Lymphomas, B-Cell - B-Cell Lymphomas

Key Points

Double- and triple-hit lymphomas

B-cell lymphomas with two recurrent chromosomal breakpoint aberrations are referred to in the WHO classification as double-hit lymphomas and usually involve the MYC oncogene in association with the BCL2 translocation, although other translocation associations with MYC occur (eg, BCL6). If three translocations (eg, MYC, BCL2 and BCL6) are present, these lymphomas are referred to as triple-hit lymphomas; however they are rare. Histologically aggressive lymphomas in adults with coexpression of CD10, bcl6, and bcl2, with a high Ki67 proliferation index or those that have unusual clinical features (such as peripheral blood involvement) may be worked up to exclude a diagnosis of double- or triple-hit lymphomas. These lymphomas are often placed in the category of B-cell lymphoma unclassifiable with features intermediate between DLBCL (diffuse large B-cell lymphoma) and Burkitt lymphoma (WHO 2008). It is important to identify these lymphomas as they tend to manifest aggressive behavior and respond poorly to traditional chemotherapy.

Breakpoints Used to Identify Double- or Triple-Hit Lymphomas

Oncogene

Break apart MYC

BCL2

BCL6

Locus8q2418q213q27
BiologyAccelerator of cell proliferationApoptosis inhibitorTranscription modifier
Cytogenetics  (translocations)Any MYC translocationBCL2/IGH t(14;18)(q32;21)
  • BCL6 almost always has a non-IG translocation partner– BCL6 (3q27)
  • Uncommon partner –BCL6/IGH [t(3;14)(q27;q32)]
Specific lymphomas associated with translocation
  • Burkitt lymphoma
  • Diffuse large B-cell lymphoma (DLBCL)
  • Aggressive B-cell lymphoma not otherwise specified (NOS)
  • Follicular lymphoma
  • DLBCL
  • Follicular lymphoma
  • DLBCL
  • High grade lymphomas (rare)
Other malignancies associated with translocation
  • B-cell ALL (rare)
  • B-cell ALL (rare)
 

DIAGNOSTIC TESTING

ARUP Tests

  • Individual probes
    • Chromosome FISH, Interphase 2002298 – order probes separately 
  • Panel
    • Lymphoma (Aggressive) Panel by FISH 2002650 – probes include IGH/BCL2, BCL6, and MYC
  • For histologically aggressive B-cell lymphomas with either Burkitt-like or diffuse large cell morphologies in adults demonstrating a CD20+, CD10+ phenotype with high proliferative index OR CD20+ neoplasms with morphologic features indeterminate between DLBCL and Burkitt lymphoma, it is reasonable to test for MYC, BCL2, BCL6 rearrangements using FISH
    • IGH-BCL2 Fusion, t(14;18) by FISH 2001536
    • IGH-MYC t(8;14) by FISH 2001538
    • MYC (8q24) Gene  Rearrangement by FISH 2002345
    • BCL6 (3q27) Gene Rearrangement by FISH 2010107
References:  Aukema SM, 2011; Johnson NA et al, 2009; Salaverria I et al, 2011; Savage et al, 2009; WHO 2008.

Diagnosis

Indications for Testing

  • Most common presentation for lymphoma is adenopathy with or without fever, also night sweats and fatigue

Laboratory Testing

  • See the Lymphoma Phenotyping algorithm for specific test ordering recommendations
  • Initial testing involves the following
    • CBC with peripheral smear
    • Liver chemistries
    • Lactate dehydrogenase (LD)
    • Serum uric acid, potassium, calcium, phosphorus
    • HIV for at-risk patients
  • Immunophenotyping to identify the lymphoid proliferation malignancy and to categorize lymphoma type
    • May also be performed on bone marrow
  • Testing prior to treatment with immunosuppressive therapies
    • HBV – surface antigen and core antibodies for all patients considering rituximab
      • Also include HBV e antigen testing for patients with relevant risk factors
    • HCV – for high-risk patients considering rituximab
    • CMV – PCR quantitative

