3. What additional laboratory test do you want to request?

Alpha-fetoprotein (AFP) is used as a tumor marker to help detect and diagnose cancers of
the liver, testicles, and ovaries or benign diseases.
Liver Biopsy was requested and the following tests are requested:
Hematoxylin and Eosin Staining
Hematoxylin and Eosin (H&E) staining of the liver mass must also be performed in order
to aid in the proper tissue-based diagnosis. H&E stain is a popular staining method used in
histology since it works well with various fixatives and has the capacity to display a broad range
of cytoplasmic, nuclear, and extracellular matrix features. The primary stain hematoxylin, which
is formed from the combination of aluminum ions and iodized hematoxylin, colors the nucleus
blue. Following the nuclear staining is the counterstaining with eosin, which stains other cellular
structures in various shades of red and pink (Al-Refu, 2011).

Biopsy of the liver mass showed aggregation of atypical clonal B-cell lymph proliferation
and small cells with prominent plasmacytic differentiation (Polprasert, 2009). Plasmacytic cells
are described to have eccentric nuclei with bluish cytoplasm (Mitchelson, 2014). Large lymphoid
cells on the other hand contain vesicular nuclear chromatin and prominent nucleoli (Kumar,
2015).

 LCA/ CD45
Since gram stain reveal characteristic mixture of small lymphoid cells exhibiting various
degrees of plasma cell differentiation, we requested for this marker to confirm the lymphocytes.
Test revealed: lymphocytes stain brightly at CD45 marker while plasma cells will test negative.

CD 138
This is requested to express the plasma cells. Test Revealed: Immunohistochemistry for
CD138 highlighted the presence of plasma cells.

References:
Al-Refu, K. (2011). General methods in preparation of skin biopsies for haematoxylin & eosin
stain and immunohistochemistry, skin biopsy - Perspectives, Dr. Uday Khopkar (Ed.), ISBN:

978-953-307-290-6, InTech. Retrieved November 11, 2016 from

http://www.intechopen.com/books/skin-biopsy-perspectives/general-methods-inpreparation-of-skin-biopsies-for-haematoxylin-eosin-stain-and-immunohistochemistr
Kumar, V. (2015). Robbins and Cotran pathologic basis of disease. 9th edition. USA: Elsevier
Saunders
Mitchelson, B. (2014). Haematopathology: an introduction to lymphoid neoplasms. Retrieved
November 11, 2016 from http://www.slideshare.net/islaydoc/haematopathology-anintroduction-to-lymphoid-neoplasms
Polprasert, C. (2009). Lymphoplasmacytic Lymphoma with IgA Hypergammaglobulinemia and
Liver Involvement. Retrieved November 11, 2016 from
https://www.researchgate.net/profile/Chantana_Polprasert/publication/26762350_Lymphopl
asmacytic_lymphoma_with_IgA_hypergammaglobulinemia_and_liver_involvement/links/5
405e7b60cf2c48563b1f468.pdf