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Not personally my case, but my group recently made the diagnosis of follicular lymphoma, grade 3A. Due to the circumstances of the case, this diagnosis was based upon H&E and IHC alone. Flow could not be done. The morphology is classic, slam-dunk, 99 out of 100 hematopathologists would agree, take a picture and put it in a textbook classic (I'm not a hemepath, though we do have one here who agrees this is classic). Patient and material went to a nearby academic center for consultation where they decided to throw everything including the molecular kitchen sink at it. Well...FISH negative and B-cell gene rearrangement PCR reported as polyclonal. On the basis of these results, though they describe morphologically classic follicular lymphoma, they state that you can't call it lymphoma.
When I left training, all of 2.5 years ago, we never would have considered doing PCR or FISH on a node like this. It would have been follicular lymphoma, that's it. Has the world changed so much in a few years? I always considered such testing to be ancillary, only used in difficult cases, and then the results have to be correlated with the morphology. What do you think of this?
When I left training, all of 2.5 years ago, we never would have considered doing PCR or FISH on a node like this. It would have been follicular lymphoma, that's it. Has the world changed so much in a few years? I always considered such testing to be ancillary, only used in difficult cases, and then the results have to be correlated with the morphology. What do you think of this?