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IHC Panels with reporting - Lymph Node, FFPE Tissue
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Tumor immunohistochemistry panels.
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IHC Panels with Reporting - Lymph Node FFPE Tissue
- Why is it done?
- Immunohistochemistry (IHC) panels on lymph node tissue identify specific antigens and markers using antibodies to classify lymphomas, metastatic malignancies, and reactive lymphoid processes
- Diagnose and classify lymphoid neoplasms including Hodgkin lymphoma, non-Hodgkin lymphoma subtypes, and T-cell lymphomas
- Detect metastatic carcinoma, melanoma, and other solid tumors in lymph nodes
- Differentiate between reactive and neoplastic lymphadenopathy
- Evaluate immunophenotype to determine prognosis and guide treatment decisions
- Typically performed when lymph node biopsy is obtained for investigation of lymphadenopathy, staging of malignancy, or assessment of lymphoid tissue abnormalities
- Normal Range
- Normal/Reference Values: IHC panels are primarily descriptive rather than quantitative; results are reported qualitatively
- Negative Result: Absence of specific antigen expression indicates tissue-type compatibility or absence of targeted abnormal cells; typically normal for reactive lymphoid tissue
- Positive Result: Presence of specific antigens; interpretation depends on marker type and staining pattern; may indicate malignancy, infection, or specific lymphoid subset involvement
- Staining Intensity: Reported as negative, weak, moderate, or strong; percentage of cells staining may be quantified (0-100%)
- Normal Reactive Pattern: Mixed B-cell (CD20+) and T-cell (CD3+) populations with appropriate germinal center formation and normal architectural pattern
- Interpretation
- Lymphoma Classification: IHC markers such as CD5, CD10, BCL2, BCL6, and MUM1 help differentiate B-cell lymphoma subtypes; CD4, CD8, and TCR markers aid in T-cell lymphoma classification
- Hodgkin Lymphoma: CD30+ and CD15+ Reed-Sternberg cells with CD20- and CD45- (appropriate negative markers) indicates classic Hodgkin lymphoma
- Monoclonality: Kappa or lambda light chain restriction indicates clonal B-cell population suspicious for lymphoma; polyclonal pattern supports reactive process
- Metastatic Disease: Cytokeratin+, TTF-1+, PSA+, or S100+ cells indicate carcinoma, lung cancer, prostate cancer, or melanoma respectively in lymph nodes
- Prognostic Markers: BCL2 overexpression and high MIB-1 proliferation index may indicate worse prognosis in certain lymphomas
- Factors Affecting Results: Tissue fixation and processing, antigen retrieval methods, antibody quality, and timing of staining may affect interpretation; background tissue staining and crush artifacts may complicate assessment
- Clinical Correlation: IHC results must be interpreted in context of morphology, clinical presentation, molecular studies (if available), and flow cytometry findings for accurate diagnosis
- Associated Organs
- Primary Organ System: Lymphatic system and hematopoietic system; lymph nodes as part of immune surveillance network
- Lymphomas: Hodgkin lymphoma, diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, marginal zone lymphoma, lymphoplasmacytic lymphoma, mantle cell lymphoma, T-cell lymphomas, and Burkitt lymphoma
- Secondary Malignancies: Metastatic lung cancer, breast cancer, gastric cancer, colorectal cancer, melanoma, renal cell carcinoma, and other solid tumors
- Reactive Conditions: Infectious mononucleosis, toxoplasmosis, tuberculosis, fungal infections, viral lymphadenitis, drug reactions, and autoimmune conditions
- Other Lymphoid Disorders: Angioimmunoblastic T-cell lymphoma, Castleman disease, rosai-dorfman disease, and hemophagocytic lymphohistiocytosis
- Complications of Abnormal Results: Diagnosis of malignancy may lead to chemotherapy toxicity, immunosuppression, increased infection risk, organ dysfunction from treatment or disease dissemination, and reduced survival if not appropriately managed
- Follow-up Tests
- Flow cytometry performed on lymph node tissue or peripheral blood to confirm immunophenotype and assess for clonality
- Molecular studies including t(9;14), t(14;18), t(11;14), and t(8;14) translocations by FISH or PCR based on suspected lymphoma subtype
- T-cell receptor (TCR) clonality analysis if T-cell lymphoma is suspected
- Cytogenetics and karyotyping for high-grade lymphomas or if prognostic stratification is needed
- Staging studies including CT chest/abdomen/pelvis, PET-CT, and bone marrow biopsy if lymphoma is confirmed
- Complete blood count (CBC) and comprehensive metabolic panel (CMP) to assess for cytopenias and organ involvement
- LDH level if lymphoma diagnosed to assess disease burden and prognosis
- Infectious disease studies (EBV, CMV, tuberculosis) if reactive lymphadenopathy or infectious etiology suspected
- Special stains (PAS, acid-fast bacillus, GMS) if granulomatous inflammation or infection is suspected
- Repeat biopsy may be needed if initial results are equivocal or if disease progression is suspected during follow-up
- Fasting Required?
- Fasting Required: No
- This is a tissue-based test performed on formalin-fixed paraffin-embedded (FFPE) lymph node tissue obtained by biopsy; fasting is not required as no blood sample is needed
- Biopsy Preparation: Standard lymph node biopsy may be performed via excisional biopsy, core needle biopsy, or fine needle aspiration; local anesthesia is typically used; patient should avoid anticoagulants per physician instruction if biopsy is planned
- Medications: No specific medication restrictions for IHC testing itself; however, anticoagulant therapy (warfarin, DOACs, aspirin) may need to be held before biopsy procedure per clinician guidance
- Tissue Handling: Proper fixation in formalin and processing into paraffin blocks is essential; tissue must not be allowed to dry; specimens should be submitted promptly to pathology lab
- Additional Preparation: Informed consent required for biopsy procedure; patient education regarding biopsy site care and reporting of excessive bleeding or infection post-procedure
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