Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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Nodular/Follicular pattern a. Nodular/follicular pattern with small cell morphology Follicular Lymphoma Mantle Cell Lymphoma Marginal Zone Lymphoma SLL/CLL BASIC IHC PANEL ON FFPET CD20 CD3 CD5 CD10 CD23 Cyclin D1 BCL 2 Ki67 FCM Cytogenetics b. Nodular/follicular pattern with larger cells or “atypical” morphology consider - NLPHL Lymphocyte Rich HL NSHL And handle as per HL c. Non-nodular small cell morphology Investigate as per basic IHC panel Consider Lymphoplasmacytic lymphoma Potential diagnostic pitfalls for small cell morphology ■ Lymphoplasmacytic lesions 11
Summary of the usual Immunostaining Pattern of B-cell Neoplasms Precursor B-cell neoplasms CD20 CD79 CD5 CD23 CD10 CD30 CD15 CyclinD1 Precursor B-lymphoblastic leukaemia/lymphoma - +/- - - + - - - Mature B-cell neoplasms B-cell chronic lymphocytic leukaemia/lymphoma + + + + - - - - B-cell prolymphocytic leukaemia + + - +/- - - - -/+ Lymphoplasmacytic lymphoma + + - -/+ - - - - Mantle Cell lymphoma + + + - - - - + Follicular lymphoma + + - -/+ + - - - Marginal zone B-cell lymphoma of mucosa associated lymphoid tissue type + + - - - - - - Nodal marginal zone lymphoma +/- (monocytoid B-cells) + + - - - - - - Splenic marginal zone lymphoma + + - - - - - - Hairy cell leukaemia + + - - - - - - Plasmacytoma - + - - - -/+ - - Plasma cell myeloma - +/- - - - -/+ - - Diffuse large B-cell lymphoma + + -/+ -/+ -/+ -/+ - - Mediastinal (thymic) + + - +/- -/+ -/+ -/+ - Intravascular + + -/+ - -/+ -/+ - - Primary effusion lymphoma - + - - - + - - Burkitt lymphoma + + - - + - - KEY +/- The lymphoma cells are commonly but not always positive -/+ The lymphoma cells are usually but not always negative Note that for T-cell and putative NK-cell neoplasms, immunostaining is complex and variable. 12
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 and 12: Hodgkin lymphoma and its differenti
Page 13: Potential diagnostic pitfalls for l
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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