Info
Diagnostic Evaluation of marginal zone lymphoma
Bx required
Either excisional/incisional or core plus FNA w/ flow cytometry, splenic MZL often diagnosed on splenectomy specimen
Histology
Polymorphous infiltrate of small lymphocytes, centrocyte-like B cells, & plasma cells; reactive follicles; lymphoepithelial lesions (epithelial tissues) → Splenic MZL w/ characteristic villous lymphocytes on peripheral smear
Molecular diagnostics for clonal IgH rearrangement (proves malignancy)
- Lab evaluation of marginal zone lymphoma
- BM aspirate & core bx: Send for flow cytometry, splenic MZL classically shows “intrasinusoidal” lymphocytic infiltrations
- Imaging: CT C/A/P w/ contrast; may need MRI orbits (ocular) or neck (salivary); FDG PET not routinely required
- Special considerations for gastric ENMZL:
- → Endoscopy ± EUS w/ core bx required, stain specimen for H. pylori
- → if H. pylori negative by histopath, then perform H. pylori stool Ag test, urea breath test, or H. pylori blood Ab test