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:*There is no evidence, however, that high Ki-67 should guide the selection of therapy.
:*There is no evidence, however, that high Ki-67 should guide the selection of therapy.
:*Molecular genetic analysis to detect BCL2 rearrangement, cytogenetics or FISH to identify t(14;18), and immunohistochemistry for Ki-67 may be useful under certain circumstances.
:*Molecular genetic analysis to detect BCL2 rearrangement, cytogenetics or FISH to identify t(14;18), and immunohistochemistry for Ki-67 may be useful under certain circumstances.
===Use of Immunophenotyping/Genetic Testing in Differential Diagnosis of Mature B-Cell and NK/T-Cell Neoplasms===
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{{Familytree|boxstyle=border: 0;| | | | | B01 | | | | | | | | B02 | | | | | |B01={{F1|CD5+}}|B02={{F1|CD5-}}}}
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{{Familytree|boxstyle=border: 0;| | C01 | | | | C02 | | | | | C03 | | | | | |C01={{F1|CCND1+}}|C02={{F1|CCND1-}}|C03={{F1|DLBCL}}}}
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===Classification of large cells based on Immunophenotypic/Genetic testing <ref>{{cite web | title = Non-Hodgkin's Lymphomas (NCCN.org) | url = http://www.nccn.org/professionals/physician_gls/PDF/nhl.pdf }}</ref>===
*Diffuse large B-cell lymphoma (DLBCL),NOS
:*T-cell/histocyte-rich large B-cell lymphoma (THRLBCL)
:*Primary DLBCL of the CNS
:*Primary cutaneous DLBCL, leg type
:*EBV-positive DLBCL of the elderly (EBV + DLBCL)
*DLBCL associated with chronic inflammation
*Lymphoid granulomatosis
*Primary mediastinal (thymic) large B-cell Lymphoma (PMBL)
*Intravascular large B-cell lymphoma
*ALK-positive large B-cell lymphoma
*Plasmablastic lymphoma
*Large B-cell lymphoma arising in HHV8-assciated multicentric Castleman disease (LBCL in HHV8 + MCD)
*Primary effusion lymphoma
*B-cell lymphoma unclassifiable, intermediate between DLBCL(U-DLBCL) and classical Hodgkins lymphoma(CHL)
*Mantle cell Lymphoma(MCL),pleomorphic variant

Revision as of 21:32, 24 August 2015

 
 
 
 
 
 
 
 
 
B-cell neoplasms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CD5+
 
 
 
 
 
 
 
CD5-
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CCND1+
 
 
 
CCND1-
 
 
 
 
DLBCL
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pleomorphic MCL
 
 
 
DLBCL, NOS CD5+
 
CD10+
 
 
 
 
 
 
 
CD10-
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
DLBCL, NOS GCB type
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BCL6+ IRF4/MUM1-
 
BCL6+ IRF4/MUM1+
 
BCL6- IRF4/MUM1+
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
DLBCL, NOS GCB type
 
Non-GCB
 
Post-GCB
 
 


Laboratory Findings

The diagnosis is easily established on histological grounds, but immunophenotyping is encouraged to distinguish follicular lymphoma from a nodular MCL or SLL.

  • Diagnosis is established by immunophenotyping using IHC and/or flow cytometry for cell surface marker analysis.
  • Follicular lymphoma has a characteristic immunophenotype, which includes CD20+, CD10+, BCL2+, CD23+/-, CD43-, CD5-, CCND1- and BCL6+. Occasional cases of FL may be CD10- or BCL2-.*In patients with BCL2-negative localized disease, the diagnosis of pediatric-type follicular lymphoma may be considered.
  • Low-grade follicular lymphoma with a high proliferation index (as determined by Ki-67 immunostaining) has been shown to be associated with an aggressive clinical behavior.
  • There is no evidence, however, that high Ki-67 should guide the selection of therapy.
  • Molecular genetic analysis to detect BCL2 rearrangement, cytogenetics or FISH to identify t(14;18), and immunohistochemistry for Ki-67 may be useful under certain circumstances.

Use of Immunophenotyping/Genetic Testing in Differential Diagnosis of Mature B-Cell and NK/T-Cell Neoplasms


 
 
 
 
 
 
 
 
 
B-cell neoplasms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CD5+
 
 
 
 
 
 
 
CD5-
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CCND1+
 
 
 
CCND1-
 
 
 
 
DLBCL
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pleomorphic MCL
 
 
 
DLBCL, NOS CD5+
 
CD10+
 
 
 
 
 
 
 
CD10-
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
DLBCL, NOS GCB type
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BCL6+ IRF4/MUM1-
 
BCL6+ IRF4/MUM1+
 
BCL6- IRF4/MUM1+
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
DLBCL, NOS GCB type
 
Non-GCB
 
Post-GCB
 
 

Classification of large cells based on Immunophenotypic/Genetic testing [1]

  • Diffuse large B-cell lymphoma (DLBCL),NOS
  • T-cell/histocyte-rich large B-cell lymphoma (THRLBCL)
  • Primary DLBCL of the CNS
  • Primary cutaneous DLBCL, leg type
  • EBV-positive DLBCL of the elderly (EBV + DLBCL)
  • DLBCL associated with chronic inflammation
  • Lymphoid granulomatosis
  • Primary mediastinal (thymic) large B-cell Lymphoma (PMBL)
  • Intravascular large B-cell lymphoma
  • ALK-positive large B-cell lymphoma
  • Plasmablastic lymphoma
  • Large B-cell lymphoma arising in HHV8-assciated multicentric Castleman disease (LBCL in HHV8 + MCD)
  • Primary effusion lymphoma
  • B-cell lymphoma unclassifiable, intermediate between DLBCL(U-DLBCL) and classical Hodgkins lymphoma(CHL)
  • Mantle cell Lymphoma(MCL),pleomorphic variant
  1. ↑ "Non-Hodgkin's Lymphomas (NCCN.org)" (PDF).
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