Histology

  • Follow-up testing with bone marrow biopsy
    • ≥2 cm specimen length
    • Classified as involved or not
    • Flow cytometry testing and immunoperoxidase staining of tissue for specific B-cell antigens or clonality with kappa and lambda light-chain staining
  • B-cell clonality studies
    • Locate clonal rearrangements of the immunoglobulin gene in B-cell malignancies
    • Provide information regarding prognosis and treatment recommendations
  • Translocation characterizations – may be helpful if tumor diagnosis is unclear using clinical, morphologic, and flow cytometric data
    • Follicular lymphoma – BCL2 t(14;18)(q32;q21)
      • FISH – recommended methodology
    • Burkitt lymphoma – MYC  t(8;14), t(2;8), t(8;22)
    • Mantle cell lymphoma – BCL1 (CCND1)  t(11;14)(q13;q32)
    • Diffuse large B-cell lymphoma (DLBCL) – BCL6 and BCL2 rearrangement testing
    • B-cell lymphoma unclassifiable with features intermediate between DLBCL (diffuse large B-cell lymphoma) and Burkitt lymphoma (WHO 2008) – refer to Key Points for double- and triple-hit lymphomas
    • ALL translocations – refer to acute lymphoblastic leukemia
    • Mucosa-associated lymphoid tissue (MALT) – molecular testing for t(11;14), t(14;18)
    • Hairy cell leukemia – BRAF V600E mutation testing
    • Other testing
      • EBV genome presence in immune suppression (eg, post transplantation) – in situ hybridization testing
      • Kappa and lambda light-chain clonality in situ hybridization
      • Other testing may be necessary to differentiate B-cell from T-cell NHL (eg, ALK by FISH)
      • BRAF V600E – present in most classic hairy cell leukemias
  • Immunohistochemistry – useful in conjunction with phenotyping for NHL cell type
    • Most commonly used stains include cyclin D1, Pax-5, Ki-67, MUM1-IRF4, HHV8, EBV, ALK-1, CD3, CD5, CD10 (CALLA), CD19, CD20, CD21 (dendritic cell), CD22, CD23, CD25, CD30 (Ki-1), CD79A, CD138 (Syndecan-1), BCL-2, kappa and lambda light chains, TRAP, and TdT
    • Other available stains – BOB-1, Bax, caspase-3, CD15, CD43, CD45, CD45RA-MT2, CD45RO, CD74, c-Myc, DBA.44, and Oct 2

Prognosis

  • International Prognostic Index scoring system
    • Based on pretreatment clinical factors of age (≤60 years); Ann Arbor tumor stage (I or II); number of extranodal sites (≤1); Eastern Cooperative Oncology Group (ECOG) performance status (0 or 1); and serum LD (≤1 times normal) – all scored as 0
    • Patients placed in 4 risk groups
    • Limited usefulness in follicular lymphoma, mantle cell lymphoma, NK lymphoma, nasatype, hepatosplenic lymphoma and enteropathy-type lymphoma
  • Follicular Lymphoma International Prognostic Index scoring system
    • 5 risk factors (scored as 1)
      • IgG <12 g/dL
      • LD >normal
      • Ann Arbor tumor stage (III or IV)
      • >4 nodal sites
      • Age >60 years
    • 0-1 risk factors – low risk (5-year survival 90%)
    • 2 risk factors – intermediate risk (5-year survival 78%)
    • 3 risk factors – high risk (5-year survival 53%)
  • All prognostic indices may change in the future as the IPI and FLIPI indices were developed before immunotherapy
  • Genetic mutations (cytogenetics)
    • Follicular lymphoma
      • Adverse prognosis associated with del 17p, trisomy 12 and abnormalities of 6p
    • Diffuse large B-cell lymphoma (DLBCL)
      • Better prognosis associated with t(14;18)
      • Adverse prognosis with MYC oncogene; BCL2 gene, p53(+)
    • Follicular and DLBCL
      • Dismal outcomes for 8q24/MYC in association with 18q21/BCL2 or 3q27/BCL6
    • Double-hit and triple-hit lymphomas
      • Tend to manifest aggressive behavior and respond poorly to traditional chemotherapy
      • Refer to Key Points for double- and triple-hit lymphomas
    • CLL
      • CD38 and ZAP-70 – mutation status correlates inversely with prognosis

