molar

1. • The diagnosis of lymphoma is an
integrated process and encompasses:
• 1. Clinical information
• 2. H and E morphology
• 3. Immunophenotyping
• 4. Cytogenetics
• 5. Molecular studies.

2. • Tissue sample sent to the laboratory for a suspected
case of lymphoma can be sent for the following tests:
– Microscopy on appropriately fixed and stained tissue
samples.
– IHC or for flowcytometry.
– Cytogenetic analysis by Giemsa banding.
– FISH on cell suspensions, films, imprints or paraffin
sections.
– Molecular genetic analysis by RT-PCR or gene
sequencing.

3. Morphological Analysis of
Lymph Nodes:

4. • Well fixed LN tissue cut at 3 microns and
stained with H and E.
– Cornerstone for the diagnosis of lymphoma
– Regardless of number of advanced anicillary
tests available at hand.

5. Points to Note Under Low
Power:
• Architecture pattern of the lymph node:
– Diffuse
– Nodular/follicular
– Mantle zone
– Marginal
– Interfollicular
– Sinusoidal
– Heterogenous

6. Points to Note Under High
Power
• Cell size
• Monotonous/heterogenous
• Chromatin pattern
• Nucleoli
• Nuclear shape
• Cytoplasm

7. Cell Size:
• Good guide to the grade of many types of
NHL.
• Poor fixation / Thick section: cell assumes
shrunken apppearence.
• Excess intense nuclear staining: masks
subtle nuclear details.
• Hence most impportant: adequate tissue
fixxation.

8. Assessing the Size of Lymphoid
Cells:
• Large lymphoid cells: nuclei larger than that of a
histiocyte nucleus.
• Medium sized cells: comparable/slightly smaller than that
of a histiocyte nucleus.
• Small lymphoid cells: nuclei much smaller than that of a
• histiocyte.

9. Lymphoid Neoplasm with Small
Cells:
• Follicular lymphoma grade 1-2
• Mantle cell lymphoma
• Marginal zone lymphoma
• CLL/SLL
• LPL

10. Lymphoid Neoplasm with
Medium-sized cells:
• Burkitt’s lymphoma.
• Lymphoblastic lymphoma
• DLBCL (rare)
• PTCL-NOS (variants)
• NMZL

11. Lymphoid Neoplasms with
Large Cells:
• DLBCL
• PTCL
• ALCL
• Follicular lymphoma grade 3B