Page 81 - The lraternational Journal of the Royal Society of Thailand.indd

The International Journal of the Royal Society of Thailand
Volume XV-2023

3) Excision of the whole enlarged lymph node or extranodal lesion is ideal for
pathologic evaluation and there is no doubt that it is far much better than core
needle biopsy or fine needle aspiration/biopsy (Syrykh et al, 2022). Nevertheless,
physicians should keep in mind that any lymph node or lesion larger than 1 cm.
needs good logistics and attention from pathologist or pathology laboratory

personnel to handle the tissue specimen properly. The most commonly used
formalin fixative needs time to fix the tissue (1 mm. per 1 hour) so that it needs
approximately 5 hours to completely fix the 1 cm. thick tissue with the hope that the

cells located in the very center of the tissue are still intact and preserved well after
formalin fixation. Pathologists often observe poor immunostaining results in the
center of any large mass without proper handle when compared to the peripheral
part of the tissue. A precise pathologic evaluation needs a proper handling of the
tissue sample so that the histologic sections and immunostaining are in good

quality (Sukpanichnant, 2022).
4) At present, physicians and patients prefer core needle biopsy so that it is very
challenging for pathologists to excel skills, knowledge, and experience in order to

reach a definitive diagnosis of lymphoma. Certainly, it needs good histologic
sections without distortion artefacts. Usually core needle biopsy does not have
problem with improper fixation unless the lesion itself has tissue necrosis. Physicians
should take care of the tissue quality by applying a proper apparatus and technic
to perform a good core needle biopsy to avoid distortion artefacts. Importantly,

physician should submit fresh representative tissue for flow cytometry and
microbiological studies to provide additional important information about
immunophenotyping of the lymphoid cells and microbiological studies for any

possible microorganisms (Ingersoll et al, 2019; Sukpanichnant, 2022).
5) Good histologic sections and a proper panel of immunostaining are important to
diagnose lymphoma especially in the core needle biopsy (Ingersoll et al, 2019; Cho,
2022; Sukpanichnant, 2022). Limitation, however, occurs in small B-cell lymphoid
neoplasm under a difficult situation when reactive states are in differential

diagnosis because aberrant expression of some T-cell associated antigens (e.g., CD5
or CD43) in the small B-cells or restriction to cytoplasmic immunoglobulin light
chain (kappa or lambda) in the admixed plasma cells may not be detected. Flow

cytometry is the technic to demonstrate restriction to surface immunoglobulin light
chain that is impossible to detect in paraffin section immunostaining. PCR test to
detect clonal rearrangement of immunoglobulin genes is another way to prove
monoclonality and support the diagnosis of small B-cell lymphoid neoplasm
(Ingersoll et al, 2019; Sukpanichnant, 2022). Recognition of blastic/blastoid nuclear

Sanya Sukpanichnant 73