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FeedbackB-cell non-Hodgkin lymphomas (NHL) represent a heterogenous group of hematologic malignancies of lymphoid cells. Following biopsy, flow cytometry, immunohistochemical stains, and cytogenetic studies can confirm the diagnosis.
Key Points
Double- and Triple-Hit Lymphomas
B-cell lymphomas with 2 or 3 recurrent chromosomal breakpoint aberrations (rare) are referred to as double- or triple-hit lymphomas. These usually involve the MYC oncogene in association with the BCL2 and/or BCL6 gene rearrangements. These are classified by WHO as a “high-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements” (Swerdlow, WHO, 2016).
It is important to identify these high-grade lymphomas as they tend to manifest aggressive behavior and respond poorly to traditional chemotherapy.
- Follicular lymphoma
- DLBCL
- High-grade lymphomas (rare)
| Oncogene | Break-apart MYC | BCL2 | BCL6 |
|---|---|---|---|
| Locus | 8q24 | 18q21 | 3q27 |
| Biology | Accelerator of cell proliferation | Apoptosis inhibitor | Transcription modifier |
| Cytogenetics (translocations) | Any MYC translocation | BCL2/IGH t(14;18)(q32;21) |
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| Specific lymphomas associated with translocation |
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| Other malignancies associated with translocation | B-cell ALL (rare) | B-cell ALL (rare) | n/a |
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DIAGNOSTIC TESTING ARUP Tests
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References: Aukema SM, 2011; Johnson NA et al, 2009; Salaverria I et al, 2011; Savage et al, 2009; WHO, 2008. ALL, acute lymphoblastic lymphoma; n/a, not available |
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Diagnosis
Indications for Testing
- Adenopathy
- Fevers/night sweats
- Recurrent infections
- Unexplained lymphocytosis or abnormal manual differential
Laboratory Testing
- 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
- See the Lymphoma Phenotyping algorithm for specific test-ordering recommendations
- May be performed on peripheral blood, bone marrow
Histology
- Fine-needle aspiration (FNA) not considered adequate – use incisional biopsy specimen (NCCN, 2015)
- Follow-up testing with bone marrow biopsy
- ≥2 cm specimen length
- Classified as involved or not
- Immunophenotyping (flow cytometry testing) and immunoperoxidase staining of tissue for specific B-cell antigens or clonality with kappa and lambda light-chain staining
- Immunohistochemistry – useful in conjunction with phenotyping
- Most commonly used stains – 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, and TdT
- Other available stains – BOB-1, Bax, caspase-3, CD15, CD43, CD45, CD45RA-MT2, CD45RO, CD74, c-Myc, DBA.44, and Oct-2
- B-cell clonality studies
- Locate clonal rearrangements of the immunoglobulin gene in B-cell malignancies
- Provide information regarding prognosis and treatment recommendations
- T-cell clonality studies
Genetic Testing
| Disease | Genetics | Comments |
|---|---|---|
| High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements, and Burkitt lymphoma | MYC, BCL2, BCL6 | Refer to Key Points |
| Burkitt lymphoma | MYC t(8;14), t(2;8), t(8;22) | |
| Diffuse large B-cell lymphoma (DLBCL) | BCL6, BCL2, IRF4/MUM1 | |
| Follicular lymphoma | BCL2 t(14;18)(q32;q21), IRF4/MUM1 | Recommended methodology – FISH or cytogenetics |
| Hairy cell leukemia | BRAF V600E | |
| Mantle cell lymphoma | BCL1(CCND1) t(11;14)(q13;q32) | |
| Marginal zone lymphoma (nodal, MALT, splenic) | MYD88 | Use to differentiate from lymphoplasmacytic lymphoma |
| Mucosa-associated lymphoid tissue (MALT) (gastric) | t(11;14), t(14;18), t(1;14), t(3;14), t(11:18) |
FISH or cytogenetics PCR useful for t(14;18) |
Other Testing
- Virus testing
- EBV – posttransplant lymphomas, endemic nasopharyngeal lymphomas
- HHV8 – AIDS-related lymphomas
- Bacteria testing
- Helicobacter – mucosa-associated lymphoid tissue (MALT) lymphoma
- Kappa and lambda light-chain clonality in situ hybridization
- Testing prior to treatment with immunosuppressive therapies
