Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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Large/Intermediate Cell Morphology on H&E BASIC IHC PANEL ON FFPET CLA CD20 CD3 CD5 + Cyclin D1 (To exclude Blastic Mantle Cell Lymphoma) CD30 Ki67 BCL2 BCL6 CD10 IRF4/MUM1 } To provide additional prognostic/ therapeutic information to clinician CLA } + CD20 + CD79a .........................Profile of Diffuse large B Cell lymphoma CD3 - CD30 - CD5 - IF CD20+ /CD79a + but proliferative index (Ki67) is high (>90%) ■ Consider BURKITT (look for “starry sky” morphology; BCL2 NEG) or Intermediate BL/DLBCL Confirm with Molecular testing for MYC , BCL2, BCL6 ■ Consider Lymphoblastic – Do TdT IF CD20 - Do CD79A and CD138 IF CD79a + ■ Consider MYELOMA (CD138 +) ■ Consider Myeloid neoplasms (MPO, CAE) IF CLA – ■ Consider ALCL (CD30+, ALK +) or Non Lymphoid Malignancy T CELL ■ ■ ■ ■ IF CD20- / CD79A-/CD3+ T-Cell Lymphoma Do CD30, ALK-1 CD56, CD4, CD8 9
Potential diagnostic pitfalls for large/intermediate cell morphology Non-lymphoid malignancy ■ Germ Cell tumour ■ Carcinoma ■ Melanoma ■ Sarcoma Burkitt lymphoma is missed – (If proliferative index (Ki67) is high and BCL2 is negative – think Burkitt) Confirm with Molecular genetic studies for MYC and BCL2 translocations B Cell Lymphoblastic lesions - (include TdT in panel) Myeloid lesions If CD20 is negative but CD79A positive Plasma Cell lesions consider these “Blastic” Mantle Cell lymphoma – include CD5 in initial panel. Confirm with Cyclin D1 or molecular genetic studies for BCL1 translocation. 10
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 and 10: Pathologic Diagnosis of Lymphoma Ge
Page 11: Hodgkin lymphoma and its differenti
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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