We have now realised the importance of application of FCM in routine cytopathological diagnosis, which is now being set up in our laboratory. Oncologist. No genetic abnormality was detected by FISH. An algorithmic approach based on morphology and immunohistochemistry is the key to making an accurate diagnosis of haematopoietic and lymphoid tumours in effusion. For T‐acute lymphoblastic leukaemia/lymphoma (T‐ALL/LBL), we used a panel of T‐cell evolution, including CD2, CD7, CD5, CD1a, C34, CD4 and CD8, as it is hypothesised that the neoplastic cells are frozen at a certain stage of normal thymocyte maturation.4. They consisted of small to medium sized monotonous lymphoid cells with round to convoluted nuclei of dispersed chromatin as previously reported in our paper.5 They were T‐cell predominant, demonstrating strong TDT and CD99 expression (Table 3). Knittel G, Liedgens P, Korovkina D, Seeger JM, Al-Baldawi Y, Al-Maarri M, Fritz C, Vlantis K, Bezhanova S, Scheel AH, Wolz OO, Reimann M, Möller P, López C, Schlesner M, Lohneis P, Weber AN, Trümper L; German International Cancer Genome Consortium Molecular Mechanisms in Malignant Lymphoma by Sequencing Project Consortium, Staudt LM, Ortmann M, Pasparakis M, Siebert R, Schmitt CA, Klatt AR, Wunderlich FT, Schäfer SC, Persigehl T, Montesinos-Rongen M, Odenthal M, Büttner R, Frenzel LP, Kashkar H, Reinhardt HC. Malignancy in body effusion is generally associated with the advanced stage of the disease; we would have expected to encounter DHLs/THLs or DE. google_ad_client = "pub-8451019964492775"; The other case was an elderly lady having ascites as the first clinical presentation and a suspicion of a gynaecological tumour. Flow cytometry has the advantage over immunohistochemistry of being faster and better at simultaneously identifying coexpression of multiple markers on multiple cell populations. Mitosis can be frequently observed (arrowhead), but there was no obvious necrosis. Lymphoma 3rd most common cancer in children Incidence is 15 per million children Two broad categories 1- Hodgkin disease 2- Non- Hodgkin disease 4. JCSO 2017;15(1):43-48. This official classification is currently being updated3 and is expected to be published in full in 2017, at which time it is anticipated to include definitions for more than 70 distinct neoplasms. Lymphoma of T‐cell origin was first diagnosed in ascites and later confirmed by pelvic tumour resection as PTCL, NOS after other specific entities were excluded. Am J Clin Pathol 2011;136:183-94. Two cases were T‐ALL/LBL diagnosed in pleural effusion as the first clinical presentation. NIH HLs are comparatively rare, less heterogeneous, uniformly of B-cell origin and, in the case of classical Hodgkin lymphoma, highly curable.1,2 It is beyond the scope of this manuscript to outline the features of each of the >70 specific entities, but the reader is referred elsewhere for more detail and encouraged to become familiarized with the complexity, challenges, and beauty of lymphoma diagnosis.2,3. Pan Z, Hu S, Li M, Zhou Y, Kim YS, Reddy V. Vega F, Chang CC, Medeiros LJ, Udden MM, Cho-Vega JH, Lau CC. The role of IHC in routine clinical practice to detect occult lymphoma in the BM and its effect on patient survival is largely unknown. If the infiltrate is composed of a homogeneous expansion of lymphoid cells that disrupts or replaces the normal lymphoid architecture, a lymphoma will be suspected or diagnosed. The fourth edition of the World Health Organization (WHO) Classification of Tumours of Haematopoietic and Lymphoid tissues, published in 2008, is the official and most current guideline used for diagnosis of lymphoid neoplasms.2 The WHO scheme classifies lymphomas according to the type of cell from which they are derived (mature and immature B cells, T cells, or natural killer (NK) cells, findings determined by their morphology and immunophenotype) and their clinical, cytogenetic, and/or molecular features. If deemed suitable for accurate diagnosis, a search for signs of preservation or disruption of the organ that was biopsied will follow. Clipboard, Search History, and several other advanced features are temporarily unavailable. The immunophenotype is the combination of proteins/markers (eg, CD20, CD3, TdT) expressed by cells. Ahn JS, Okal R, Vos JA, Smolkin M, Kanate AS, Rosado FG. B-cell lymphomas, in particular have variable and distinctive histologic features: as a diffuse infiltrate of large mature lymphoid cells (eg, diffuse large B-cell lymphoma), an expansion of immature lymphoid cells (lymphoblastic lymphoma), and a nodular infiltrate of small, intermediate and/or mature large B cells (eg, follicular lymphoma). Some lymphoma cells may mimic RS cells in a background of discohesive monotypic or polymorphic background, such as anaplastic large cell lymphoma (ALCL), peripheral T‐cell lymphoma (PTCL) or polymorphic variant of mantle cell lymphomas (MCL). This study aimed to assess the clinical use of routine IHC analysis in staging bone marrows in DLBCL, including its effect on outcome factors … The entities are defined based on morphology, immunohistochemistry (on some occasions in situ hybridization), cytogenetics/fluorescent in situ hybridization (FIS… Appl Immunohistochem Mol Morphol 2010;18:199-205. Teenager with a Primary Renal Lymphoma: A Case Report. Indeed, it is important for the hematologist/oncologist and/or surgeon and/or interventional radiologist to converse with the hematopathologist prior to and even