Lymphoproliferative Disorders Workup

Updated: Dec 09, 2014
  • Author: Donna A Wall, MD; Chief Editor: Robert J Arceci, MD, PhD  more...
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Workup

Laboratory Studies

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  • General tests in lymphoproliferative disorders (LPDs)
    • Clinical findings indicate local or distant adenopathy and hepatosplenomegaly.
    • In certain conditions, the GI tract or lung tissue may also be affected.
  • Biochemical panel
    • Perform serologic tests for cytomegalovirus and Epstein-Barr virus (EBV).
    • Measure the erythrocyte sedimentation rate.
    • Evaluate electrolyte, BUN, creatinine, phosphate, calcium, and uric acid levels to rule out tumor lysis syndrome.
    • Assess lactate dehydrogenase levels to assess the neoplastic burden.
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Imaging Studies

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  • Radiography
    • CT scans obtained with intravenous or oral contrast material can help in determining the true extent of abdominal adenopathy, infiltration of the bowel wall, and the accurate sizes of tumorous masses. This information is important for staging and assessing therapeutic response. For example, the CT scan in the image below reveals parenchymal nodularities.
      Parenchymal nodularities. Parenchymal nodularities.
    • MRI studies of soft-tissue infiltrative processes can refine the clinician's understanding of the tumor burden and the potential that vital structures might be compromised.
    • Chest radiography is performed in patients with pulmonary lesions to follow the progression or regression of disease. In some patients, pulmonary functional tests can provide further objective evidence of disease progression or a therapeutic response.
  • Bone scanning
  • Ultrasonography: Ultrasonography is sometimes helpful.
  • Small bowel follow-through study: In children with GI lesions, this test helps in diagnosing ileal disease.
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Other Tests

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  • As with all neoplastic processes, "the tissue is the issue." In rapidly growing tumors, areas of necrotic tissue may complicate morphologic use of fine-needle aspirates.
  • EBV detection by means of Southern blot hybridization or polymerase chain reaction (PCR) can be helpful. The in situ hybridization of the EBV-encoded RNA (EBER) test has become a useful adjunct in the diagnosis of EBV-related lymphoproliferative disorders.
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Procedures

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  • Examination of the bone marrow may help in differentiating metastatic disease from other diseases.
  • Diagnostic spinal tap is used in children with primary tumors involving the head or neck region to exclude spread to the neuraxis.
  • Surgical resection does not play an important role in the control of lymphoproliferative disorders. Most lymphoproliferative tumors are not easily resectable and, given the underlying nature of the affected cell type, rapid lymphatic spread to distant sites is common.
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Histologic Findings

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  • Important histologic findings often include an amorphous oligoclonal or monoclonal population of immature-appearing lymphocytes. Histologic samples tend to show either polymorphic or monomorphic infiltrates of lymphocytes.
  • In most cases, flow cytometric and cytogenetic analyses show polyclonal populations of B cells or T cells without cytogenetic abnormalities. These features can distinguish lymphoproliferative disorders from true malignancies, which frequently show monoclonal cell populations and acquired cytogenetic abnormalities. However, the cell morphology occasionally mimics specific malignant lymphomas, such as Hodgkin disease or Burkitt lymphoma.
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