What is the role of biopsy in the workup of primary mediastinal B-cell lymphoma (PMBCL)?

Updated: Sep 14, 2019
  • Author: Sonali M Smith, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Adequate diagnostic biopsy is needed and may require surgery to obtain a sufficient sample for accurate diagnosis. Not uncommon, biopsies can initially be nondiagnostic owing to extensive fibrosis and necrosis, and additional studies might be needed. Most commonly, patients either undergo mediastinoscopy or thoracoscopy depending on the location and feasibility. [22]

Ancillary studies, which include immunohistochemistry, immunophenotyping (flow cytometry), and gene rearrangement studies, are often necessary to establish the diagnosis.

Bone marrow aspirate and biopsy are necessary for staging. A unilateral sample is sufficient if the biopsy specimen is larger than 2 cm. By definition, the bone marrow is not usually involved. Patients with marrow involvement might have systemic diffuse large B-cell lymphoma (DLBCL) with secondary mediastinal disease, as opposed to primary mediastinal B-cell lymphoma (PMBCL).

Other tests should be performed if clinically indicated (eg, thoracentesis for pleural effusion, lumbar puncture for neurologic symptoms).

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