit sections for histologic processing | *Submit sections for histologic processing with '''H&E staining'''. | ||
Otherwise, as per location or specimen type, such as '''[[lymph node]]''' or '''[[tumor]]'''. | Otherwise, as per location or specimen type, such as '''[[lymph node]]''' or '''[[tumor]]'''. | ||
==Microscopic examination== | ==Microscopic examination== | ||
On the histologically processed slides, first compare the lymphoid cells with endothelial cells, and designate the lymphoid cells as '''large''' if | On the histologically processed slides, first compare the lymphoid cells with endothelial cells, and designate the lymphoid cells as '''large''' if a significant amount are larger than the transverse diameter of endothelial cells, otherwise as medium to small. | ||
===Small to medium sized lymphocytes=== | |||
In addition, you generally need to order immunohistochemistry, consisting of: | |||
*'''CD3''', to raise the possibility of a T cell lymphoma if it stains a vast majority of cells. | *'''CD3''', to raise the possibility of a T cell lymphoma if it stains a vast majority of cells. | ||
*'''CD20''', to raise the possibility of a B cell lymphoma if predominant. | *'''CD20''', to raise the possibility of a B cell lymphoma if predominant. | ||
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*{{Moderate-begin}}'''CD5''', mainly to suggest chronic lymphocytic leukemia or mantle zone lymphoma if it positive in the CD20 positive cells.{{Moderate-end}} | *{{Moderate-begin}}'''CD5''', mainly to suggest chronic lymphocytic leukemia or mantle zone lymphoma if it positive in the CD20 positive cells.{{Moderate-end}} | ||
*{{Moderate-begin}}'''CD10''', essentially confirming a [[follicular lymphoma]] if stains the BCL2 positive cells of secondary follicles.{{Moderate-end}} | *{{Moderate-begin}}'''CD10''', essentially confirming a [[follicular lymphoma]] if stains the BCL2 positive cells of secondary follicles.{{Moderate-end}} | ||
*{{Moderate-begin}}'''Cyclin D''', suggesting a [[mantle cell lymphoma]] if it is present in CD20 and CD5 positive cells. | *{{Moderate-begin}}'''CD23''', suggesting a small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL) if it is present in CD20 and CD5 positive cells.{{Moderate-end}} | ||
*{{Moderate-begin}}'''Cyclin D''', suggesting a [[mantle cell lymphoma]] if it is present in CD20 and CD5 positive cells.{{Moderate-end}} | |||
If CD20 positive cells (B cells) are predominant, attempt to fit their pattern into one of the following:<ref name="Attanoos2018">{{cite book|last1=Attanoos|first1=Richard|title=Practical Pathology of Serous Membranes|chapter=Lymphoid Malignancies of the Pleura and Peritoneum|year=2018|pages=203–208|doi=10.1017/9781316402009.016|isbn=9781316402009}}</ref> | |||
{|class="wikitable" style="text-align: center" | {|class="wikitable" style="text-align: center" | ||
! | ! | ||
! [[Follicular lymphoma]] | ! [[Follicular lymphoma]] | ||
! | ! Marginal zone B-cell lymphoma (MZL) or mucosa-associated lymphatic tissue (MALT) lymphoma | ||
! | ! Small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL) | ||
! | ! Mantle cell lymphoma (MCL) | ||
|- | |- | ||
! CD5 | |||
|style="background: lightpink"| - | |style="background: lightpink"| - | ||
|style="background: lightpink"| - | |style="background: lightpink"| - | ||
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|style="background: lightgreen"| + | |style="background: lightgreen"| + | ||
|- | |- | ||
! CD10 | |||
|style="background: lightgreen"| + | |style="background: lightgreen"| + | ||
|style="background: lightpink"| - | |style="background: lightpink"| - | ||
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|style="background: lightpink"| - | |style="background: lightpink"| - | ||
|- | |- | ||
! CD23 | |||
|style="background: lightpink"| - | |style="background: lightpink"| - | ||
|style="background: lightpink"| - | |style="background: lightpink"| - | ||
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|style="background: lightpink"| - | |style="background: lightpink"| - | ||
|- | |- | ||
! Cyclin D1 | |||
|style="background: lightpink"| - | |style="background: lightpink"| - | ||
|style="background: lightpink"| - | |style="background: lightpink"| - | ||
Latest revision as of 18:53, 13 July 2023
Author:
Mikael Häggström [note 1]
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Presentations
Mainly:
Gross processing
Whenever there is a suspicion of lymphoma, perform the following before putting the specimen in formalin:
- Take a small sample for flow cytometry.
- Make a "touch prep": lightly press a glass slide against the cut surface of the lymph node, lift the glass slide, apply cytologic fixative solution immediately (to avoid drying artifacts) and stain with H&E.
- Submit sections for histologic processing with H&E staining.
Otherwise, as per location or specimen type, such as lymph node or tumor.
Microscopic examination
On the histologically processed slides, first compare the lymphoid cells with endothelial cells, and designate the lymphoid cells as large if a significant amount are larger than the transverse diameter of endothelial cells, otherwise as medium to small.
Small to medium sized lymphocytes
In addition, you generally need to order immunohistochemistry, consisting of:
- CD3, to raise the possibility of a T cell lymphoma if it stains a vast majority of cells.
- CD20, to raise the possibility of a B cell lymphoma if predominant.
- BCL2, to suggest a follicular lymphoma if it stains B cells in secondary follicles.[1]
- (CD5, mainly to suggest chronic lymphocytic leukemia or mantle zone lymphoma if it positive in the CD20 positive cells.)
- (CD10, essentially confirming a follicular lymphoma if stains the BCL2 positive cells of secondary follicles.)
- (CD23, suggesting a small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL) if it is present in CD20 and CD5 positive cells.)
- (Cyclin D, suggesting a mantle cell lymphoma if it is present in CD20 and CD5 positive cells.)
If CD20 positive cells (B cells) are predominant, attempt to fit their pattern into one of the following:[2]
| Follicular lymphoma | Marginal zone B-cell lymphoma (MZL) or mucosa-associated lymphatic tissue (MALT) lymphoma | Small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL) | Mantle cell lymphoma (MCL) | |
|---|---|---|---|---|
| CD5 | - | - | + | + |
| CD10 | + | - | - | - |
| CD23 | - | - | + | - |
| Cyclin D1 | - | - | - | + |
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ Error on call to Template:cite web: Parameters url and title must be specifiedProPath Staff. . Retrieved on 2022-01-09.
- ↑ Attanoos, Richard (2018). "Lymphoid Malignancies of the Pleura and Peritoneum". Practical Pathology of Serous Membranes . pp. 203–208. doi:. ISBN 9781316402009.
Image sources