Lymphoma Phenotyping

Diagnosis

Indications for Testing

  • Evaluation of peripheral lymphocytosis (absolute lymphocytosis >4,000/µL)
  • Lineage-associated antigens and minimal monoclonal antibody panels for diagnosis

    Lymphoma Surface and Nuclear Antigens

    B-cell

    CD10, CD19, CD20, CD21, CD22, CD23, CD24, CD79a, CD79b, CD138, PCA-1, immunoglobulins (IgA, IgG, IgM, IgD, κ, λ)

    T-cell

    CD1, CD2, CD3, CD4, CD5, CD7, CD8, CD45RA, CD45RO, TCRαβ, TCRγδ

    NK-cell

    CD16, CD56, CD57

    Minimal Monoclonal Antibody Panels for Lymphoma Diagnosis

    B-cell

    κ/λ, CD5/CD19, CD23, CD10, FMC7

    T-cell

    CD3/CD4, CD3/CD8, CD5, CD7, CD25, CD30

    NK-cell

    CD2, CD3/CD4, CD3/CD8, CD16, CD56, CD57

Laboratory Testing

  • Rule out other disorders associated with lymphocytosis
  • If lymphoproliferative disorder remains a significant possibility after clinical evaluation, cell surface phenotyping of lymphocytes should be performed
    • Usually performed on peripheral blood using flow cytometry
      • Technique provides percentage of lymphocytes positive for a particular antigen and density of antigens
      • Normal peripheral blood lymphocytes consist of approximately 10% B-cells, 80% T-cells and 10% NK-cells
    • Most commonly used markers (CD = cluster designation)
      • B-cell – CD10, CD19, CD20, CD22, CD23, CD24, CD79b, CD103, Pax-5, kappa, lambda, FMC7, cytoplasmic kappa, cytoplasmic lambda
      • T-cell – CD1, CD2, CD3, CD4, CD5, CD7, CD8, TCR α-β, TCR γ-δ, cytoplasmic CD3
      • Myeloid/monocyte – CD11b, CD13, CD14 (Mo2), CD14 (MY4), CD15, CD33, CD64, CD117, myeloperoxidase
      • Miscellaneous – CD11c, CD16, CD25, CD30, CD34, CD38, CD41, CD42b, CD45, CD56, CD57, CD61, HLA-DR, glycophorin, TdT, bcl-2
  • B-cell lymphoproliferative disorders
    • Probable if immunoglobulin light chain restriction is demonstrated by surface typing of kappa or lambda
    • B-cell CLL or mantle cell lymphomas are suspected if CD5 is positive and CD10 is negative
    • Circulating mantle cell lymphoma can be mistaken morphologically for B-cell CLL
      • Mantle cell lymphoma considered in the following
        • CD20, CD19 – strong intensity
        • Surface immunoglobulin – strongly expressed
        • CD23 – absent
        • Diagnosis
          • Molecular and FISH testing
          • Requires t(11;14) translocation demonstration
      • CLL is more likely when
        • CD20 – weak intensity
        • Surface immunoglobulins –  weakly expressed
        • CD23 – present
    • Circulating germinal center cell-derived lymphoma is probable if CD10 is positive and CD5 is negative
      • Germinal center lymphomas – follicular, BL, diffuse large B-cell lymphoma (DLBCL)
      • Diagnosis
        • Some cases can be confirmed by demonstration of  t(14;18) breakpoint by PCR or FISH testing
        • PCR detects approximately 80% of t(14;18) translocations found in follicular lymphoma
          • FISH is more sensitive for this translocation in fixed tissue
        • FISH can also detect an MYC or BCL6 rearrangement for BL or DLBCL
    • Marginal zone lymphoma should be considered if both CD5 and CD10 are negative
    • Hairy cell leukemia has a characteristic phenotype that is CD5-, CD10-, CD11c+, CD25+ and CD103+
      • CD103 antigen (also known as B-ly7) is present in virtually all cases
      • CD11c and CD25 are less specific but present in almost all cases of hairy cell leukemia
  • T-cell lymphoproliferative disorders
    • Most show abnormalities of pan T-cell antigens CD2, 3, 5, or CD7
    • T-cell disorders
      • Proliferating lymphocytes are usually positive for CD3
      • Most common form is large granular lymphocytosis
      • Usually show rearrangement of TCR locus
      • Clonality assessed by flow cytometry, PCR or Southern blot
    • Large granular lymphocytosis is suspected if percentage of CD16, CD56 or CD57 positive T-cells is >50% or if absolute count of these cells >2,000/µL
    • Peripheral T-cell lymphoma (NOS)
      • Phenotypic abnormalities
    • Angioimmunoblastic lymphoma has characteristic CD10 and CD4 positive and CD52, CD56 and CD16 negative
    • Anaplastic large cell lymphoma – positive CD30 and ALK(+)
      • Some pan T-cell antigens are frequently deleted
    • Sézary syndrome should be considered if CD7 and CD26 are negative
    • Clinical spectrum and prognosis are variable in both T-cell and NK-cell types
      • Most behave in indolent fashion
    NK-cell lymphoproliferative disorders
    • Many show abnormalities of pan NK-cell antigens CD2, CD7, CD16, CD56, and/or CD57

