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Author: Mikael Häggström [note 1]


On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))



Gross processing

Making a "touch prep".

Whenever there is a suspicion of lymphoma, perform the following before putting the specimen in formalin:

  • Take a small sample for flow cytometry.
  • Make a "touch prep": lightly press a glass slide against the cut surface of the lymph node, apply cytologic fixative solution immediately (to avoid drying artifacts) and stain with H&E.
  • Submit sections for histologic processing with H&E staining.

Otherwise, as per location or specimen type, such as lymph node or tumor.

Microscopic examination

On the histologically processed slides, first compare the lymphoid cells with endothelial cells, and designate the lymphoid cells as large if a significant amount are larger than the transverse diameter of endothelial cells, otherwise as medium to small.

Small to medium sized lymphocytes

In addition, you generally need to order immunohistochemistry, consisting of:

  • CD3, to raise the possibility of a T cell lymphoma if it stains a vast majority of cells.
  • CD20, to raise the possibility of a B cell lymphoma if predominant.
  • BCL2, to suggest a follicular lymphoma if it stains B cells in secondary follicles.[1]
  • (CD5, mainly to suggest chronic lymphocytic leukemia or mantle zone lymphoma if it positive in the CD20 positive cells.)
  • (CD10, essentially confirming a follicular lymphoma if stains the BCL2 positive cells of secondary follicles.)
  • (CD23, suggesting a small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL) if it is present in CD20 and CD5 positive cells.)
  • (Cyclin D, suggesting a mantle cell lymphoma if it is present in CD20 and CD5 positive cells.)

If CD20 positive cells (B cells) are predominant, attempt to fit their pattern into one of the following:[2]

Follicular lymphoma Marginal zone B-cell lymphoma (MZL) or mucosa-associated lymphatic tissue (MALT) lymphoma Small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL) Mantle cell lymphoma (MCL)
CD5 - - + +
CD10 + - - -
CD23 - - + -
Cyclin D1 - - - +


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page


  1. Error on call to Template:cite web: Parameters url and title must be specifiedProPath Staff. . Retrieved on 2022-01-09.
  2. Attanoos, Richard (2018). "Lymphoid Malignancies of the Pleura and Peritoneum". Practical Pathology of Serous Membranes . pp. 203–208. doi:10.1017/9781316402009.016. ISBN 9781316402009. 

Image sources