Differential Diagnosis

Monitoring

  • Alemtuzumab (Campath) therapy – risk of CMV reactivation
    • PCR quantitative 2-3 weeks after start of therapy
    • Rituximab (Rituxan) therapy – high risk of hepatitis reactivation
      • HBV surface antigen and core antibody testing for all patients
        • Add HBV e antigen testing for patients with relevant risk factors
      • HCV testing for at-risk patients

Clinical Background

B-cell non-Hodgkin lymphomas (NHL) represent a heterogenous group of malignancies of the lymphoid system.

Epidemiology

  • Incidence – represents 80-85% of the cases of NHL diagnosed annually
    • >66,000 new cases of NHL diagnosed in 2008
  • Age – peaks in 60s
  • Sex – M<F (minimal)

WHO Classification of Mature B-Cell Neoplasms (2008)

  • Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)
  • B-cell prolymphocytic leukemia
  • Splenic marginal zone lymphoma (MZL)
  • Hairy cell leukemia
  • Splenic lymphoma/leukemia, unclassifiable
  • Lymphoplasmacytic lymphoma
  • Heavy chain diseases
  • Plasma cell neoplasms
  • Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT)
  • Nodal MZL
  • Follicular lymphoma
  • Primary cutaneous follicle center lymphoma
  • Mantle cell lymphoma
  • Diffuse large B-cell lymphoma (DLBCL), NOS (not otherwise specified)
  • T-cell/histiocyte-rich large B-cell lymphoma
  • Primary DLBCL of the central nervous system
  • Primary cutaneous DLBCL, leg type
  • Epstein-Barr virus (EBV)-positive DLBCL of the elderly
  • DLBCL associated with chronic inflammation
  • Lymphomatoid granulomatosis
  • Primary mediastinal (thymic) large B-cell lymphoma
  • Intravascular large B-cell lymphoma
  • ALK-positive large B-cell lymphoma
  • Plasmablastic lymphoma
  • Large B-cell lymphoma arising in HHV8-associated multicentric Castleman disease
  • Primary effusion lymphoma
  • Burkitt lymphoma
  • B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma
  • B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma

Risk Factors

Clinical Presentation of Selected Lymphoma Subtypes (based on WHO classification)