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 four risk groups
- Limited usefulness in follicular lymphoma, mantle cell lymphoma, NK lymphoma, nasal-type lymphoma, hepatosplenic lymphoma, and enteropathy-type lymphoma
- Follicular Lymphoma International Prognostic Index scoring system
- Five risk factors (each scored as one point)
- Blood hemoglobin <12 g/dL
- Serum LD >normal
- Ann Arbor tumor stage (III or IV)
- >4 nodal sites
- Age >60 years
- 0-1 risk factor – low risk (5-year survival 90%)
- 2 risk factors – intermediate risk (5-year survival 78%)
- 3 risk factors – high risk (5-year survival 53%)
- Five risk factors (each scored as one point)
- 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
- Refer to Key Points for double- and triple-hit lymphomas
- CLL
- CD38 – mutation status correlates inversely with prognosis
- Follicular lymphoma
Differential Diagnosis
- Infections
- Babesia microti
- Bartonella spp
- CMV
- EBV
- Fungal disease
- HIV
- M. tuberculosis
- Toxoplasma gondii
- Treponema pallidum
- Human herpesvirus 8
- Reactive lymphocytosis
- Malignancy
- Head and neck cancer
- Metastatic cancer
- Other lymphomas – T-cell, Hodgkin
- Sarcoidosis
Monitoring
- Alemtuzumab (Campath) therapy – risk of CMV reactivation
- PCR quantitative two to three weeks after start of therapy
- Rituximab (Rituxan) therapy – high risk of hepatitis reactivation
Background
Epidemiology
- Incidence – represents 80-85% of the cases of non-Hodgkin lymphomas (NHL) diagnosed annually
- >70,000 new cases of NHL (NCCN, 2014)
- Age – peaks in 60s
- Sex – M<F (minimal)
Classification
Mature B-cell Neoplasms (WHO, 2016)
- Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)
- Monoclonal B-cell lymphocytosis
- B-cell prolymphocytic leukemia
- Splenic marginal zone lymphoma (MZL)
- Hairy cell leukemia
- Splenic lymphoma/leukemia, unclassifiable (provisional entities)
- Splenic diffuse red pulp small B-cell lymphoma
- Hairy cell leukemia variant
- Lymphoplasmacytic lymphoma
- Waldenström macroglobulinemia
- Monoclonal gammopathy of undetermined significance (MGUS), IgM
- Heavy chain diseases
- Alpha heavy chain disease
- Gamma heavy chain disease
- Mu heavy chain disease
- MGUS, IgG/A
- Plasma cell neoplasms
- Solitary plasmacytoma of bone
- Extraosseous plasmacytoma
- Monoclonal immunoglobulin deposition diseases
- Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT)
- Nodal MZL
- Pediatric nodal marginal zone lymphoma (provisional entity)
- Follicular lymphoma
- In situ follicular neoplasia
- Duodenal-type follicular lymphoma
- Pediatric-type follicular lymphoma
- Large B-cell lymphoma with IRF4 rearrangement (provisional entity)
- Primary cutaneous follicle center lymphoma
- Mantle cell lymphoma
- In situ mantle cell neoplasia
- Diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS)
- Germinal center B-cell type
- Activated B-cell type
- 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
- EBV-positive mucocutaneous ulcer (provisional entity)
- 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
- Primary effusion lymphoma
- Human herpes virus 8 (HHV8)-positive DLBCL, NOS
- Burkitt lymphoma
- Burkittlike lymphoma with 11q aberration (provisional entity)
- High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
- High-grade B-cell lymphoma, NOS
- B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma
Risk Factors
- Presence of autoimmune diseases immune deficiency (iatrogenic or acquired)
- Celiac disease
- HIV infection
- Immunosuppressive drugs
- Posttransplant immunosuppression
- Rheumatoid arthritis
- Sjögren syndrome
- Inherited disorders
- Chronic infection
- Cytomegalovirus (CMV) – high risk of reactivation with immunosuppressive treatment regimens (eg, alemtuzumab)
- EBV – diffuse large B-cell lymphoma (DLBCL) of the CNS
- Helicobacter pylori – gastric extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma
- Hepatitis B (HBV) – risk of reactivation with immunosuppressive treatment regimens (eg, rituximab)
- Hepatitis C (HCV) – lymphoplasmacytic lymphoma, marginal zone lymphoma (MZL), follicular lymphoma
