NCCN Guidelines for Patients
Peripheral T-cell Lymphoma, Version 1.2016
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 (
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.
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.
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.
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
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
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,