Biopsy of an abnormal area, either nodal or extranodal, is the "gold standard" for the diagnosis of lymphoma. Aside from morphologic assessment, additional immunophe-notypic analyses are usually performed, to confirm the presence of monoclonality. Southern blot analysis may be performed to document genotypic monoclonality, although this technique is used only rarely for clinical purposes. Additional immuno-histochemical analyses are usually performed, to document expression of other B-cell markers, such as CD20.
If an abnormal mass lesion is present in a relatively inaccessible site, such as the retroperitoneum, a fine needle aspiration (FNA) may be performed, in place of definitive biopsy. However, although the FNA may be helpful in the diagnosis of certain infections, the technique can lead to substantial error in patients with AIDS-lymphoma. At a minimum, an immunophenotypic study should be performed on cells obtained by FNA to confirm monoclonality, as a means of attempting to prove presence of lymphoma, as opposed to a reactive lesion of some type. In patients with known history of AIDS-lymphoma, an FNA is fully acceptable for diagnosis of relapsed disease.
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