Histology

Prognosis

  • Non-Hodgkin B-cell lymphoma
    • Indolent
      • CLL/SLL – favorable 
        • Sequencing – >2% mutation of IGHV
        • Flow cytometry – <30% CD38, <20% ZAP 70
        • Cytogenetics – del(13q) as sole abnormality
      • CLL/SLL – unfavorable
        • Sequencing – ≤2% mutation of IGHV or any IGHV rearrangements involving VH3-21 even if mutated
        • Flow cytometry – ≥30% CD38, ≥20% ZAP 70
        • Cytogenetics – del(11q), del(17p)
      • Follicular lymphoma
        • Unfavorable – multiple prior therapies; transformation into DLBCL
      • MZL (includes nodal, MALT, and splenic)
        • MALT (extranodal MZL)
          • Gastric MALT associated with Helicobacter pylori infection; good prognosis if infection is eradicated
    • Aggressive
      • DLBCL
        • Unfavorable – known risk factors, including age (>60 years), disease stage, elevated LD, therapy response (ECOG 1496 trial), number of extra-nodal sites
        • Favorable – no risk factors
      • Mantle cell lymphoma
        • Favorable – Ki-67 proliferation fraction <30%
    • Highly aggressive
      • Burkitt lymphoma and lymphoblastic lymphoma (T and B)
        • Unfavorable – elevated LD, concurrent HIV infection
      • AIDS-related B-cell lymphoma (includes Burkitt and PCNSL)
        • Unfavorable – PCNSL, persistent CD4 count <100
      • Double- /triple-hit lymphomas (B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt)
        • Most unfavorable – triple mutation (MYC, BCL2, BCL6)
    Non-Hodgkin T-cell lymphoma
    • All considered aggressive
    •   Peripheral T-cell lymphoma (PTCL)
      • Favorable – ALK-positive ALCL subtype; normal LD level, younger age (<60 years)
      • Unfavorable – AILT, EBER-positive tumors
    • Mycosis fungoides/Sézary syndrome
      • Unfavorable – older age (>56 years), tumor-stage disease or erythrodermic skin involvement, TCR gene rearrangements, extracutaneous disease
    Hodgkin lymphoma
    • Unfavorable prognostic factors
      • Mediastinal bulk in early stage disease
      • Presence of B-cell lymphoma symptoms
      • Disease found in ≥3 sites
      • Erythrocyte sedimentation rate of ≥50
      • Age ≥45 years
      • Male sex
      • Stage IV disease
      • Albumin level <4 g/dL
      • Hemoglobin level <10.5 g/dL
      • Leucocytosis – WBC >15,000/mm
      • Lymphocytopenia – lymphocyte count <8% of WBC count and/or <600/mm

Differential Diagnosis

Clinical Background

During evaluation of peripheral lymphocytosis (absolute lymphocytosis >4,000/µL), the possibility of a malignant disorder requires evaluation.

