NON-HODGKIN LYMPHOMA/LYMPHOID NEOPLASMS: Biopsy, Resection

Andy Nguyen, M.D. / UT-Medical School at Houston, Pathology/ Last Revision on: 1/28/2013

Cancer Synoptic Case Summary

Specimen (select all that apply)

___ Lymph node(s)

___ Other (specify): ___________________________

___ Not specified

Procedure

___ Biopsy

___ Resection

___ Other (specify): ___________________________

___ Not specified

Tumor Site (select all that apply)

___ Lymph node(s), site not specified

___ Lymph node(s)

Specify site(s): ___________________________

___ Other tissue(s) or organ(s): ___________________

___ Not specified

Histologic Type

***Select one from the list at the end

Pathologic Extent of Tumor (select all that apply)

___ Involvement of a single lymph node region

Specify site: ____________________________

___ Involvement of 2 or more lymph node regions on the same side of the diaphragm
Specify sites: _______________________________

___ Involvement of lymph node regions on both sides of the diaphragm

Specify sites: _______________________________

___ Spleen involvement

___ Liver involvement

___ Bone marrow involvement

___ Other site involvement

Specify site(s): ________________________________

Additional Pathologic Findings

Specify: _______________________________________

Immunophenotyping (flow cytometry and/or immunohistochemistry)

___ Performed, see separate report: ___________________

___ Performed

Specify method(s) and results: ______________________________

_____________________________________________________

___ Not performed

Cytogenetic Studies (note E)

___ Performed, see separate report: ___________________

___ Performed

Specify method(s) and results: ______________________________

_____________________________________________________

___ Not performed

Molecular Genetic Studies

___ Performed, see separate report: ___________________

___ Performed

Specify method(s) and results: ______________________________

_____________________________________________________

___ Not performed

Clinical Prognostic Factors and Indices (select all that apply)

___ International Prognostic Index (IPI) (specify): _____

___ Follicular Lymphoma International Prognostic Index (FLIPI) (specify): _____

___ B symptoms present

___ Other (specify): _________________________________

Comment(s)

+++++

Histologic Type

___ Histologic type cannot be assessed

Precursor Lymphoid Neoplasms

___ B lymphoblastic leukemia/lymphoma, not otherwise specified (NOS)^#

___ B lymphoblastic leukemia/lymphoma with t(9;22)(q34;q11.2); BCR-ABL1

___ B lymphoblastic leukemia/lymphoma with t(v;11q23); MLL rearranged

___ B lymphoblastic leukemia/lymphoma with t(12;21)(p13;q22); TEL-AML1 (ETV6-RUNX1)

___ B lymphoblastic leukemia/lymphoma with hyperdiploidy

___ B lymphoblastic leukemia/lymphoma with hypodiploidy (hypodiploid acute lymphoblastic leukemia/lymphoma [ALL])

___ B lymphoblastic leukemia/lymphoma with t(5;14)(q31;q32); IL3-IGH

___ B lymphoblastic leukemia/lymphoma with t(1;19)(q23;p13.3); E2A-PBX1 (TCF3-PBX1)

___ T lymphoblastic leukemia/lymphoma

Mature B-Cell Neoplasms

___ B-cell lymphoma, subtype cannot be determined (Note: not a category within the WHO classification)

___ Chronic lymphocytic leukemia/small lymphocytic lymphoma

___ B-cell prolymphocytic leukemia

___ Splenic B-cell marginal zone lymphoma

___ Hairy cell leukemia

___ Splenic B-cell lymphoma/leukemia, unclassifiable

___ Splenic diffuse red pulp small B-cell lymphoma

___ Hairy cell leukemia-variant

___ Lymphoplasmacytic lymphoma

___ Gamma heavy chain disease

___ Mu heavy chain disease

___ Alpha heavy chain disease

___ Plasma cell myeloma

___ Solitary plasmacytoma of bone

___ Extraosseous plasmacytoma

___ Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)

___ Nodal marginal zone lymphoma

___ Pediatric nodal marginal zone lymphoma

___ Follicular lymphoma

___ Pediatric follicular lymphoma

___ Primary intestinal follicular lymphoma

___ Primary cutaneous follicle center lymphoma

___ Mantle cell lymphoma

___ Diffuse large B-cell lymphoma (DLBCL), NOS

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

___ Primary DLBCL of the central nervous system (CNS)

___ Primary cutaneous DLBCL, leg type

___ Epstein-Barr virus (EBV)-positive DLBCL of the elderly

___ DLBCL associated with chronic inflammation

___ Lymphomatoid granulomatosis

___ Primary mediastinal (thymic) large B-cell lymphoma

___ Intravascular large B-cell lymphoma

___ Anaplastic lymphoma kinase (ALK)-positive large B-cell lymphoma

___ Plasmablastic lymphoma

___ Large B-cell lymphoma arising in HHV8-associated multicentric Castleman disease

___ Primary effusion lymphoma

___ Burkitt lymphoma

___ B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma

___ B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma

___ Other (specify): ____________________________

Mature T- and NK-Cell Neoplasms

___ T-cell lymphoma, subtype cannot be determined (Note: not a category within the WHO classification)

___ T-cell prolymphocytic leukemia

___ T-cell large granular lymphocytic leukemia

___ Chronic lymphoproliferative disorder of NK cells

___ Aggressive NK-cell leukemia

___ Systemic EBV-positive T-cell lymphoproliferative disease of childhood

___ Hydroa vacciniforme-like lymphoma

___ Adult T-cell leukemia/lymphoma

___ Extranodal NK/T-cell lymphoma, nasal type

___ Enteropathy-associated T-cell lymphoma

___ Hepatosplenic T-cell lymphoma

___ Subcutaneous panniculitis-like T-cell lymphoma

___ Primary cutaneous anaplastic large cell lymphoma

___ Lymphomatoid papulosis

___ Primary cutaneous gamma-delta T-cell lymphoma

___ Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma

___ Primary cutaneous CD4-positive small/medium T-cell lymphoma

___ Peripheral T-cell lymphoma, NOS

___ Angioimmunoblastic T-cell lymphoma

___ Anaplastic large cell lymphoma, ALK-positive

___ Anaplastic large cell lymphoma, ALK-negative

___ Other (specify): ____________________________

Histiocytic and Dendritic Cell Neoplasms

___ Histiocytic sarcoma

___ Langerhans cell histiocytosis

___ Langerhans cell sarcoma

___ Interdigitating dendritic cell sarcoma

___ Follicular dendritic cell sarcoma

___ Fibroblastic reticular cell tumor

___ Indeterminate dendritic cell tumor

___ Disseminated juvenile xanthogranuloma

Posttransplant Lymphoproliferative Disorders (PTLD)^##

Early lesions:

___ Plasmacytic hyperplasia

___ Infectious mononucleosis-like PTLD

___ Polymorphic PTLD

___ Monomorphic PTLD (B- and T/NK-cell types)

Specify subtype: ____________________

___ Classical Hodgkin lymphoma type PTLD^###