The role of morphology, cytochemistry and immunohistochemistry in the diagnosis of lymphoproliferative disorders
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The bone marrow examination is a valuable procedure in the diagnosis and management of patients who have NHL. Posttherapy bone marrow examination is useful for assessing a patient’s response to chemotherapy and for monitoring previously treated patients for evidence of recurrent disease. The bone marrow examination should include trephine biosy section, trephine imprints, aspiration smears, clot sections and blood smears and all of these preparations should be studied by the same pathologist. In addition to the morphologic evaluation, the aspirated marrow is the best material for several important supplemental studies for characterization of NHLs, including immunophenotyping by flow cytometry, cytogenetics, most molecular studies, and microbiologic cultures. Flow cytometric immunophenotyping studies to determine lineage, clonality of B-cell processes, and approximate stage of neoplastic infiltrates are the most useful adjuvant to morphologic assessment for NHLs. This review concentrates on the characteristic morphology, cytochemistry, immunohistochemical assessment and immunophenotyping of each clinical entity according to WHO classification. For the differential diagnosis, reactive lymphoid lesions, incluing lymphocytic aggregates, reactive polymorphous lymphohistiocytic lesions, benign follicles with germinal centers and polyclonal immunoblastic proliferations will be discussed.