- Human herpes virus 8 (HHV8) – primary effusion lymphoma
Clinical Presentation
Selected Lymphoma Subtypes (Based on WHO, 2016)
Diffuse large B-cell lymphoma (DLBCL)
- Incidence – 25-30% of NHL
- Age – median is 60 yrs
- Sex – M>F (minimal)
- Symptoms – rapidly enlarging tumor at nodal or extranodal site
- Prognosis – poor, aggressive tumor
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
- Genetics – BCL2 mutation
- 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
CLL/SLL
- Incidence – 2-6/100,000; ~7% of NHL
- Age – median >60 yrs
- Sex – M>F, 1.5-2:1
- Symptoms – fatigue, adenopathy, hepatosplenomegaly, autoimmune hemolytic anemia, recurrent infections
- Prognosis – good; indolent tumor
Mantle cell lymphoma
- Incidence – 6-10% of NHL
- Age – median is 60 yrs
- Sex – M>F, 2:1
- Genetics – CCND1 mutation
- Symptoms – adenopathy, splenomegaly, bone marrow involvement
- Prognosis – poor; aggressive tumor
Extranodal marginal zone lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT)
- Gastric subtype associated with chronic Helicobacter infection
- Incidence – 8-10% of NHL
- Age – median 60 yrs
- Sex – M<F (minimal)
- Ethnicity – increased prevalence in northeast Italy and Middle East
- Symptoms – related to organ location
- Gastric subtype associated with chronic Helicobacter infection
- Prognosis – favorable; indolent tumor
Splenic marginal zone lymphoma (MZL)
- Incidence – rare
- Age – >50 yrs
- Sex – M:F, equal
- Symptoms – splenomegaly, often with autoimmune thrombocytopenia
- Prognosis – good; indolent tumor
Nodal MZL (+/- monocytoid B-cells)
- Incidence – rare
- Age – median 60 yrs
- Sex – M:F, equal
- Symptoms – peripheral lymphadenopathy
- Prognosis – good; can be predicted by Follicular Lymphoma International Prognostic Index
Burkitt lymphoma
- Incidence – rare in U.S., endemic in Africa
- Age – depends on subtype; endemic in young
- Three clinical forms
- HIV/transplant patients – immunocompromised form
- EBV-associated endemic form
- Sporadic form
- Symptoms – lesions commonly found in jaw and face in endemic form
Hairy cell leukemia
- Incidence – rare
- Age – median 50 yrs
- Sex – M>F, 5:1
- Symptoms – hepatosplenomegaly, fatigue, fever, pancytopenia, recurrent infections, peripheral adenopathy rare
- Prognosis – good; with treatment, disease may remain silent for years
Primary effusion lymphoma
- Associated with HIV infection and HHV8
- Incidence – rare
- Age – 30s-40s
- Sex – M>F
- Symptoms – dyspnea, abdominal distention
- Prognosis – poor; aggressive tumor
Lymphoplasmacytic lymphoma
- Incidence – rare
- Age – median 65 yrs
- Increased risk for patients with monoclonal gammopathy of undetermined significance
- Genetics – MYD88 L265P, CXCR4 mutations
- Symptoms – fatigue, malaise, hepatosplenomegaly, adenopathy, hyperviscosity syndrome, and Waldenstrom macroglobulinemia
- Prognosis – moderately good; indolent tumor
Posttransplant lymphoproliferative disorder
- Incidence – more common following solid organ transplantation or allogeneic hematopoietic stem cell transplant
- 1-3% of transplant patients
- Majority occur 6-12 months posttransplant
- Symptoms – depend on site of tumor
- Associated with EBV and CMV (in EBV-negative patients)
- Usually B cell, uncommonly T cell or NK cell
Cutaneous B-cell lymphomas
- Incidence – 20-25% of all cutaneous lymphomas
- 3 types
- Primary cutaneous MZL
- Primary cutaneous follicular cell lymphoma
- Primary cutaneous DLBCL
- Symptoms – lesions that grow in size
- Prognosis – good; indolent course except for DLBCL (tends to be aggressive in the legs)
Plasma cell neoplasms – plasmacytoma (plasma cell dyscrasias)
ARUP Laboratory Tests
Aid in evaluation of hematopoietic neoplasms (ie, leukemia, lymphoma)
Specimens include bone marrow, whole blood, tissue, or fluid
Monitor therapy in patients with established diagnosis of hematopoietic neoplasms
Markers selected based on provided clinical history and/or previous test results
Antigens included
T cell: CD1a, CD2, CD3, CD4, CD5, CD7, CD8, TCR γ-δ, cytoplasmic CD3
B cell: CD10, CD19, CD20, CD22, CD23, CD103, CD200, kappa, lambda, cytoplasmic kappa, cytoplasmic lambda
