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{{Non-Hodgkin lymphoma}}  
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==Overview==
==Overview==
The diagnostic study of choice for non-Hodgkin lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy.  
The diagnostic study of choice for non-Hodgkin lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy.  
==Diagnostic study of choice==
==Diagnostic study of choice==
*The diagnostic study of choice for non-Hodgkin's lymphoma is excisional lymph node biopsy. An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma. Fine needle aspiration biopsy is insufficient. In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine non-Hodgkin's lymphoma subtypes and distinguish non-Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma. The presence of CD20 positive clonal B cells defines non-Hodgkin lymphoma. Flow cytometry is an effective method in differentiating between Hodgkin's lymphoma and non-Hodgkin lymphoma, as well as subtypes of non-Hodgkin lymphoma.<ref name="pmid22693682">{{cite journal| author=Schwock J, Geddie WR| title=Diagnosis of B-cell non-hodgkin lymphomas with small-/intermediate-sized cells in cytopathology. | journal=Patholog Res Int | year= 2012 | volume= 2012 | issue= | pages= 164934 | pmid=22693682 | doi=10.1155/2012/164934 | pmc=3368210 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22693682 }} </ref>
*The diagnostic study of choice for non-Hodgkin's lymphoma is excisional lymph node biopsy.<ref name="pmid28395545">{{cite journal| author=Jiang M, Bennani NN, Feldman AL| title=Lymphoma classification update: B-cell non-Hodgkin lymphomas. | journal=Expert Rev Hematol | year= 2017 | volume= 10 | issue= 5 | pages= 405-415 | pmid=28395545 | doi=10.1080/17474086.2017.1318053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28395545  }} </ref>
 
*An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma.  
*A bone marrow biopsy can also be done to diagnose non-Hodgkin lymphoma if there is sufficient evidence of marrow involvement (i.e. presence of cytopenias). Non-Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation. A length of 2cm of the core biopsy is generally needed for diagnosis, which is in contrast to diagnostic requirements for leukemias. A bone marrow is not the diagnostic study of choice for Hodgkin lymphoma if a lymph node can be biopsied.
*Fine needle aspiration biopsy is usually insufficient.<ref name="pmid28332735">{{cite journal| author=Intragumtornchai T, Bunworasate U, Wudhikarn K, Lekhakula A, Julamanee J, Chansung K et al.| title=Non-Hodgkin lymphoma in South East Asia: An analysis of the histopathology, clinical features, and survival from Thailand. | journal=Hematol Oncol | year= 2018 | volume= 36 | issue= 1 | pages= 28-36 | pmid=28332735 | doi=10.1002/hon.2392 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28332735  }} </ref>
 
*In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine non-Hodgkin's lymphoma subtypes and distinguish non-Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma.<ref name="pmid28332735">{{cite journal| author=Intragumtornchai T, Bunworasate U, Wudhikarn K, Lekhakula A, Julamanee J, Chansung K et al.| title=Non-Hodgkin lymphoma in South East Asia: An analysis of the histopathology, clinical features, and survival from Thailand. | journal=Hematol Oncol | year= 2018 | volume= 36 | issue= 1 | pages= 28-36 | pmid=28332735 | doi=10.1002/hon.2392 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28332735  }} </ref>
 