CLL/SLL
  • Incidence – 2-6/100,000; 6-7% of NHL
  • Age – median >60 years
  • Sex – M>F, 1.5-2:1
  • Symptoms – adenopathy hepatosplenomegaly; some patients present with autoimmune hemolytic anemia, fatigue, infections
  • Prognosis – good; indolent tumor
Splenic marginal zone lymphoma (MZL)
  • Incidence – rare
  • Age – >50 years
  • Sex – M:F, equal
  • Symptoms – splenomegaly, often with autoimmune thrombocytopenia
  • Prognosis – good; indolent adenopathy
Hairy cell leukemia
  • Incidence – rare; ≤2% of NHL
  • Age – median 50 years
  • Sex – M>F, 5:1
  • Symptoms – peripheral adenopathy rare; splenomegaly, fatigue, weakness, fever, bleeding, infections
  • Prognosis – good; with treatment, disease may remain silent for years
Lymphoplasmacytic lymphoma
  • Incidence – rare; 3/1,000,000
  • Age – median 65 years
  • Sex – M>F (minimal)
    • Higher risk if patient has monoclonal gammopathy of undetermined significance
  • Symptoms – fatigue, malaise, hepatosplenomegaly, adenopathy, hyperviscosity syndrome (~30%)
  • Prognosis – usually moderately good; indolent tumor
Extranodal marginal zone lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT)
  • Incidence – 8-10% of NHL; increased risk with chronic Helicobacter infection
  • Age – median 60 years
  • Sex – M<F (minimal)
  • Ethnicity – increased prevalence in northeast Italy and Middle East
  • Symptoms – related to organ location
  • Prognosis – favorable; indolent tumor
Nodal MZL (+/- monocytoid B-cells)
  • Incidence – rare
  • Age – median 60 years
  • Sex – M:F, equal
  • Symptoms – lymphadenopathy
  • Prognosis – good; can be predicted from Follicular Lymphoma International Prognostic Index
Follicular lymphoma
  • Incidence – 20-25% of NHL
  • Age – 50s-60s; rare in children
  • Sex – M<F, 1:1.7
  • Ethnicity – higher incidence in U.S. and western Europe
  • Symptoms – lymphadenopathy extranodal disease, bone marrow involvement (other sites uncommon)
  • Prognosis – reasonably good but disease tends to relapse; can be predicted from International Prognostic Index
Mantle cell lymphoma
  • Incidence – 6-10% of NHL
  • Age – median is 60 years
  • Sex – M>F, 2:1
  • Symptoms – adenopathy, splenomegaly, bone marrow involvement
  • Prognosis – poor; aggressive tumor
Diffuse large B-cell lymphoma (DLBCL)
  • Incidence – 25-31% of NHL
  • Age – median is 60 years
  • Sex – M>F (minimal)
  • Symptoms – rapidly enlarging tumor at nodal or extranodal site
  • Prognosis – poor, aggressive tumor
Primary effusion lymphoma
  • Incidence – rare; occurs in HIV patients and universally associated with HHV8
  • Age – 30s-40s
  • Sex – M>F
  • Symptoms – dyspnea, abdominal distention
  • Prognosis – poor; aggressive tumor
Burkitt lymphoma
  • Incidence – rare in U.S., endemic in Africa; significant risk with EBV
  • Age
    • Children – endemic form
    • Individuals in 30s – nonendemic form
  • Symptoms – lesions commonly found in jaw and face
  • Prognosis – poor; highly aggressive tumor

Indications for Laboratory Testing

  • Tests generally appear in the order most useful for common clinical situations
  • Click on number for test-specific information in the ARUP Laboratory Test Directory
Test Name and Number Recommended Use Limitations Follow Up
Cyclin D1, SP4 by Immunohistochemistry 2003842
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
IGH-BCL2 Fusion, t(14;18) by FISH 2001536
Method: Fluorescence in situ Hybridization

Diagnose follicular lymphoma in conjunction with clinical, morphologic, and flow cytometric data

Most sensitive method to detect IGH-BCL2 fusion in FFPE tissue specimens

Not validated for tissue fixed in alcohol-based or nonformalin fixatives

Negative result does not exclude possibility of translocations involving other partners nor rule out follicular lymphoma

 
IGH-MYC Fusion t(8;14) by FISH 2001538
Method: Fluorescence in situ Hybridization

Diagnose Burkitt lymphoma (BL) or diffuse large B-cell lymphoma (DLBCL) with features intermediate between BL and DLBCL in conjunction with clinical, morphologic, and flow cytometric data

Negative result does not rule out BL or B-cell lymphomas with features intermediate between BL and DLBCL involving MYC with other translocation partners such as t(2;8) or t(8;22)

IGH-MYC t(8;14) by FISH has not been validated for tissue fixed in alcohol-based or nonformalin fixatives

MYC is not specific for BL or B-cell lymphomas with features intermediate between BL and DLBCL

 
MYC (8q24) Gene Rearrangement by FISH 2002345
Method: Fluorescence in situ Hybridization

Diagnose BL or DLBCL with features intermediate between BL and DLBCL in conjunction with clinical, morphologic, and flow cytometric data

Detects all MYC rearrangements including t(8;14), t(2;8), and t(8;22) rearrangements

Negative result does not rule out BL or B-cell lymphomas with features intermediate between BL and DLBCL