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, CD123, CD138, CD26, CD45, CRLF-2
Flow Cytometry
Use to order individual or multiple oncology FISH probes if standard FISH panels are not desired
Fresh tissue sample required
Indicate names of probes needed for testing
Fluorescence in situ Hybridization (FISH)
Aid in the diagnosis of lymphoproliferative disorders
Aid in differentiating malignant from reactive lymphoid proliferations
Equally sensitive for both kappa and lambda restricted populations
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)
Polymerase Chain Reaction/Capillary Electrophoresis
Diagnose mantle cell lymphoma in conjunction with morphology and immunohistochemical studies
Formalin-fixed, paraffin-embedded (FFPE) tissue specimens only
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
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 or rule out follicular lymphoma
Fluorescence in situ Hybridization (FISH)
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
Requires FFPE tissue
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
Fluorescence in situ Hybridization (FISH)
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; does not identify translocation partner
Requires FFPE tissue
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
Fluorescence in situ Hybridization (FISH)
Diagnose BL or DLBCL with features intermediate between BL and DLBCL in conjunction with clinical, morphologic, and flow cytometric data
Sensitive method for detecting BCL6 rearrangements in FFPE, which can contribute to diagnosis and prognostication in B-cell lymphomas
Fluorescence in situ Hybridization (FISH)
Aid in diagnosis of aggressive large B-cell lymphoma with intermediate features between Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL) and confirmation of suspected double-hit lymphoma
Specimens – formalin-fixed, paraffin-embedded (FFPE) tissue specimens
Interpretation of results requires correlation with morphology and immunophenotype
MYC and/or BCL2 overexpression can be due to other mechanisms not detected by this test
Chromosome alterations outside probe region are not detected
Fluorescence in situ Hybridization (FISH)
Aid in diagnosis of aggressive large B-cell lymphoma with intermediate features between Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL) and confirmation of suspected double hit lymphoma
For reflex test, refer to Aggressive B-Cell Lymphoma FISH Reflex, Tissue
Specimens – bone marrow or whole blood specimens; other specimens may be acceptable
Probes in this panel include MYC, BCL2, IGH, BCL6
Interpretation of results requires correlation with morphology and immunophenotype
MYC and/or BCL2 overexpression can be due to other mechanisms not detected by this test
Chromosome alterations outside probe region are not detected
FFPE and frozen specimens unacceptable
Fluorescence in situ Hybridization (FISH)
Confirm diagnosis of hairy cell leukemia (HCL)
Monitor tumor burden in patients with HCL
Limit of detection – 0.2% mutant allele
Polymerase Chain Reaction
Determine risk group in newly diagnosed CLL
Results should always be correlated with morphologic and clinical information
Samples that do not yield amplification product may contain too few CLL cells (<50% B cells) or express VH genes with high numbers of mutations that may compromise clonal B-cell amplification
Not intended to detect minimal residual disease
Polymerase Chain Reaction/Sequencing
Preferred test at time of diagnosis for detecting prognostically important genomic abnormalities in leukemias/lymphomas and solid tumors involving loss/gain of DNA; loss of heterozygosity
Monitor disease progression and response to therapy
Chromosome alterations outside the regions complementary to these FISH probes will not be detected
Ideal testing is when significant disease is present
Genomic Microarray (Oligo-SNP Array)
Alternate test to detect prognostically important genomic abnormalities in CLL
Probes include ATM (11q22.3), chromosome 12 centromere (trisomy 12), D13S319 (13q14.3), and p53 (17p13.1)
Chromosome alterations outside the regions complementary to these FISH probes will not be detected