*The presence of CD20 positive clonal B cells defines non-Hodgkin lymphoma.<ref name="pmid25499449">{{cite journal| author=Casulo C, Burack WR, Friedberg JW| title=Transformed follicular non-Hodgkin lymphoma. | journal=Blood | year= 2015 | volume= 125 | issue= 1 | pages= 40-7 | pmid=25499449 | doi=10.1182/blood-2014-04-516815 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25499449  }} </ref>
*In about 40% of adult patients with Non Hodgkin Lymphoma, the extranodal sites are the primary presenting sites with the most common site being the Gastrointestinal tract.<ref name="pmid25499449">{{cite journal| author=Casulo C, Burack WR, Friedberg JW| title=Transformed follicular non-Hodgkin lymphoma. | journal=Blood | year= 2015 | volume= 125 | issue= 1 | pages= 40-7 | pmid=25499449 | doi=10.1182/blood-2014-04-516815 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25499449 }} </ref>
*A bone marrow (BM) biopsy can also be done to diagnose non-Hodgkin lymphoma if there is sufficient evidence of marrow involvement such as presence of cytopenias.<ref name="pmid25499449">{{cite journal| author=Casulo C, Burack WR, Friedberg JW| title=Transformed follicular non-Hodgkin lymphoma. | journal=Blood | year= 2015 | volume= 125 | issue= 1 | pages= 40-7 | pmid=25499449 | doi=10.1182/blood-2014-04-516815 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25499449  }} </ref>
*Non-Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation.
*Bilateral BM biopsy has been recommended with trephine biopsy being preferred to marrow aspiration for detecting marrow infiltration.<ref>Bartl R, Frisch B, Burkhardt R, Jδger K, Pappenberger R, Hoffmann-Fezer G. Lymphoproliferations in bone marrow: i0 dentification and evaluation, classification and staging. J Clin Pathol 1984;37:233-54.</ref><ref>Bain BJ, Clark DM, Lampert IA, Wilkins BS, editors. Bone marrow pathology. 3 rd ed. UK: Blackwell Science Ltd; 2001. </ref>
*BM biopsies, performed under local anesthesia, were obtained using the conventional technique with a Jamshidi needle from the posterior superior iliac spines, fixed in 10% formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing and paraffin embedding.<ref>Culling CF, Allison RT, Barr WT. Connective tissue. In: Cellular Pathology Techniques. 4 th ed. London: Butterworth and Co. ltd; 1985. p. 172-3. </ref>
==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Revision as of 16:56, 20 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[3]

Overview

The diagnostic study of choice for non-Hodgkin lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy.

Diagnostic study of choice

  • The diagnostic study of choice for non-Hodgkin's lymphoma is excisional lymph node biopsy.[1]
  • An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma.
  • Fine needle aspiration biopsy is usually insufficient.[2]
  • In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine non-Hodgkin's lymphoma subtypes and distinguish non-Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma.[2]
  • The presence of CD20 positive clonal B cells defines non-Hodgkin lymphoma.[3]
  • In about 40% of adult patients with Non Hodgkin Lymphoma, the extranodal sites are the primary presenting sites with the most common site being the Gastrointestinal tract.[3]
  • A bone marrow (BM) biopsy can also be done to diagnose non-Hodgkin lymphoma if there is sufficient evidence of marrow involvement such as presence of cytopenias.[3]
  • Non-Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation.
  • Bilateral BM biopsy has been recommended with trephine biopsy being preferred to marrow aspiration for detecting marrow infiltration.[4][5]
  • BM biopsies, performed under local anesthesia, were obtained using the conventional technique with a Jamshidi needle from the posterior superior iliac spines, fixed in 10% formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing and paraffin embedding.[6]

References

  1. ↑ Jiang M, Bennani NN, Feldman AL (2017). "Lymphoma classification update: B-cell non-Hodgkin lymphomas". Expert Rev Hematol. 10 (5): 405–415. doi:10.1080/17474086.2017.1318053. PMID 28395545.
  2. ↑ 2.0 2.1 Intragumtornchai T, Bunworasate U, Wudhikarn K, Lekhakula A, Julamanee J, Chansung K; et al. (2018). "Non-Hodgkin lymphoma in South East Asia: An analysis of the histopathology, clinical features, and survival from Thailand". Hematol Oncol. 36 (1): 28–36. doi:10.1002/hon.2392. PMID 28332735.
  3. ↑ 3.0 3.1 3.2 Casulo C, Burack WR, Friedberg JW (2015). "Transformed follicular non-Hodgkin lymphoma". Blood. 125 (1): 40–7. doi:10.1182/blood-2014-04-516815. PMID 25499449.
  4. ↑ Bartl R, Frisch B, Burkhardt R, Jδger K, Pappenberger R, Hoffmann-Fezer G. Lymphoproliferations in bone marrow: i0 dentification and evaluation, classification and staging. J Clin Pathol 1984;37:233-54.
  5. ↑ Bain BJ, Clark DM, Lampert IA, Wilkins BS, editors. Bone marrow pathology. 3 rd ed. UK: Blackwell Science Ltd; 2001.
  6. ↑ Culling CF, Allison RT, Barr WT. Connective tissue. In: Cellular Pathology Techniques. 4 th ed. London: Butterworth and Co. ltd; 1985. p. 172-3.
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