Guidelines on Diagnosis and Treatment of Malignant Lymphomas

Pathologic Diagnosis
of Lymphoma
General comments
1. Primary diagnosis
a. Complete lymph node excision in the presence of nodal
disease is the optimum diagnostic material and should be
utilised wherever possible. *
b. The complete lymph node excision should be transported
immediately in a fresh state to the laboratory.
c. The fresh lymph node should be handled as per algorithm
on page 15.
d. *Where full lymph node excision is not possible e.g.
inaccessible mass or extranodal disease, core biopsy is the
next best option for accurate primary diagnosis unless a
resection has been or will be undertaken. Multiple large
cores should ideally be submitted fresh to the laboratory on
saline soaked gauze otherwise they should be submitted in
10% buffered formalin.
e. All cases must be received with relevant clinical information.
2. The role of Flow Cytometry (FCM)
a. FCM is useful for accurate diagnosis in all small cell /
follicular pattern lesions.
b. FCM on aspirated material may provide a reasonable
alternative to biopsy in recurrent disease where tissue is
not easily obtainable e.g. elderly/frail patient, inaccessible
site. Such FNA samples require co-ordination with the
laboratory as special fixation (RPMI) and immediate
processing is required
3. Optimum handling of fresh lymph node excision
a. Ensure immediate transfer from the theatre to laboratory.
b. Bisect node and perform touch preparations.
i. Air dried x 2 – Giemsa stain
ii. Air dried X6-8 FISH studies if required
iii. Fixed x 2 – H & E stain
c. Sample portion of tissue for:
i. Freezing – 1 portion in “RNA later”, 1 portion fresh
frozen (this will preserve material for molecular study
should this be required).
ii. RPMI for FCM (this will preserve the cells and allow
transport to nearest centre offering FCM and/or
Cytogenetics service).
iii. Formalin for routine fixation and processing.
4. Classification and grading
a. Use WHO classification 4th edition 2008
b. Where applicable use WHO grading e.g.
Follicular Lymphoma (see page 29)
5. The role of FCM/Cytogenetics/
Gene expression profiling
Material should be preserved in RPMI and frozen
for availability for cytogenetic analysis and other
relevant evaluation
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