Knowing Lymphology·Phase 3 Pathology Expert Talk: How to clarify the idea of ​​differential diagnosis of lymphoma?

In order to further enhance the pathologist’s ability in the clinical differential diagnosis of common tissue diseases and lymphoma, and reduce the occurrence of missed lymphoma diagnosis, the "Knowledge of Lymphoma-Basic Lymphoma Diagnosis" series of interviews officially set sail, and Yimaitong will invite many people Experts in pathological diagnosis of lymphoma were interviewed to share the theories and practical experience in the differential diagnosis of common diseases and lymphomas in different tissues, so as to help pathologists to improve the comprehensive diagnosis ability of lymphoma
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In this issue of "Knowing the Principles of Leaching", Professor Yi Hongmei from Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Professor Wu Meijuan from Cancer Hospital Affiliated to the Chinese Academy of Sciences, Professor Zhai Qiongli from Tianjin Medical University Cancer Hospital, and Dr.
Xie Jianlan from Beijing Friendship Hospital, Capital Medical University Accept an interview to share the pathological diagnosis ideas of lymphoma
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Yimaitong is well known that the difficulty of lymphoid tissue proliferative lesions is very high, how to avoid missed diagnosis/misdiagnosis in pathological diagnosis, can you please share the diagnosis ideas of lymphoid tissue proliferative lesions? Professor Yi Hongmei’s diagnosis of lymphoid tissue proliferative lesions should start from the diagnosis ideas and diagnostic points, which are mainly divided into five steps
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(1) The pathologist should first understand the patient's age, location, symptoms, and disease evolution
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(2) Evaluation of tissue structure: understand the pattern of lymphoid tissue proliferation, and observe the pathological tissue structure under a low-power microscope
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Follicular/nodular hyperplasia requires observation of the number of follicular cells, single/polyclonal, and whether there is invasion/fusion.
Diffuse hyperplasia requires observation of blood vessels and staining to determine whether it is a paracortical area
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(3) Judgment of cell morphology: Determine cell morphology under medium/high magnification
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(4) Observation of growth pattern: understand the morphological evidence of each tumor diagnosis
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(5) Application of auxiliary means: make full use of auxiliary means, such as immunohistochemistry, molecular detection, in situ hybridization, etc.
for comprehensive diagnosis of pathological tissues
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Yimaitong Central Nervous System Lymphoma (PCNSL) is a rare subtype of non-Hodgkin’s lymphoma, and the diagnosis is more complicated
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Can you share your experience in the differential diagnosis of PCNSL and related lesions? Professor Wu Meijuan’s PCNSL lymphoma is 95% of diffuse large B-cell lymphoma (DLBCL), mostly non-GCB subtypes.
Pathological diagnosis follows the general principles of lymphoma diagnosis
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Stereotactic tissue biopsy is usually recommended for pathological diagnosis .

To diagnose DLBCL of the primary central nervous system, we must first focus on the primary site, and secondly exclude systemic DLBCL involvement in the central system, such as primary dural lymphoma, intravascular large B-cell lymphoma, systemic lymphoma involving the brain, Immunodeficiency-related lymphoma
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A few cases have ectopic BCL6 and MYC, and rarely have BCL2 ectopic
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The prognosis of primary central nervous system DLBCL is poor, usually accompanied by MYD88 and CD79B mutations.
The molecular classification of PCNSL-DLBCL is MCD type, which has a poor prognosis
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In addition, the diagnosis of PCNSL must be communicated with the clinic, and the doctor should instruct the patient to prohibit the use of hormone therapy during pathological biopsy, so as not to affect the diagnosis
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Yimaitong children’s lymphoma accounts for 15% of childhood malignancies and ranks third in childhood malignancies
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The diagnosis of childhood lymphoma is very demanding, and if the doctor is not experienced, it is very easy to misdiagnose and cause delay in treatment
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Could you please briefly introduce the pathological diagnosis ideas of childhood lymphoma? Professor Zhai Qiongli's treatment methods for different pathological subtypes of lymphoma are very different.
Because of pathological diagnosis errors, clinicians adopt the wrong treatment plan, which will seriously affect the treatment effect
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Age is an important clinical information for the diagnosis of childhood lymphoma, which can quickly narrow the scope of diagnosis, such as lymphoblastic lymphoma (LBL), Hodgkin’s lymphoma (HL), Burkitt’s lymphoma (BL), anaplastic large cell lymphoma Tumor (ALCL)
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Children’s non-Hodgkin’s lymphoma (NHL) is usually aggressive lymphoma (such as BL), and almost no indolent B-cell lymphoma.
If indolence occurs, children’s follicular lymphoma (PFL) and IRF4 should be considered.