MYC (8q24) gene rearrangement by FISH has not been validated for tissue fixed in alcohol-based or nonformalin fixatives

MYC is not specific for BL or B-cell lymphomas with features intermediate between BL and DLBCL

 
BCL6 (3q27) Gene Rearrangement by FISH 2010107
Method: Fluorescence in situ Hybridization

Diagnose BL or DLBCL with features intermediate between BL and DLBCL in conjunction with clinical, morphologic, and flow cytometric data

Sensitive method to detect MYC rearrangement in FFPE

   
Lymphoma (Aggressive) Panel by FISH 2002650
Method: Fluorescence in situ Hybridization

Use to identify double- or triple-hit lymphomas in fresh (unfixed) tissue samples

Bone marrow; other specimens may be acceptable

FFPE and frozen specimens unacceptable

Probes in this panel include MYC, BCL2, IGH, BCL6

Interpretation of results requires correlation with morphology and immunophenotype

Panel detects only the specific aberrations targeted by the probes

MYC and/or BCL2 overexpression can be due to other mechanisms not detected by this test

Chromosome alterations outside the regions complementary to these FISH probes will not be detected

 
Leukemia/Lymphoma Phenotyping by Flow Cytometry 2008003
Method: Flow Cytometry

Aid in evaluation of hematopoietic neoplasms (ie, leukemia, lymphoma)

Monitor therapy in patients with established diagnosis of hematopoietic neoplasms

Specimens include peripheral blood, bone marrow, and tissue

Markers selected based on clinical history, previous flow studies, and pathologist interpretation

Available markers

B cell: CD10, CD19, CD20, CD22, CD23, CD103, kappa, lambda, FMC7, cytoplasmic kappa, cytoplasmic lambda

T cell: CD1, CD2, CD3, CD4, CD5, CD7, CD8, TCR alpha-beta, TCR gamma-delta, cytoplasmic CD3

Myelo/Mono: CD11b, CD13, CD14 (Mo2), CD14 (MY4), CD15, CD33, CD64, CD117, myeloperoxidase

Misc: CD11c, CD16, CD25, CD30, CD34, CD38, CD41, CD42b, CD45, CD56, CD57, CD61, HLA-DR, glycophorin, TdT, bcl-2, ALK-1, CD123, CD138, CD200, CD26, CD45

   
Chromosome FISH, Interphase 2002298
Method: Fluorescence in situ Hybridization

Detect translocation found in some NHL 

Fresh tissue sample required

Indicate names of probes needed for testing
ARUP Oncology FISH Probes menu

   
B-Cell Clonality Screening (IgH and IgK) by PCR 2006193
Method: Polymerase Chain Reaction/Capillary Electrophoresis

Aids in the diagnosis and follow up of lymphoproliferative disorders

Aids in differentiating malignant from reactive lymphoid proliferations

Clinical sensitivity – >95% for mature B-cell non-Hodgkin lymphomas

Analytical sensitivity – clone must represent at least 1-5% of population examined

Analytic specificity – >98%

False-negative results may result from specimen inadequacy and mutations affecting primer sites

Detection of clonally rearranged IgH is seen in a subset of T-cell neoplasms (ie, a positive result in the test should not be used to differentiate between T- and B-cell neoplasms)

 
BRAF V600E Mutation Detection in Hairy Cell Leukemia by Real-Time PCR, Quantitative 2007132
Method: Polymerase Chain Reaction

Confirm diagnosis of hairy cell leukemia (HCL)

Monitor tumor burden in patients with HCL

   
ZAP-70 Analysis by Flow Cytometry 0092392
Method: Flow Cytometry

Determine CLL prognosis

Results should always be correlated with morphologic and clinical information

   
IGHV Mutation Analysis by Sequencing 0040227
Method: Polymerase Chain Reaction/Sequencing

Determine CLL prognosis

Results should always be correlated with morphologic and clinical information

Assay designed for individuals with a confirmed diagnosis of CLL; for these individuals testing will include sequencing; all other diagnoses will terminate after amplification and will not have the sequencing component

