Early lesions in lymphoid neoplasia

The increasing use of immunophenotypic and molecular techniques on lymphoid tissue samples without obvious involvement of malignant lymphoma has resulted in the increased detection of ‘early’ lymphoid proliferations which show some, but not all, of the criteria necessary for a diagnosis of malignant lymphoma. In most instances, these are incidental findings in asymptomatic individuals, and their biological behaviour is uncertain. In order to better characterize these premalignant conditions and to establish diagnostic criteria, a joint workshop of the European Association for Haematopathology and the Society of Hematopathology was held in Uppsala, Sweden, in September 2010. The panel reviewed and discussed more than 130 submitted cases and reached consensus diagnoses. Cases representing the nodal equivalent of monoclonal B cell lymphocytosis were discussed, as well as the ‘in situ’ counterparts of follicular lymphoma (FL) and mantle cell lymphoma, topics that also stimulated discussions concerning the best terminology for these lesions. The workshop also addressed the borderland between reactive hyperplasia and clonal proliferations such as paediatric marginal zone lymphoma and paediatric FL, which may have very limited capacity for progression. Virus-driven lymphoproliferations in the grey zone between reactive lesions and manifest malignant lymphoma were covered. Finally, early manifestations of T cell lymphoma, both nodal and extranodal, and their mimics were addressed. This workshop report summarizes the most important conclusions concerning the diagnostic features, as well as proposals for terminology and classification, of early lymphoproliferations and tries to give some practical guidelines for diagnosis and reporting.