LBCL, testicular follicular lymphoma (FL), and childhood marginal zone lymphoma (PMZL)
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It should be noted that in young patients, nodal onset, especially with high fever, is most common in T-cell lymphoma (T-NHL)-anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (AKL+ALCL)
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In addition, certain specific parts can also provide good classification clues, such as mediastinal space occupation, consider HL, primary mediastinal large B-cell lymphoma (PMLBCL), DLBCL, difficult to define HL; gastrointestinal ileocephaly DLBCL can not be directly considered for the area occupied by the neck; the neck area is occupied and inert, and B-cell lymphoma is usually considered
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If Yimaitong finds an ileocecal area in the gastrointestinal tract, how should it be diagnosed? Professor Zhai Qiongli occupies the ileocecal area of ​​the gastrointestinal tract, so DLBCL cannot be directly considered
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Because the incidence of BL is much higher than that of DLBCL when the ileocecal area of ​​the gastrointestinal tract is occupied in children
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Under the premise of ensuring the quality of pathological sections, the diffusely distributed B cells under the microscope, especially the "starry sky", the Ki67 index is very high, the germinal center origin, BCL-2 is negative, and the CMYC expression is high, you must be highly suspected of BL
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At any time, remember that the age and location of a child are not absolute, and a diagnosis must be made after a complete examination
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The accurate diagnosis of diffusely distributed B cells (obviously "starry sky") Yimaitong is the basis for reasonable treatment of lymphoma patients.
How should pathologists diagnose immunodeficiency and non-immune deficiency-related B cell disease in clinic? When Dr.
Xie Jianlan diagnoses the disease, the pathologist should first understand how B lymphoid tissue lesions are classified, and clarify congenital and primary immunodeficiency-related lymphoid tissue proliferative diseases (LPD), HIV infection-related LPD, post-transplant LPD, and medical Source LPD
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The next step is to determine the cell morphology of the pathological tissue (early lesions, pleomorphic lesions or monomorphic lesions), and then further confirm the diagnosis based on different pathological tissue morphologies
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Epstein-Barr virus (EBV)-related mucosal skin ulcers can also be seen in immunodeficiency-related diseases.
The main point of identification is that these patients have negative peripheral blood serum antibodies and often have low gene copy numbers
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Primary immunodeficiency-related lymphoid group lesions need to be comprehensively diagnosed.
The diagnosis cannot be made only by pathology.
The diagnosis should be made in conjunction with the patient's family history and genetic and immunological examinations
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Professor Yi Hongmei, Deputy Chief Physician, Department of Pathology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Doctor of Medicine, Backbone of Lymphohematopoietic Subspecialty Pathology, Deputy Director, Department of Pathology, Shanghai Jiaotong University School of Medicine, Member of Lymphocytic Disease Group, Chinese Medical Association Hematology Branch, China Education Standing member of the Lymphoma Committee of the Association, Youth Member of the Pathology Branch of the Shanghai Medical Association, Professor Wu Meijuan, Member of the Tumor Mark Professional Committee of the Chinese Anti-Cancer Association Master student supervisor of the University of Medicine Secretary of the Zhejiang Provincial Center for Quality Control of Clinical Pathology and Member of the Expert Group Member of the Oncology Group Member of the Pathology Branch of Zhejiang Medical Association.
He has been engaged in tumor pathological diagnosis and scientific teaching and research for more than 20 years.
He is good at pathological diagnosis of tumors in various systems, especially the pathological diagnosis of tumors of the lymphoid and hematopoietic system.
Professor Zhai Qiongli, Lymphoma Pathology, Tianjin Medical University Cancer Hospital Professional Team Leader, Chief Physician, Doctor of Medicine, Chinese Society of Gerontology and Geriatrics, Vice Chairman of Hematology Expert Committee, Chinese Society of Anticancer Association, Member of Tumor Metastasis Committee, Chinese Society of Anticancer Association, Member of Lymphohematopoietic Diseases Group, Chinese Society of Pathology, China Member of the Pathology Group of the Hematology Branch of the Anti-Cancer Association China Anti-Cancer Association Hematology Committee Member of the Standing Committee of the Chinese Clinical Flow Cytometry Association Member of the Brain Metastasis Group of the Neuro-Tumor Committee of the Chinese Anti-Cancer Association Member of the Standing Committee of Beijing Cancer Pathology Precision Diagnosis Research Association Member of the Standing Committee of the Hematology Branch of Tianjin Geriatric Association Member of the Hematology Committee of Tianjin Anti-Cancer Association Xie Jianlan Attending Physician Xie Jianlan, Department of Pathology, Beijing Friendship Hospital, has long been engaged in lymphoma diagnosis and research work.
Special contract of Chinese Journal of Pathology Reviewers published more than ten articles related to lymphoma in both Chinese and English.
RECOMMEND recommended reading 1.
Knowing about Lymphology·Issue 1 | A gathering of leading experts, focusing on improving pathological techniques to help accurate diagnosis of lymphoma 2.
Knowing about Lymphoma·Second Issue | Pathology Masters Talk: Combination of theory and practice can help pathological diagnosis of lymphoma.
View the full version of the interview video, please