 
Chromosome FISH, CLL Panel 2002295
Method: Fluorescence in situ Hybridization

Determine CLL prognosis; specific genomic abnormalities tested include ATM deletion, 13q deletion, trisomy 12, TP53 deletion

   
IGH-CCND1 Fusion, t(11;14) by FISH 2007226
Method: Fluorescence in situ Hybridization

Aids in diagnosis of MCL if cyclin testing is noninformative

Fixed tissue sample required

Analytic sensitivity – 20%

Not validated for tissue fixed in alcohol-based or nonformalin fixatives or decalcified tissue

Negative result does not exclude the possibility of translocations involving other partners

This mutation is not specific for MCL; results need to be analyzed in conjunction with morphology, immunohistochemistry, and immunophenotyping results

 
IGH-CCND1 (BCL-1/JH) Translocation, t(11;14) by PCR 0055557
Method: Polymerase Chain Reaction

Aids in diagnosis of MCL if cyclin testing is noninformative

Blood, bone marrow, fresh frozen tissue, and FFPE tissue specimens are acceptable

Analytic sensitivity – 1 in 105

Not validated for tissue fixed in alcohol-based or nonformalin fixatives or decalcified tissue

Negative result does not exclude the possibility of translocations involving other partners

This mutation is not specific for MCL; results need to be analyzed in conjunction with morphology, immunohistochemistry, and immunophenotyping results

 
Pax-5 by Immunohistochemistry 2004082
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
Ki-67 with Interpretation by Immunohistochemistry 2007182
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
MUM1/IRF4 by Immunohistochemistry 2003975
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
Herpes Virus 8 by Immunohistochemistry 2003932
Method: Immunohistochemistry

Aid histologic diagnosis of multicentric Castleman disease, angioimmunoblastic lymphadenopathies, and Kaposi sarcoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
Anaplastic Lymphoma Kinase 1 (ALK-1) by Immunohistochemistry 2003439
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD3 by Immunohistochemistry 2003508
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD5 by Immunohistochemistry 2003514
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD10 (CALLA) by Immunohistochemistry 2003523
Method: Immunohistochemistry

Aid histologic diagnosis of lymphoblastic lymphoma, BL, follicular lymphoma, and CML

Aid differential diagnosis of small B-cell lymphomas and subtyping of lymphoblastic leukemias

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD19 by Immunohistochemistry 2005114
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell leukemia/lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD20, L26 by Immunohistochemistry 2003532
Method: Immunohistochemistry

Aid in identifying common acute lymphoblastic leukemia, pre-B ALL, CLL, prolymphocytic leukemia, hairy cell leukemia, lymphoma cell leukemia, B-cell lymphomas, including BL, Waldenstrom, and immunoblastic B-cell

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD21 (Dendritic Cell) by Immunohistochemistry 2003535
Method: Immunohistochemistry

Aid in identifying B-cell CLL, follicular lymphoma, low-grade MALT-type B-cell lymphoma, primary salivary gland and gastric lymphoma, T-cell and histiocyte-rich B-cell lymphoma, angioimmunoblastic T-cell lymphoma, nodular lymphocyte-predominant Hodgkin lymphoma, follicular dendritic sarcoma and some Reed-Sternberg cells not expressing other B- or T-cell-associated markers

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD23 by Immunohistochemistry 2003541
Method: Immunohistochemistry

Aid in differentiating small lymphocytic lymphoma (+) and mantle cell lymphoma (-)

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD25 by Immunohistochemistry 2003544
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD30 (Ki-1) by Immunohistochemistry 2003547
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD79A by Immunohistochemistry 2003800
Method: Immunohistochemistry

Aid in identifying acute leukemia of precursor B-cell type, B-cell lymphomas and some myelomas

Stained and returned to client pathologist for interpretation; consultation available if needed

