HemPath

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Lymph node (Hematopathology): Click on section headings below (in blue) to expand or collapse the section content

This section is a synoptic list of diagnostic wordings for the most commonly rendered diagnoses in this organ / system. For details and more, go to the specific category sections below.

General / Common Abnormalities of the Lymph Nodes:

-- Reactive follicular and paracortical hyperplasia.

-- Benign reactive lymph nodes with follicular hyperplasia and progressive transformation of germinal center.

-- Dermatopathic lymphadenopathy

-- Diffuse large B-cell lymphoma with high proliferation rate (90% positive for Ki67) (Microscopic Description & Lab Work-Up ).

-- _______ lymphoma, grade _______ (see Microscopic Description & Lab Work-up)

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Non-Hodgkins Lymphomas

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Clinical scenario:

Left orbital mass, biopsy:

-- Follicular lymphoma, grade 3 (out of 3) .

-- See Microscopic Description & Lab Work-Up below.

Slides examined: H&E x 1, IHC x 11

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Microscopic Description & Lab Work-Up:

Touch prep of orbital mass biopsy shows presence of a mixture of small lymphocytes with mature cytological features, and many intermediate-large lymphocytes with scant cytoplasm, vesicular nuclei and one to several nucleoli.

Histologic sections show hypercellular dense lymphoid tissue with many poorly-defined neoplastic follicles of variable sizes. The follicles lack a well-defined mantle zone and contain mostly centroblasts with intermediate-large size, vesicular chromatin pattern and one to several nucleoli. Tingible-body macrophages and mitotic figures are also seen in the follicles.

Immunohistochemical stains performed on block 1A, with adequate controls, show that the neoplastic cells in the follicles are positive for bcl-2, CD10 and CD20, but are negative for bcl-1, CD3, and CD5. Ki-67 shows approximately 30% proliferation rate with even distribution in the follicles. CD23 shows residual follicular dendritic cells in the follicles. CD15 and CD30 show scattered positivity. CD57 is negative.

Immunophenotyping by flow cytometry shows a prominent B-cell population (about 85% of the cells analyzed) that is positive for CD19, CD20, CD22, FMC7, surface kappa light chain restriction (dim), and cytoplasmic kappa light chain restriction, but is negative for CD5, CD23 and CD38. These B-cells have intermediate-large nuclear size (based on forward-scatter signal). a T-cell population (about 14% of the lymphocytes analyzed) with no aberrant loss or aberrant expression of T-cell markers.

Editor's comment:

This reporting format / template is recommended for hematopathology in this DxWording although only the key features of the lesion are shown succinctly in a pop-up window for most remaining examples.

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Clinical scenario:

Left inguinale, lympho node, biopsy:

-- Diffuse large B-cell lymphoma with high proliferation rate (90% positive for Ki67) (see comment)

-- Negative for Epstein Barr virus

-- See Microscopic Description & Lab Work-Up .

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Right inguinae, lymph nodes, excisnional biopsy:

-- Diffuse large B-cell lymphoma (70%) and follicular lymphoma, grade 3/3 (30%), indicating transformation of follicular lymphoma to diffuse large B-cell lymphoma

-- See Microscopic Description & Lab Work-Up .

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Skin, left face, punch biopsy:

-- Burkitt's lymphoma.

-- See Microscopic Description & Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Left thigh, anterior mass,excisional biopsy:

-- T-cell/histiocyte-rich large B-cell lymphoma.

-- See Microscopic Description & Lab Work-Up

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

Due to relative small proportion of the neoplastic cells, flow cytometry often show normal immunophenotype. Thus, the flow cytometric results are often not diagnostic for T-cell/histiocyte-rich large B-cell lymphoma.

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Clinical scenario:

Rectum, polyps, polypectomy:

-- Mantle cell lymphoma.

-- See Microscopic Description & Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Skin, left face, punch biopsy:

-- Marginal zone (B-cell) lymphoma.

-- See Microscopic Description & Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Left axillae, lymph node, biopsy:

-- Small lymphocytic lymphoma.

-- See Microscopic Description and Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Hodgkins Lymphomas

Plasmacytic Neoplasm

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Clinical scenario:

Left thoracic spine, mass, excisional biopsy:

-- Multiple myeloma with prominent bone destruction.

-- See Microscopic Description & Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Note: The immunophenotype results, together with morphology findings and recent diagnosis of multiple myeloma, are consistent with the diagnosis of multiple myeloma involving the thoracic spine.

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Left orbital mass, excisional biopsy:

-- Plasmacytoma.

-- See Microscopic Description & Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Note: The combined histological and immunohistochemical findings are consistent with plasmacytoma in the left orbit. Further clinical work-up (serum and urine protein electrophoresis and immunofixation, serum quantitative immunoglobulins, serum calcium, bone marrow aspirate and biopsy, imaging studies to look for lytic lesions) is recommended to rule out multiple myeloma in this patients.

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Right supraclavicular lymph node, biopsy:

-- Plasmablastic lymphoma, with nearly 100% of tumor cells positive for Ki-67.

-- See Microscopic Description & Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Note: The combined histological and immunohistochemical findings are consistent with plasmacytoma in the left orbit. Further testing and clinical correlation are recommended to rule out multiple myeloma in this patients (serum and urine protein electrophoresis and immunofixation, serum quantitative immunoglobulins, serum calcium, CBC, renal function tests, bone marrow aspirate and biopsy, imaging studies to look for lytic lesions).

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Non-Neoplastic Lymphadenopathy

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Clinical scenario:

Right cervical lymph nodes, biopsy: #

-- Follicular lymphoid hyperplasia (see Note).

-- No granuloma or necrosis

Note: Immunophenotyping of the cervical lymph node by flow cytometry shows a T-cell population (about 70% of the cells analyzed) with no aberrant loss or aberrant expression of t cell markers, a B-cell population (about 30% of the cells analyzed) that is negative for CD5, CD10, with no surface light-chain restriction.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Right axillary lymph nodes, biopsy: #

-- Benign reactive lymph nodes with follicular hyperplasia and progressive transformation of germinal center.

-- No lymphoma or metastatic carcinoma.

-- See Microscopic Description and Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Left cervical posterior triangle, lymph nodes, biopsy:

-- Reactive follicular and paracortical hyperplasia.

-- No granuloma, necrosis or malignancy.

-- See Microscopic Description and Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Note: Use this template first. Convert is later into table formats as shown in the Design section

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Left axilla, lymph nodes, biopsy:

-- Dermatopathic lymphadenopathy

-- No granuloma, lymphoma or metastatic carcinoma

-- See Microscopic Description and Lab Work-Up.

Slides examined: H&E, IHC x __

CPT code: 88309-GC x __, 88331-GC x __, 88187-GC x __, 88342-26 x __, 88342-TC x __

Editor's comment:

For most cases, a limited panel of imuunohistochemical stains to exclude clonal expansion or light chain restriction is sufficient for uncertain cases by routine H&E histology.