Diagnosis & Pathology
Diagnosis & Biopsy Information
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"About 85% of non- Hodgkin's lymphomas arise in B-cells;
occur in T-cells.
Activation of a gene called BCL-2 is believed to be
partly responsible for many B-cell lymphomas.
This defect prevents
apoptosis in the lymphoma cells (a natural process whereby cells self-
"Storing all frozen specimens in the vapor
phase of liquid nitrogen freezers will ensure that physical and
chemical reactions within tissue are slowed so that the specimens
remain stable for use over many years, and biomarkers of interest to
researchers preserved. If cryopreservation for viable cells is
required, biospecimens should undergo controlled rate freezing to
prevent damage by ice crystallization."
NBN blueprint. PDF
often first appears as an enlarged lymph nodes, a
condition called lymphadenopathy. Importantly, most cases of enlarged
lymph nodes are NOT cancers, as the following resource describes:
Lymphadenopathy: Differential Diagnosis
Robert Ferrer, M.D., M.P.H. American
the finding of lymphadenopathy sometimes raises fears about serious
illness, it is, in patients seen in primary care settings, usually
a result of benign infectious causes.
Most patients can be
diagnosed on the basis of a careful history and physical examination.
Localized adenopathy should prompt a search for an adjacent
(nearby) precipitating lesion and an examination of other nodal areas to rule
out generalized lymphadenopathy."
To make an accurate
diagnosis of lymphoma, a lymph node biopsy must be performed
by the surgical removal (resection) of a lymph node. A fine
needle aspiration (FNA) may be performed if a lymph node is not accessible,
but this is not considered a definitive way to determine the
* FNA, being a small way to get a sample, can miss malignant
cells (leading to a false negative finding) and can lack the
information needed to determine the type of lymphoma and the grade
when positive (requiring a full biopsy anyway).
A series of tests will then
be performed to determine the characteristics of the cells. If a
malignancy is determine, these characteristics will allow your doctors
to determine the appropriate treatments to use when
Waiting for the results of a
biopsy may be the most stressful time
for the patient and his or her loved ones. It can take many
weeks to accurately determine the pathology of the sample.
Snap-freezing part of
this tissue is advised at this time as custom vaccines and potentially
other advanced therapies can be developed from this tissue if it's
stored correctly. You may have to request this in order to make
it happen, as fast freezing is not yet a mainstream procedure in all
This simple request is likely to result in improved diagnosis and more rational
selection of treatments in the near future.
A bone marrow biopsy may
also be ordered to determine the extent of involvement
in the bone marrow. This sounds ominous, but the presence
of malignant cells in the bone marrow is not unusual because the bone
marrow is part of the immune system. It is where b-cells form.
Treatment can also clear the marrow of malignant
The science of making a
diagnosis is evolving rapidly. Uncovering genetic and molecular characteristics of
lymphomas will also lead to new treatment targets. You need to first identify the characteristics of the enemy before you can exploit its
CT scans and other tests may
be ordered to determine where the disease is forming tumors.
This will serve as a baseline to allow your doctor to monitor how
fast or slow your lymphoma is progressing and/or evaluate response to
When monitoring disease, you
may wish to consult with your doctor about alternatives to CT scans, such as
sonograms, especially when accurate measurements are not
required. See How Many CTs?
Lung nodules -- is it lymphoma or a cancer?
* NEJM, 2013:
Probability of Cancer in Pulmonary Nodules Detected on First
the rates of
cancer in the two data sets were 5.5% and 3.7%, respectively.
Predictors of cancer in the model included older age, female
sex, family history of lung cancer, emphysema, larger nodule
size, location of the nodule in the upper lobe, part-solid
nodule type, lower nodule count, and spiculation (needle-like
Hematopathology Approaches to Diagnosis and
Prognosis of Indolent B-Cell Lymphomas asheducationbook.org
(The advent of new technologies has contributed to improvements in
the diagnosis and classification of the non-Hodgkin lymphomas
Overview of Diffuse and Follicular patterns
Immunohistochemistry in the Evaluation
of Follicular or Nodular Lymphoid Lesions - propathlab.com
October 2003 by Rodney T. Miller, M.D., Director of Immunohistochemistry
Recommendations for the Reporting of Lymphoid Neoplasms -
(free login req.)
A checklist for pathologists and surgeons on how to evaluate and store lymphoid tissue at biopsy.
Technical Resource on diagnosis of
New Approaches to Lymphoma Diagnosis
Randomized comparison of power Doppler ultrasound-directed
excisional biopsy with standard excisional biopsy for the
characterization of lymphadenopathies in patients with suspected
J Clin Oncol. 2004 Sep 15;22(18):3733-40. PMID:
15365070 | Related
for more information
|There are many
classifications of Non-Hodgkin's and other b-cell
lymphomas, which are determined by appearance of the cells under
microscopic examination (morphologic), and the stage of development of
the cell (immunophenotypic). Increasingly, assessment of genetic
characteristics -- the expression of genes in the malignant cells --
will be used to refine our understanding of types and subtypes of
lymphomas. See REAL
and WHO systems for
describe how fast the lymphoma is likely to grow (histology), and how wide spread it
is at diagnosis (stage). Most
often, patients are diagnosed with stage 4 disease, but this does not
mean treatment is required or that the disease cannot be successfully
Arbor Stages of Non-Hodgkin's Lymphoma Grade
classifications of Lymphoma, WHO to Rappaport lymphomainfo.net
When older terminology is used to diagnose, this table becomes
cytogenetic entities Antonio Cuneo
Unfortunately, there is no lab test to screen for lymphoma. Symptoms can
resemble many other conditions, such as infection.
diagnosis of lymphoma generally requires a biopsy
-- the surgical resection of a
lymph node. The tissue is then analyzed with numerous tests to
determine if the cells are normal or have malignant
It's important to receive an accurate
diagnosis, so that the treatments selected will be appropriate. For
this reason, some pathologists recommend getting a second evaluation
of the tissue. See Getting
a Second Evaluation
If a lymphoma is diagnosed, additional tests may
be performed, such as imaging (CT or MRI) and a bone marrow biopsy, to
determine the stage of the
Also see Classifications,
above, and Pathology below.
and subsequent evaluation by a trained pathologist is the only way to
definitively diagnose lymphoma. It may take weeks to get the results, which is a
major source of anxiety for patient and family.
When surgical resection
(removal) of a lymph node is not possible, a Fine
Needle Aspiration or Large
Needle/Core Biopsy may be performed, but each of these
procedures have important diagnostic limitations.
is the science of defining characteristics of malignant cells
compared to normal cells from which the cancer cells originate.
You are likely to receive a pathology report of a lymph node tissue
and possibly a report of a sample taken from your bone marrow.
may find the meaning of terms in your pathology report in the links
We recommend that you ask for a copy of this report, as it is needed
when consulting experts about your treatment options.