Abstract
Peripheral lymphadenopathy in the pediatric age group is screened using fine needle aspiration cytology (FNAC). Cases found to have features suspicious for lymphoma on FNAC need to undergo biopsy with immunohistochemistry for characterization and typing. In pediatric age group, peripheral lymph nodes are common in Hodgkin’s lymphoma for which biopsy is needed for subtyping. Distinction of classical Hodgkin’s lymphoma of lymphocyte rich type from nodular lymphocyte predominant Hodgkin’s lymphoma needs biopsy evaluation and a panel of immunostains. T lymphoblastic lymphomas and Burkitt’s lymphoma are the common types of non Hodgkin’s lymphoma seen in the pediatric age group. All lymphomas require a biopsy evaluation with immunohistochemistry and analysis of molecular genetic markers for proper characterization and selection of optimal treatment which are discussed in detail in this review.
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References
World Health Organization Classification of Tumors. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. Pathology and Genetics: Tumors of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press; 2001.
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO Classification of Tumors of Haemopoietic and Lymphoid Tissues. Lyon: IARC Press; 2008.
Swaminathan R, Rama R, Shanta V. Childhood cancers in Chennai, India, 1990–2001: Incidence and survival. Int J Cancer. 2008;122:2607–11.
Gatta G, Capocaccia R, Stiller C, Kaatsch P, Berrino F, Terenziani M; the EUROCARE Working Group. Childhood cancer survival trends in Europe: A EUROCARE Working Group study. J Clin Oncol. 2005;23:3742–51.
Joy MP, Iyer VK, Aron M, Kapila K, Verma K. Rapid staining using toluidine blue: A reliable method for quick diagnosis in ultrasound-guided aspiration cytology. Indian J Pathol Microbiol. 2003;46:589–92.
Das P, Iyer VK, Mathur SR, Ray R. Anaplastic large cell lymphoma: A critical evaluation of cytomorphological features in seven cases. Cytopathology. 2010;21:251–8.
Jindal B, Agarwala S, Bakhshi S, Jain V, Gupta AK, Kumar R, et al. Bilateral primary renal lymphoma with orbital metastasis in a child. Pediatr Blood Cancer. 2009;52:539–41.
Rubnitz JE, Crist WM. Molecular genetics of childhood cancer: Implications for pathogenesis, diagnosis, and treatment. Pediatrics. 1997;100:101–8.
Tiemann M, Claviez A, Lüders H, Zimmermann M, Schellong G, Dörffel W, et al. Proliferation characteristics in pediatric Hodgkin’s lymphoma point to a cell cycle arrest in the G(1) phase. Mod Pathol. 2005;18:1440–7.
Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood. 2004;103:275–82.
Alizadeh AA, Eisen MB, Davis RE, Ma C, Lossos IS, Rosenwald A, et al. Distinct types of diffuse large B-cell lymphomaidentified by gene expression profiling. Nature. 2000;403:503–11.
Shipp MA, Ross KN, Tamayo P, Weng AP, Kutok JL, Aguiar RC, et al. Diffuse large B-cell lymphoma outcome prediction by gene-expression profiling and supervised machine learning. Nat Med. 2002;8:68–74.
Rosenwald A, Wright G, Chan WC, Connors JM, Campo E, Fisher RI, et al. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:1937–47.
Hummel M, Bentink S, Berger H, Klapper W, Wessendorf S, Barth TF, et al. A biological definition of Burkitt’s lymphoma from transcriptional and genomic profiling. N Engl J Med. 2006;354:2419–30.
Dave SS, Fu K, Wright GW, Lam LT, Kluin P, Boerma EJ, et al. Molecular diagnosis of Burkitt’s lymphoma. N Engl J Med. 2006;354:2431–42.
Sup SJ, Alemañy CA, Pohlman B, Elson P, Malhi S, Thakkar S, et al. His. Expression of bcl-2 in classical Hodgkin’s lymphoma: An independent predictor of poor outcome. J Clin Oncol. 2005;23:3773–9.
Kim LH, Peh SC, Poppema S. Expression of retinoblastoma protein and P16 proteins in classic Hodgkin lymphoma: Relationship with expression of P53 and presence of Epstein–Barr virus in the regulation of cell growth and death. Hum Pathol. 2006;37:92–100.
Lossos IS, Jones KD, Warnke R, Natkunam Y, Kaizer H, Zehnder JL, et al. The expression of a single gene, BCL-6, strongly predicts survival in patients with diffuse large B-cell lymphoma. Blood. 2001;98:945–51.
Lossos IS, Morgensztern D. Prognostic biomarkers in diffuse large B-cell lymphoma. J Clin Oncol. 2006;24:995–1007.
Gascoyne RD. Emerging prognostic factors in diffuse large B cell lymphoma. Curr Opin Oncol. 2004;16:436–41.
Mournier N, Briere J, Gisselbreacht C, Emile JF, Lederlin P, Sebban C, et al. Rituximab plus CHOP (R-CHOP) overcomes bcl-2 associated reststance to chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL). Blood. 2003;101:4279–84.
Wilson KS, Sehn LH, Berry B, Chhanabhai M, Fitzgerald CA, Gill KK, et al. CHOP-R therapy overcomes the adverse prognostic influence of BCL-2 expression in diffuse large B-cell lymphoma. Leuk Lymphoma. 2007;48:1102–9.
Adida C, Haioun C, Gaulard P, Lepage E, Morel P, Briere J, et al. Prognostic significance of survivin expression in diffuse large B-cell lymphomas. Blood. 2000;96:1921–5.
Schlette EJ, Medeiros LJ, Goy A, Lai R, Rassidakis GZ. Survivin expression predicts poorer prognosis in anaplastic large-cell lymphoma. J Clin Oncol. 2004;22:1682–8.
Podar K, Anderson KC. The pathophysiologic role of VEGF in hematologic malignancies: Therapeutic implications. Blood. 2005;105:1383–95.
Iyer VK, Raina V, Dawar R. Prognostic utility of silver stained nucleolar organiser region counting in non Hodgkin’s lymphoma. Indian J Cancer. 2000;37:140–7.
Moorthy G, Agarwala S, Sharma A, Iyer VK, Srinivas M, Bajpai M, et al. Cytogenetic evaluation of neuroblastoma using fine needle aspiration cultures. Pediatr Surg Int. 2009;25:939–43.
Ensani F, Mehravan S, Irvanlou G, Aghaipoor M, Vaeli S, Hajati E, et al. Fine needle aspiration cytology and flow cytometric immunophenotyping in diagnosis and classification of non-Hodgkin lymphoma in comparison to histopathology. Diagn Cytopathol. 2012;40:305–10.
Hay A, Pai I, Pitkin L, Williamson P, Wilson P, Deery A. Value of fine needle aspiration cytology in head and neck lymphoma: Experience in a head and neck cancer unit in the United Kingdom. Acta Otolaryngol. 2011;131:1226–31.
Barrena S, Almeida J, Del Carmen García-Macias M, López A, Rasillo A, Sayagués JM, et al. Flow cytometry immunophenotyping of fine needle aspiration specimens: Utility in the diagnosis and classification of non-Hodgkin lymphomas. Histopathology. 2011;58:906–18.
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Iyer, V.K. Pediatric Lymphoma Diagnosis: Role of FNAC, Biopsy, Immunohistochemistry and Molecular Diagnostics. Indian J Pediatr 80, 756–763 (2013). https://doi.org/10.1007/s12098-013-1128-2
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DOI: https://doi.org/10.1007/s12098-013-1128-2