The World Health Organization (WHO) and numerous expert guidelines for lymphoma diagnosis and subclassification advocate the use of histology from surgical nodal excision biopsy (SEB) over core needle biopsy (CNB) due to perceived higher diagnostic yield. CNB is associated with lower morbidity and is more cost‐effective compared to SEB. Furthermore, current practice increasingly demonstrates material obtained from CNB can rapidly diagnose individuals with a clinical suspicion of lymphoma and allow initiation of treatment in the majority of patients. We performed a literature review to assess the suitability of CNB in lymphoma diagnosis given recent advances in radiological and histopathological techniques in obtaining and processing tissue. Additionally, expert international guidelines in lymphoma diagnosis were compared. We found that CNB demonstrated a diagnostic efficacy between 79% and 97% (median 91%) where the diagnostic outcome was conclusive with full lymphoma subclassification. Studies demonstrate that there is a high diagnostic reproducibility amongst haematopathologists (87%‐93%) in lymphoma diagnoses with full subtyping from material obtained via CNB. Furthermore, CNB is a safe, rapid and reliable method of obtaining tissue from lymph nodes for histopathological analysis. These procedures are minimally invasive, well‐tolerated and should be considered the first‐line diagnostic approach in clinical practice in patients with suspected lymphoproliferative disorders.
A 68-year-old man presented with neutropenic sepsis requiring Intensive Care Unit admission for severe community-acquired pneumonia and multi-organ failure. Laboratory tests showed pancytopenia: haemoglobin concentration 84 g/l, white blood cell count 3 9 10 9 /l, platelets 6 9 10 9 /l and C-reactive protein 604 mg/l. A blood film showed dysplastic neutrophils and 19% blast cells. A bone marrow aspirate was notably malodourous and not suitable for morphological examination. Bone marrow immunophenotyping failed due to a highly degraded sample. The trephine biopsy sections were hypercellular and necrotic, with small areas of blastic infiltration. Peripheral blood immunophenotyping showed 28% CD34+ cells with the phenotype CD117+, HLA-DR+, CD33À, CD15À, CD64À, CD14À, CD13 weak, CD38À, CD11bÀ, terminal deoxynucleotidyl transferase (TdT)À and myeloperoxi-daseÀ. Cytogenetic analysis showed a complex karyotype: 43, Y,add(X)(p22.1),t(1;20)(q21;q13.1),del(5)(q31q33),À7,À12, del(17)(p11.2p13),À20,+mar,inc[5]/46,XY [12]. NPM1 and FLT3 were wild type and a myeloid gene panel confirmed TP53 deletion with no additional mutations. Computed tomography showed a left iliopsoas abscess containing
Multiple myeloma (MM) involving the breast tissue is rare. We report the case of a 70-year-old woman with a background of previously treated MM in remission presenting with a breast lump. Histology showed a plasma cell neoplasm and subsequent staging investigations showed widespread extramedullary relapse of MM. Despite its rarity, this diagnosis should be considered within the differential diagnosis of breast masses as it can arise de novo or may be the first presenting feature of myeloma. The importance of the multidisciplinary team approach with triple assessment of the breast, as well as recent advances in knowledge regarding extramedullary disease in myeloma and novel treatment approaches in MM are discussed.
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