during some procedures to ensure the correct processing of the specimen. Multiple morphological, phenotypical and molecular genotypical data are assessed in order to categorise lymphomas into germinal centre (GC) and extracentric (EC) subgroups. An algorithmic approach to diagnose haematolymphoid neoplasms in serosal effusion. Monotypic light chain expression was observed for Kappa (D, ×200), not for Lambda (not shown). Twenty‐eight of them had IHC confirmation, and cytogenetic studies were performed in 22 of them. PEL and PBL have morphological overlapping, and both express markers of plasma cell origin.8 HHV8 immunopositivity plays a key role in differentiating PEL from PBL, as HHV8 positivity is often detected in PEL, but not in PBL.11 Plasmablastic PCM and PBL can have virtually identical immunophenotypic profiles. Plasmablastic lymphoma (PBL) is a distinctly rare neoplasm believed to arise from post-germinal center, terminally differentiated, activated B cells before transformation to plasma cells; and predominantly affecting human immunodeficiency virus (HIV) infected or immunodeficient males. These included two cases of MCL, which were diagnosed by strong expression of Cyclin D1 and CD20, and were further confirmed by CCND1/IGH alteration. The hematopathologist should evaluate factors such as age, gender, location of the tumor, symptomatology, medications, serology, and prior history of malignancy, immunosuppression or immunodeficiency in every case. She was later found to have a right upper abdominal mass 15 cm in diameter in the mesentery of the small intestine and a pelvic mass up to 10 cm in diameter affecting the uterus, left ovary and bilateral round ligament. It fulfilled the criteria of pleomorphic variant of MCL.2 The third one was an SLL with clumped chromatin and small nucleoli demonstrating strong immunopositivity of CD5 and CD23. Despite the general approach as described above, one should also be wary of overlapping in cell size, morphological characteristics or even IHC phenotypes. Learn more. Diagnosis of Hodgkin Lymphoma from Cell Block: A Reliable and Helpful Tool in “Selected” Diagnostic Practice. 1 Da Hua Road, Dong Dan, Beijing, China, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Dongcheng District, Beijing, China. This review aims to interrelate the major lymphoma types in the current World Health Organization (WHO) classification to construct a framework for understanding and diagnostic application. An algorithmic approach combining morphology, immunophenotyping and genomics was applied on smears and cell blocks in three steps as follows (Figure 1). Plasma cell neoplasms are usually non-reactive. A supernatant was decanted and cell aggregates were collected, wrapped in filter paper, stored in a cassette and immediately fixed in 10% neutral buffered formalin to prepare a cell block. Multinucleated large cells were observed, with the occasional plasmablastic feature of prominent nucleoli as shown in one case, which also had 1q21 amplification (Figure 3). It included 7 DLBCL, two plasmablastic or anaplastic PCM, one PBL, one PTCL NOS, one extranodal NK/T‐cell lymphoma, nasal type and two T‐ALL/LBL. Precision in lymphoma diagnosis requires expertise and infrastructure. WHO classification of tumours of haematopoietic and lymphoid tissues. Plasmablastic lymphomas with light chain restriction – Plasmablastic extramedullary plasmacytomas? The expression pattern of the basic panel of CD3, CD20 and Ki‐67 gives clue of the cell origin and leads to further application of IHC panels for specific diagnosis as shown here. ALCL and PBL may not express any B‐ or T‐cell lineage antigens or predominance, but all in our collection had a high Ki‐67 index of 90% as a clue to their neoplastic nature. 2009;41(4):305-26. doi: 10.1080/00313020902884501. FCM has great advantage over routine morphology in diagnosing B‐cell lymphoma with light chain restriction, especially for low grade lymphoma, which has mild atypia to be recognised by morphology and IHC.21 However, diagnostic pitfalls still remain with FCM, such as large cell lymphoma of B‐cell linage which generally has fragile cytoplasm with a subsequent artificial loss of surface antigen, and plasma cell neoplasms may often lack surface light chain expression. The latter always corresponds to small or intermediate cell with mild morphological atypia. doi: https://doi.org/10.12788/jcso.0328. Single translocation of MYC, BCL2 or BCL6 was detected in five out of 10 effusions. Plasmacytoid cells are normally intermediate in size with abundant eosinophilic cytoplasm and eccentric clock‐faced nuclei. World Health Organization Classification of Tumours. Therefore, morphological recognition of lymphoid origin remains the basic task for cytopathologists in developing countries and worldwide, especially in body effusion without previous history of haematolymphoid neoplasms. USA.gov. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. An individual red dot was detected in 19% of hallmark cells, indicating, I have read and accept the Wiley Online Library Terms and Conditions of Use, Serous effusions in malignant lymphomas: a review, WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Proposals for the immunological classification of acute leukemias. There is no prevalent genetic abnormality in T‐ALL/LBL despite a range of genetic abnormalities reported, including 6q or P16 deletion.2 Neither 6q nor P16 deletion was detected in our cases of T‐ALL/LBL.