Ideal testing is when significant disease is present
Fluorescence in situ Hybridization (FISH)
Aid in diagnosis of mantle cell lymphoma (MCL) if cyclin testing is noninformative
FFPE specimen require
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 should be analyzed in conjunction with morphology, immunohistochemistry, and immunophenotyping results
Fluorescence in situ Hybridization (FISH)
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid in identifying colorectal adenomas, carcinomas; distinguishes follicular lymphoma from reactive follicles
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid in identifying large cell lymphomas, BL, and Hodgkin lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
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
Immunohistochemistry
Aid histologic diagnosis of B-cell leukemia/lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
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, macroglobulinemia, and immunoblastic B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
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
Immunohistochemistry
Aid in differentiating small lymphocytic lymphoma (+) and mantle cell lymphoma (-)
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
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
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Primarily aids the distinction between CLL/SLL and mantle cell lymphoma where CD200 is usually positive in CLL/SLL and negative in mantle cell lymphoma; CD200 is also positive in other B-cell lymphoproliferative disorders
Stained and returned to client pathologist for interpretation; consultation available if needed
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
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aids in the prognostic determination of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Detect IRF4/DUSP22 rearrangements which can contribute to diagnosis and prognosis in B-cell and T-cell lymphomas
Fluorescence in situ Hybridization (FISH)
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Useful for cyclin D1-negative MCL that is difficult to distinguish from other small B-cell lymphomas
Highly specific marker for both cyclin D1-positive and negative MCL
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Aid histologic diagnosis of B-cell lymphoma
Stained and returned to client pathologist for interpretation; consultation available if needed
Immunohistochemistry
Initial test to evaluate lymphoma
May provide prognostic information
Automated Cell Count/Differential
Initial test to evaluate lymphoma
May provide prognostic information
Quantitative Enzymatic/Quantitative Spectrophotometry
Initial test to evaluate lymphoma
May provide prognostic information
Quantitative Enzymatic
Initial test to evaluate lymphoma
May provide prognostic information
Assay interference (negative) may be observed when high concentrations of N-acetylcysteine (NAC) are present
Negative interference has also been reported with NAPQI (an acetaminophen metabolite) but only when concentrations are at or above those expected during acetaminophen overdose
Quantitative Spectrophotometry
Order for rituximab monitoring
Flow Cytometry
Diagnose, prognose, and monitor hematopoietic neoplasms
Giemsa Band
Immunohistochemistry
Immunohistochemistry
Immunohistochemistry
Immunohistochemistry
Immunohistochemistry
Immunohistochemistry
Identify HBV status if considering rituximab therapy
Qualitative Chemiluminescent Immunoassay
Identify HBV status if considering rituximab therapy
Chemiluminescent Immunoassay
Screen for hepatitis C virus (HCV) infection in at-risk individuals
Screen for IgG antibodies to HCV
Qualitative Chemiluminescent Immunoassay
Detect and quantify cytomegalovirus (CMV)
Quantitative Polymerase Chain Reaction
Use for at-risk patients
Qualitative Chemiluminescent Immunoassay /Qualitative Western Blot
Medical Experts
Lamb
Miles
Perkins
Professor of Pathology, University of Utah
Chief Executive Officer at ARUP Laboratories
References
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