Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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Immunohistochemistry (IHC) Hodgkin Lymphoma (HL) BASIC IHC PANEL ON FFPET (Formalin fixed, paraffin-embedded tissue) - CD45 - CD3 - CD20 - CD15 -CD30 - EMA (EMA should be negative in classic HL; positive in NLPHL) IF H&E MORPHOLOGY IS TYPICAL CD45 CD3 CD20 CD15 CD30 CD3 CD20 CD15 CD30 } } .......................NEGATIVE .......................POSITIVE } .......................NEGATIVE } .......................NEGATIVE .......................POSITIVE } .....................HL Consider ALCL Perform ALK1 If ALK 1 NEG If ALK 1 POS ................................................................HL ................................................................ALCL IF H&E MORPHOLOGY IS ATYPICAL ADD THE FOLLOWING TO THE INITIAL BASIC IHC PANEL CD79A CD5 CD10 ALK 1 Myeloperoxidase – to exclude myeloid origin. MCT – to exclude mast cell origin. Non-lymphoid markers as appropriate e.g. to exclude – Germ Cell tumours Malignant melanoma Poorly differentiated carcinoma 7
Hodgkin lymphoma and its differential diagnosis CD20 CD79a T-Cell CD4 CD30 CD15 EMA antigen CD8 Nodular lymphocyte predominant HL + + - - -/+ - + Classical HL -/+ -/+ - - + + -/+ T-cell rich large B-cell lymphoma + + - - - - - Anaplastic large cell lymphoma - - +/- CD8>CD4> + - + CD4&8-ve KEY +/- The lymphoma cells are commonly but not always positive -/+ The lymphoma cells are usually but not always negative Potential diagnostic pitfalls in Hodgkin lymphoma With “Typical” H&E Morphology ■ ALCL ■ T cell rich B cell lymphoma ■ Diffuse large B cell lymphoma With “Atypical” H&E Morphology ■ ALCL ■ ■ ■ ■ ■ ■ T cell rich B cell lymphoma Diffuse large B cell lymphoma Intermediate CHL/DLBCL (Grey zone lymphoma) Myeloid origin Mast cell origin Non-lymphoid neoplasms 8
Page 1 and 2: Guidelines on Diag
Page 3 and 4: Guidelines on Diag
Page 5 and 6: Standards In Diagnosis of Lymphoma
Page 7 and 8: Standards in Staging of Lymphoma An
Page 9: Pathologic Diagnosis of Lymphoma Ge
Page 13 and 14: Potential diagnostic pitfalls for l
Page 15 and 16: Summary of the usual Immunostaining
Page 17 and 18: Mature B-Cell Neoplasms Mature B-Ce
Page 19 and 20: Immunophenotype The tumour cells ex
Page 21 and 22: Lymphoplasmacytic Lymphoma Definiti
Page 23 and 24: Splenic Marginal Zone Lymphoma Defi
Page 25 and 26: Extra-nodal Marginal Zone B-Cell Ly
Page 27 and 28: Persistent / progressive disease or
Page 29 and 30: Follicular Lymphoma Definition and
Page 31 and 32: Potential Pitfalls a. Failure to di
Page 33 and 34: Mantle Cell Lymphoma Definition and
Page 35 and 36: Diffuse Large B-Cell Lymphoma Defin
Page 37 and 38: Stage 1 (bulky) and stages II - IV
Page 39 and 40: Treatment Standard chemotherapy for
Page 41 and 42: Burkitt Lymphoma/Leukaemia Definiti
Page 43 and 44: CODOX-M, (3 cycles) for low risk di
Page 45 and 46: Potential pitfalls Failure to diffe
Page 47 and 48: Precursor T Cell Neoplasms PRECURSO
Page 49 and 50: Mature T-Cell and NK-Cell Neoplasms
Page 51 and 52: Potential Pitfalls Treatment planni
Page 53 and 54: Recommended Investigations Evaluati
Page 55 and 56: Mycosis Fungoides and Sézary Syndr
Page 57 and 58: ■ ■ Lymph node biopsy if there
Page 59 and 60: Primary Cutaneous CD30-Positive T-C
Page 61 and 62:
Angioimmunoblastic T-Cell Lymphoma
Page 63 and 64:
Prognostic factors The IPI is of li
Page 65 and 66:
Hodgkin Lymphoma (HL) Definition an
Page 67 and 68:
Prognostic Factors / Index: i. Earl
Page 69 and 70:
Immunodeficiency Associated Lymphop
Page 71 and 72:
of cases and EBV in about 50%, but
Page 73 and 74:
Common Issues in Lymphoma Managemen
Page 75 and 76:
Tumour Lysis Syndrome Tumour Lysis
Page 77 and 78:
Haematopoietic Recombinant Growth F
Page 79 and 80:
Follow-Up Follow-up for patients wi
Page 81 and 82:
Follow-up for patients with concern
Page 83 and 84:
77 Appendix
Page 85:
Lower border: The lower of (i) 5 cm
Page 88 and 89:
Glossary of Treatment Regimens Chlo
Page 90:
2nd Edition. May 2010. Supported by
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Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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