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The diagnosis of lymphoma involves an integrated process using clinical information, histology, immunophenotyping, cytogenetics, and molecular studies. A tissue sample suspected of lymphoma is tested with microscopy, immunohistochemistry, flow cytometry, cytogenetic analysis, fluorescence in situ hybridization, and molecular genetic analysis. The morphological analysis of lymph nodes is the cornerstone for diagnosis, involving examination of cell size, patterns, chromatin, and more under low and high power microscopy regardless of additional tests. Cell size can guide the grade of many lymphomas.

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? The diagnosis of lymphoma is an integrated process and encompasses: ? 1. Clinical information ? 2. H and E morphology ? 3. Immunophenotyping ? 4. Cytogenetics ? 5. Molecular studies.
? Tissue sample sent to the laboratory for a suspected case of lymphoma can be sent for the following tests: C Microscopy on appropriately fixed and stained tissue samples. C IHC or for flowcytometry. C Cytogenetic analysis by Giemsa banding. C FISH on cell suspensions, films, imprints or paraffin sections. C Molecular genetic analysis by RT-PCR or gene sequencing.
Morphological Analysis of Lymph Nodes:
? Well fixed LN tissue cut at 3 microns and stained with H and E. C Cornerstone for the diagnosis of lymphoma C Regardless of number of advanced anicillary tests available at hand.
Points to Note Under Low Power: ? Architecture pattern of the lymph node: C Diffuse C Nodular/follicular C Mantle zone C Marginal C Interfollicular C Sinusoidal C Heterogenous
Points to Note Under High Power ? Cell size ? Monotonous/heterogenous ? Chromatin pattern ? Nucleoli ? Nuclear shape ? Cytoplasm
Cell Size: ? Good guide to the grade of many types of NHL. ? Poor fixation / Thick section: cell assumes shrunken apppearence. ? Excess intense nuclear staining: masks subtle nuclear details. ? Hence most impportant: adequate tissue fixxation.
Assessing the Size of Lymphoid Cells: ? Large lymphoid cells: nuclei larger than that of a histiocyte nucleus. ? Medium sized cells: comparable/slightly smaller than that of a histiocyte nucleus. ? Small lymphoid cells: nuclei much smaller than that of a ? histiocyte.
Lymphoid Neoplasm with Small Cells: ? Follicular lymphoma grade 1-2 ? Mantle cell lymphoma ? Marginal zone lymphoma ? CLL/SLL ? LPL
Lymphoid Neoplasm with Medium-sized cells: ? Burkitt¨s lymphoma. ? Lymphoblastic lymphoma ? DLBCL (rare) ? PTCL-NOS (variants) ? NMZL
Lymphoid Neoplasms with Large Cells: ? DLBCL ? PTCL ? ALCL ? Follicular lymphoma grade 3B

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New PPT Presentation.ppt

  • 1. ? The diagnosis of lymphoma is an integrated process and encompasses: ? 1. Clinical information ? 2. H and E morphology ? 3. Immunophenotyping ? 4. Cytogenetics ? 5. Molecular studies.
  • 2. ? Tissue sample sent to the laboratory for a suspected case of lymphoma can be sent for the following tests: C Microscopy on appropriately fixed and stained tissue samples. C IHC or for flowcytometry. C Cytogenetic analysis by Giemsa banding. C FISH on cell suspensions, films, imprints or paraffin sections. C Molecular genetic analysis by RT-PCR or gene sequencing.
  • 4. ? Well fixed LN tissue cut at 3 microns and stained with H and E. C Cornerstone for the diagnosis of lymphoma C Regardless of number of advanced anicillary tests available at hand.
  • 5. Points to Note Under Low Power: ? Architecture pattern of the lymph node: C Diffuse C Nodular/follicular C Mantle zone C Marginal C Interfollicular C Sinusoidal C Heterogenous
  • 6. Points to Note Under High Power ? Cell size ? Monotonous/heterogenous ? Chromatin pattern ? Nucleoli ? Nuclear shape ? Cytoplasm
  • 7. Cell Size: ? Good guide to the grade of many types of NHL. ? Poor fixation / Thick section: cell assumes shrunken apppearence. ? Excess intense nuclear staining: masks subtle nuclear details. ? Hence most impportant: adequate tissue fixxation.
  • 8. Assessing the Size of Lymphoid Cells: ? Large lymphoid cells: nuclei larger than that of a histiocyte nucleus. ? Medium sized cells: comparable/slightly smaller than that of a histiocyte nucleus. ? Small lymphoid cells: nuclei much smaller than that of a ? histiocyte.
  • 9. Lymphoid Neoplasm with Small Cells: ? Follicular lymphoma grade 1-2 ? Mantle cell lymphoma ? Marginal zone lymphoma ? CLL/SLL ? LPL
  • 10. Lymphoid Neoplasm with Medium-sized cells: ? Burkitt¨s lymphoma. ? Lymphoblastic lymphoma ? DLBCL (rare) ? PTCL-NOS (variants) ? NMZL
  • 11. Lymphoid Neoplasms with Large Cells: ? DLBCL ? PTCL ? ALCL ? Follicular lymphoma grade 3B