Page 87 - The lraternational Journal of the Royal Society of Thailand.indd

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

germinal center, then these large cells are positive for CD10, BCL6, and Ki-67 but
negative for BCL2 and MUM1. If it is an aggregate of large lymphoma B-cells, then
they can be evaluated for cell of origin according to Hans algorithm. Moreover,
the other 2 unstained slides can be used for c-myc (MYC protein) and cyclin D1
evaluation if needed.

3) Follow the essential diagnostic criteria given in the WHO-HAEM5 in order to
classify lymphoma (WHO Classification of Tumours Editorial Board, 2022) after
morphologic evaluation and immunostaining work-up above.

Using an effective approach in morphologic evaluation and even a limited
panel of immunostaining, the D&C of lymphoma can be given within an appropriate

rapid turnaround time (24-48 hours) under a good clinical correlation (Sukpanichnant,
2022). While targeted therapies improve clinical outcomes since anti-CD20 immuno-
therapy in the past 25+ years, advances in diagnostics for lymphoma and sophisticated

technics, especially in molecular studies, allow us to better understanding of lymphoma
as well as high-throughput workups. The author believes that a good histology is
still critical and concurs with Nathwani and colleagues about the important role of
histology in conjunction with a good clinical correlation to decide the most effective
way to gather information for a better management for individual patient care

(Nathwani et al, 2007).

Conclusion

There is no doubt that technology advances lead to better medical treatment
and care in history of humankind but along the way, some delays or misunderstandings
occur from time to time. The D&C of lymphoma is also an example of such experiences
as already shown in the aforementioned reflections but it will get better eventually and

that means the present practice using morphologic evaluation and immunostaining
will be more precise by more sophisticated technology that provides more useful
information for better patient care and quality of life. Anyway, in this interim, there is
no guarantee about the benefit of the high-throughput workups over the conventional

approach, using morphology and immunophenotype to the D&C of lymphoma with
an appropriate rapid turnaround time under a good clinical correlation.

Acknowledgements
The author Sanya Sukpanichnant is supported by Chalermphrakiat Grant,
Faculty of Medicine Siriraj Hospital, Mahidol University.

Sanya Sukpanichnant 79