   
CD138 (Syndecan-1) by Immunohistochemistry 2003812
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
BCL-2 by Immunohistochemistry 2004513
Method: Immunohistochemistry

Aids in identifying colorectal adenomas, carcinomas; distinguishes follicular lymphoma from reactive follicles

Stained and returned to client pathologist for interpretation; consultation available if needed

   
BCL-6 by Immunohistochemistry 2003457
Method: Immunohistochemistry

Aid in identifying large cell lymphomas, BL, and Hodgkin lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
Kappa Light Chains by Immunohistochemistry 2003981
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
Lambda Light Chains by Immunohistochemistry 2003984
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
Tartrate-Resistant Acid Phosphatase (TRAP) by Immunohistochemistry 2004160
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
TdT by Immunohistochemistry 2004142
Method: Immunohistochemistry

Aid histologic diagnosis of B-cell lymphoma

Stained and returned to client pathologist for interpretation; consultation available if needed

   
Additional Tests Available
 
Click the plus sign to expand the table of additional tests.
Test Name and NumberComments
CBC with Platelet Count and Automated Differential 0040003
Method: Automated Cell Count/Differential

Initial test to evaluate lymphoma

May provide prognostic information

Hepatic Function Panel 0020416
Method: Quantitative Enzymatic/Quantitative Spectrophotometry

Initial test to evaluate lymphoma

May provide prognostic information

Lactate Dehydrogenase, Serum or Plasma 0020006
Method: Quantitative Enzymatic

Initial test to evaluate lymphoma

May provide prognostic information

Uric Acid, Serum or Plasma 0020026
Method: Quantitative Spectrophotometry

Initial test to evaluate lymphoma

May provide prognostic information

IGH-BCL2 (BCL-2/JH) Translocation, t(14;18) by PCR 0055616
Method: Polymerase Chain Reaction

Diagnose follicular lymphoma

Clinical sensitivity – less than FISH

Do not use for evaluation of minimal residual disease

Blood, bone marrow, fresh tissue specimens preferred; FFPE is acceptable

B-Cell CD20 Expression 0092099
Method: Flow Cytometry
Chromosome Analysis, Bone Marrow 2002292
Method: Giemsa Band

Identify neoplastic populations in marrow

B Cell Specific Octamer Binding Protein-1 (BOB-1) by Immunohistochemistry 2003442
Method: Immunohistochemistry
Caspase-3 by Immunohistochemistry 2003496
Method: Immunohistochemistry
CD15, Leu M1 by Immunohistochemistry 2003529
Method: Immunohistochemistry
CD43, L60 (Leu 22) by Immunohistochemistry 2003568
Method: Immunohistochemistry
CD45 by Immunohistochemistry 2003574
Method: Immunohistochemistry
Hairy Cell Leukemia, DBA.44 by Immunohistochemistry 2003860
Method: Immunohistochemistry
Octamer Transcription Factor-2 (Oct 2) by Immunohistochemistry 2004061
Method: Immunohistochemistry
Hepatitis B Virus Core Antibodies (Total) 0020091
Method: Qualitative Chemiluminescent Immunoassay

Identify HBV status if considering rituximab therapy

Hepatitis B Virus Surface Antigen, Confirmation 0020128
Method: Chemiluminescent Immunoassay

Identify HBV status if considering rituximab therapy

Hepatitis C Virus Antibody by CIA 2002483
Method: Qualitative Chemiluminescent Immunoassay

Screen for hepatitis C virus (HCV) infection in at-risk individuals

Screens for IgG antibodies to HCV

Cytomegalovirus, Quantitative PCR 0051813
Method: Quantitative Polymerase Chain Reaction

Preferred test for posttransplant surveillance

Quantifies CMV viral load in plasma

Human Immunodeficiency Virus Types 1 and 2 (HIV-1, HIV-2) Antibodies by CIA with Reflex to HIV-1 Antibody Confirmation by Western Blot 2005377
Method: Qualitative Chemiluminescent Immunoassay/Qualitative Western Blot

Use for at-risk patients