WHO Classification of Lymphoid Neoplasms, 2008

  • Precursor lymphoid neoplasms

    Precursor Lymphoid Neoplasms

    • B lymphoblastic leukemia/lymphoma, NOS (not otherwise specified)
    • B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities
      • B lymphoblastic leukemia/lymphoma with t(9/22)(q34;q11.2); BCR-ABL1
      • B lymphoblastic leukemia/lymphoma with t(v;11q23); MLL rearranged
      • B lymphoblastic leukemia/lymphoma with t(12/21)(p13;q22); TEL-AML1 (ETV6-RUNX1)
      • B lymphoblastic leukemia/lymphoma with hyperdiploidy
      • B lymphoblastic leukemia/lymphoma with hypodiploidy (hypodiploid ALL)
      • B lymphoblastic leukemia/lymphoma with t(5;14)(q31;q32); IL3-IGH
      • B lymphoblastic leukemia/lymphoma with t(1;19)(q23;p13.3); E2A-PBX1 (TCF3-PBX1)
    • T lymphoblastic leukemia/lymphoma
    Mature B-cell neoplasms

    Mature B-Cell Neoplasms

    • Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)
    • B-cell prolymphocytic leukemia
    • Splenic marginal zone lymphoma (MZL)
    • Hairy cell leukemia (HCL)
    • Splenic lymphoma/leukemia, unclassifiable
    • Lymphoplasmacytic lymphoma
    • Heavy chain diseases
    • Plasma cell myeloma
    • Solitary plasmacytoma of bone
    • Extraosseous plasmacytoma
    • Extranodal MZL 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 (PCNSL)
    • 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
    Mature T- and NK-cell Neoplasms

    Mature T- and NK-cell Neoplasms

    • Precursor T-cell neoplasm
    • T-cell prolymphocytic leukemia
    • T-cell large granular lymphocytic leukemia
    • Chronic lymphoproliferative disorder of NK-cells (provisional entity)
    • Aggressive NK-cell leukemia
    • Epstein-Barr virus (EBV)-positive T-cell lymphoproliferative disorder of childhood
    • Adult T-cell leukemia/lymphoma (ATLL)
    • Extranodal NK/T-cell lymphoma, nasal type
    • Enteropathy-associated T-cell lymphoma
    • Hepatosplenic T-cell lymphoma
    • Subcutaneous panniculitis-like T-cell lymphoma
    • Mycosis fungoides
    • Sézary syndrome
    • Primary cutaneous CD30-positive T-cell lymphoproliferative disorders
    • Primary cutaneous gamma-delta T-cell lymphoma
    • Peripheral T-cell lymphoma, NOS (not otherwise specified)
    • Angioimmunoblastic T-cell lymphoma
    • Anaplastic large-cell lymphoma (ALCL), ALK positive
    • ALCL, ALK negative (provisional entity)
    Hodgkin lymphoma

    Hodgkin Lymphoma

    • Nodular lymphocyte predominant Hodgkin lymphoma
    • Classical Hodgkin lymphoma
      • Nodular sclerosis classical Hodgkin lymphoma
      • Lymphocyte-rich classical Hodgkin lymphoma
      • Mixed cellularity classical Hodgkin lymphoma
      • Lymphocyte-depleted classical Hodgkin lymphoma

