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Primary mediastinal B-cell lymphoma (PMBCL) is diagnosed through a combination of blood tests, bone marrow tests, and imaging tests. Each of these tests provides different information that helps in the diagnosis and staging of the disease. An expert hematopathologist review of testing samples is essential to confirm the diagnosis of PMBCL. 

Blood Tests:

  • Complete Blood Count (CBC): This test measures the amount of different types of cells in the blood. In PMBCL, there may be an increase in white blood cells and a decrease in red blood cells or platelets.
  • Blood Chemistry Tests: These tests measure the levels of various substances in the blood, such as electrolytes, kidney function, and liver function. Abnormal levels may indicate the presence of lymphoma.
  • Lactate Dehydrogenase (LDH) Levels: High levels of this enzyme in the blood can be a sign of lymphoma.
  • Immunophenotyping: This test identifies cells based on the types of proteins or markers present on the surface of the cells. It can help determine the type of lymphoma.

Biopsy Tests:

  • Biopsy: This test involves taking a small amount of tissue from the affected area and examining it under a microscope to look for lymphoma cells.
  • Cytogenetic Analysis: This test looks at the chromosomes of cells from samples of blood or tissue. It can help identify certain changes in chromosomes that are common in specific types of lymphoma. Abnormal chromosomes are common in PMBCL. 
  • Flow Cytometry: This test measures the amount of DNA in cancer cells and can help classify the lymphoma. PMBCL is positive for CD19, CD20, CD22, CD21, IRF4/MUM1 and CD23 with a variable expression of BCL2 and BCL6.

Imaging Tests:

  • Computed Tomography (CT) Scan: This test uses x-rays to make detailed pictures of the inside of the body. It can help determine the location and size of lymphomas.
  • Magnetic Resonance Imaging (MRI): This test uses magnetic fields, not x-rays, to produce detailed images of the body. It can help determine the extent of the disease.
  • Positron Emission Tomography (PET) Scan: This test uses a small amount of radioactive glucose (sugar) to find cancer cells in the body. It can help determine if the lymphoma has spread and how it is responding to treatment.

A Summary of Diagnosing Primary Mediastinal B-Cell Lymphoma

Diagnosing PMBCL involves a combination of blood tests, biopsy tests, and imaging tests. Blood tests can reveal abnormal levels of cells and substances in the blood, while biopsy tests tests can identify lymphoma cells and chromosomal changes. Imaging tests can show the location, size, and spread of the lymphoma. Together, these tests provide a comprehensive picture of the disease, aiding in diagnosis and treatment planning.

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