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10

NCCN Guidelines for Patients

®

Peripheral T-cell Lymphoma, Version 1.2016

1

PTCL basics

Do I have PTCL?

Do I have PTCL?

One of the most common symptoms of peripheral

T-cell lymphoma is a swelling of one or more lymph

nodes. Swollen nodes may occur in your neck,

armpit, or groin. However, peripheral T-cell lymphoma

is often found elsewhere in your body. Other common

sites are the skin, GI (

g

astro

i

ntestinal) tract, and bone

marrow. The GI tract is a group of organs in which

food is broken down, absorbed, and disposed of.

When your doctor suspects cancer, testing is needed.

The tests that are needed to confirm (diagnose)

peripheral T-cell lymphoma are described next.

Biopsy

In general, tissue must be removed from your body

and be tested to diagnose cancer. A biopsy removes

samples of fluid or tissue. To diagnose peripheral

T-cell lymphoma, an incisional or excisional biopsy of

the tumor is often done. An incisional biopsy removes

only a part of the tumor through a cut made into your

body. An excisional biopsy removes the whole tumor

and not much else. The methods used to do either

biopsy depend on where the tumor is in your body.

FNA (

fi

ne-

n

eedle

a

spiration) removes very small

samples with a needle. It should not be used alone to

diagnose peripheral T-cell lymphoma. You may have

cancer even if no cancer is found in the samples.

Hematopathology review

The biopsy samples will be sent to a special type of

pathologist. A pathologist is a doctor who’s an expert

in testing cells to find disease. For peripheral T-cell

lymphoma, the pathologist should be a specialist

in hematopathology. Hematopathologists spend

all of their time looking at blood and bone marrow

and lymph nodes, so they become very good at

diagnosing blood cancers. The pathologist will first

examine the samples using a microscope.

The hematopathologist will decide if cancer is

present. If it is, the type and subtype of cancer will be

noted. Furthermore, the pathologist will assess if the

cancer will grow slow or fast. Most peripheral T-cell

lymphomas grow fast.

The results of these tests and those described next

will be recorded in a pathology report. It’s a good idea

to get a copy of your pathology report. It’s used to

plan treatment.

Protein tests

For diagnosis, the hematopathologist needs to study

the proteins in the cells’ surface (membrane). This is

called immunophenotyping. The pathologist will study

the pattern of surface proteins to decide if the cancer

is from B-cells or T-cells and then the cell subtype. An

IHC (

i

mmuno

h

isto

c

hemistry) panel is a test for such

proteins. It involves applying a chemical marker to

cells then looking at them with a microscope.

The IHC panel often tests for ALK, BCL6, CD2,

CD3, CD4, CD5, CD7, CD8, CD10, CD20, CD21,

CD23, CD30, CD56, CD57, EBER-ISH, and Ki-67. In

general, T-cells often express markers such as CD2,

CD3, CD4, CD5, CD7, or CD8 while B-cells do not.

Otherwise, surface proteins on T-cell lymphomas

vary. At times, it may be useful to do an IHC panel of

ßF1, TCR-CγM1, PD1/CD279, and CXCL-13 to learn

the lymphoma subtype.

Flow cytometry is a newer method that can assess

for surface proteins. This method involves first adding

a marker—a light-sensitive dye—to cells. Then,

your blood will be passed through a flow cytometry

machine. The machine measures surface proteins on

thousands of cells.

Flow cytometry may be done in addition to an IHC

panel. For suspected T-cell lymphoma, it often

includes CD2, CD3, CD4, CD5, CD7, CD8, CD10,