Clinical Presentation

  • Nonspecific symptoms frequently in initial presentation
    • Malaise, fatigue, weight loss, fever
  • Adenopathy – may be first presenting symptom; may be bulky
  • Related syndromes – autoimmune hemolytic anemia
  • Cutaneous – skin rashes in cutaneous lymphomas
  • Gastrointestinal
    • Hepato/splenomegaly
    • Common site of extranodal disease
  • Common hematological antigens in lymphomas
    Common Hematological Antigens in Lymphomas
    Antigen or Cluster Designation (CD)Application

    CD1a

    T-cell lymphoma, particularly T-lymphoblastic lymphoma

    CD2

    T-cell lymphoma

    CD3

    T-cell lymphoma (immature T-cell neoplasms may have cytoplasmic CD3 without cell surface CD3)

    CD4

    Identify T-cell subset in all T-cell lymphomas

    CD5

    T/B-cell lymphoma, CLL; may be absent in peripheral T-cell lymphoma (PTCL) and plasmacytoid lymphoma

    CD7

    T-cell lymphoma (may be absent in PTCL, adult T-cell leukemia/lymphoma [ATLL], mycosis fungoides)

    CD8

    Identify T-cell subset in all T-cell lymphomas

    CD9

    Some CLL

    CD10 (CALLA)

    B-cell lymphoma (follicular lymphoma, Burkitt lymphoma), angioimmunoblastic T-cell lymphoma (AILT). lymphoblastic lymphomas

    CD11a

    May be absent in some B-cell neoplasms

    CD11c

    Hairy cell leukemia (HCL), marginal zone lymphoma (MZL), other B-cell neoplasms

    CD14

    Chronic myelomonocytic leukemia (CMML)

    CD15

    Hodgkin lymphoma

    CD16

    NK-cell disorder

    CD18

    Some B-cell neoplasms

    CD19

    B-cell lymphoma, CLL; usually absent in plasma cell neoplasms

    CD20

    B-cell lymphoma, CLL; usually absent in plasma cell neoplasms

    CD21

    B-cell lymphoma

    CD22

    B-cell lymphoma, HCL

    CD23

    B-cell lymphoma, CLL, small lymphocytic lymphoma (SLL); usually absent in mantle cell lymphoma

    CD24

    Most mature B-cell neoplasms

    CD25

    ATLL, HCL, some T- and B-cell lymphomas, including anaplastic large cell lymphoma (ALCL), Hodgkin lymphoma

    CD26

    Usually absent in Sézary syndrome

    CD30

    Hodgkin lymphoma, ALCL

    CD38

    PTCL, some B-cell lymphomas, myeloma, plasmacytic neoplasms

    CD45

    Lymphomas/leukemias (usually reduced/absent in lymphoblastic lymphoma, ALCL, AILT, plasma cell proliferations) 

    CD45RA

    Follicular lymphoma, some T-cell lymphomas, some mature B-cell lymphomas

    CD45RO

    T-cell lymphoma

    CD56

    NK-cell disorder, large granular lymphocytic leukemia (LGLL), hematodermic neoplasms (blastic NK-cell lymphoma)

    CD57

    NK-cell disorder, LGLL

    CD71

    Acute leukemia/lymphoma, intermediate- and high-grade lymphomas, Hodgkin lymphoma

    CD74

    B-cell lymphoma

    CDw75

    B-cell lymphoma

    CD79a

    B-cell lymphoma

    CD79b

    B-cell lymphoma

    CD103

    HCL, some splenic lymphomas

    CD138

    B-cell lymphoma, myeloma

    BCL2B-cell lymphoma
    BCL6B-cell lymphoma

    FMC-7

    B-cell lymphoma, mantle cell lymphoma, HCL, splenic lymphoma

    HLA-DR

    B-cell neoplasms, Hodgkin lymphoma, PTCL

    PCA-1

    Myeloma

    TdT

    Lymphoblastic lymphoma

    TCR - α-β

    T-cell lymphoma/leukemia (most T-cell neoplasms expressing CD3)

    TCR - γ-δ

    T-cell lymphoma/leukemia

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
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

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

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

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

   
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)

