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11/9/20101Understanding Diagnostic TestsSteven M. Horwitz AttendingLymphoma ServiceMemorial Sloan-Kettering Cancer CenterLymphomasDiagnosis and workup 2 of the most important initial questions What do you have? Where do you have it? Other important question What are you going to do about it?11/9/20102LymphomasDiagnosis Biopsy of suspicious lymph nodes or masses (extranodal) Routine histology Immunophenotyping CD2, CD3,CD4, CD5, CD7, CD8, CD20, CD30, CD56, etc11/9/20103Large CellsSmall CellsFollicularDiffuseArchitecture11/9/2 0104Types of Biopsies Fine needle aspirate (FNA) Core Needle Biopsy Surgical: Incisional or excisionalTypes of BiopsiesFNASmallest sampleBedside or hard to reachNo ArchitectureCoreHollow needleLess invasiveCT guidedSmall SampleSurgicalBest sampleMost informationMost tissueRequires an incision11/9/20105Immunophenotyping Tells what kind of cell it is B cell vs T cell (CD whatever) Patterns of markers lead to diagnosisCD3CD20CD8CD10CD30CD5Immunohist ochemistryAntigenAntibody Stain Enzyme-colorFluorescencePattern can lead to the diagnosis11/9/20106DIFFUSE LARGE B CELL STUDIES SHOW THAT THE B CELLS ARE POSITIVE FOR CD20AND HIGH PROLIFERATIVE RATEDiffuseLargeCD20Ki-67BCL2+Ki-67 10%CD20+CD10+FOLLICULAR lymphoma : IMMUNOHISTOCHEMICAL STUDIES DEMONSTRATES NEOPLASTIC CELLS TO BE POSITIVEFOR CD20, CD10, BCL2.

11/9/2010 1 Understanding Diagnostic Tests Steven M. Horwitz M.D. Assistant Attending Lymphoma Service Memorial Sloan-Kettering Cancer Center Lymphomas

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