 
T-Cell Clonality by Next Generation Sequencing 2008409
Method: Massive Parallel Sequencing

Diagnose and monitor T-cell lymphoproliferative disorders

Higher sensitivity than T-cell clonality tests by other methods

Ability to detect previously identified clonal populations at very low levels (beneficial for minimal residual disease [MRD] monitoring)

Analytical sensitivity – 10% tumor cells for initial diagnosis; 0.1% tumor cells in follow-up specimen when monitoring for MRD

Clonal TCRG gene rearrangements below the limit of detection will not be reported

 
T-Cell Clonality by Flow Cytometry Analysis of TCR V-Beta 0093199
Method: Flow Cytometry

Further characterize phenotypically abnormal T-cell populations identified by flow cytometry

Determine the existence of monoclonality based on expression of TCR β chain variable regions 

Tests only for TCR α-β receptors; if identification of TCR γ-δ receptors is desired, PCR testing is recommended

 
Chromosome FISH, Interphase 2002298
Method: Fluorescence in situ Hybridization

Detect chromosome abnormalities associated with lymphoma

FISH probes must be specified and include MYC (c-Myc) rearrangements, t(11;14) (IGH-CCND1), t(14;18) (IGH-BCL2), IGH rearrangement with unknown partner, ALK rearrangements, and BCL6 rearrangements

Indicate names of probes needed for testing

ARUP Oncology FISH Probes menu

Fresh tissue specimen required

 
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 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

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

   
Chromosome Analysis, Bone Marrow 2002292
Method: Giemsa Band

Detect chromosome abnormalities associated with lymphoproliferative disorders in bone marrow

 

Repeat testing as clinically indicated to monitor disease progression

Cyclin D1, SP4 by Immunohistochemistry 2003842
Method: Immunohistochemistry

Diagnose MCL in conjunction with morphology and immunohistochemical studies

FFPE tissue specimens only

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

Assist in prognosis of CLL

Specific genomic abnormalities tested for are: ATM deletion, 13q deletion, p53 deletion, and trisomy 12

Limit of detection is probe dependent and ~1-5% in interphase nuclei

Repeat testing as clinically indicated to monitor disease progression

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 specimen required

Analytical 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

Mutation is not specific for MCL; results should be analyzed in conjunction with morphology, immunohistochemistry, and immunophenotyping results

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

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

Bone marrow; other specimens may be acceptable

FFPE and frozen specimens unacceptable

FISH probes include MYC, BCL2, IGH, and 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

 
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

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

Assist in the clinical management of patients with established diagnosis of CLL

Assay is designed for use with a confirmed diagnosis of CLL and includes sequencing

Use of this assay for all other diagnoses will terminate after amplification and will not include sequencing

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

Assist in the clinical management of patients with established diagnosis of CLL

Results should not be used for diagnostic purposes and should always be correlated with morphologic and clinical information

 
Immunohistochemistry Stain Offering

Recommended stains for lymphoma phenotyping are available on the following ARUP Consult topics

   
Additional Tests Available
 
Click the plus sign to expand the table of additional tests.
Test Name and NumberComments
T-Cell Clonality Screening by PCR 0055567
Method: Polymerase Chain Reaction/Capillary Electrophoresis

Determine presence of monoclonal T-cell population in whole blood or bone marrow

“Not detected" result does not entirely exclude the presence of a TCRγ rearrangement (or monoclonal T-cell population) in the specimen

Epstein-Barr Virus by PCR 0050246
Method: Qualitative Polymerase Chain Reaction

Order to detect Epstein-Barr virus (EBV) in individuals suspected of having EBV-related disease

Sensitive and specific qualitative test for detecting EBV in plasma, serum, and cerebrospinal fluid

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 uninformative

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

Analytical sensitivity – 1 in 105

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

Mutation is not specific for MCL; results should be analyzed in conjunction with morphology, immunohistochemistry, and immunophenotyping results