56 yrs old female presents with lymphadenopathy.  
HISTO: The architecture partially obliterated (single FC are still remain). There is prominent marginal zone expansion/pattern with confuent and nodular formations consisting of small cc like cells with admixture of pmn's, macrophages and single activated cells/immunoblasts. There are any granulomas, MASSIVE clustering of macrophages (single accumulations only), necrosis and other signs of well known reactive lymphadenopathies.  
IH (marginal zone): CD20 (+) 80% with admixture of CD3+ lympho's, Bcl 2(+) 30%, CD43 (+) 30% (in SINUS the expression is more prominent, maybe due to normal cells admixture?), Ki67 <10%, IgD/IgM(-)(I do not believe in Ig stains:)), single CD68+ macrophages and single clusters with some larger nuclei,  
CyclinD1/CD34(-). Ig kappa/lambda- "backgroud noise" only (uninformative as usual).  
"WORKING FORMULATION": Marginal zone lymphoma.  
DISCUSSION: Differential of reactive and malignant marginal proliferations.  
THE QUALITY IS NOT OPTIMAL (external blocks). IMMUNOREACTIVITY IS LOW, ESP. NUCLEAR REACTIONS!  
Thank you for participating.

anpo 2006-08-02 10:40	On the basis of presented pictures I would not dare make a lymphoma diagnosis - there is expansion of both mantle and marginal zones and signs of transformation of germinal centers. My first choice would be a reactive condition unless one can prove that there is a clonal B-cell population. Were there any signs of clonal excess in kappa/lambda stains? they should work at least for plasma cells? Any more information on clinical picture - extent of lymphadenopathy? spleen? blood values? general symptoms?
ugnius 2006-08-02 14:30	Thank you dr. Anna. Clinical details are requested from other hospital. There is any evidence of Ig kappa/lambda, but in our lab these reactions do not work properly. Plasmacytes are single- CD138 is pending.
ugnius 2006-08-04 09:41	Dr.M.Andrulis visiting our Centre propose idea of reactive lymphadenopathy (dominating sinus pattern) with extrafollicular activation os B population (due to systemic infections? oth.?   Histopathology. 2005 Jul;47(1):90-100.   Extrafollicular proliferation of B cells in the absence of follicular hyperplasia: a distinct reaction pattern in lymph nodes correlated with primary or recall type responses.Brighenti A, Andrulis M, Geissinger E, Roth S, Muller-Hermelink HK, Rudiger T.
anpo 2006-08-04 16:14	I agree with your last comment. However, it is important to put the morphology into clinical context and if possible look more into clonality of B-cells.
dirnhofer 2006-08-05 21:03	probably reactive but suggest close observation and rebiopsy if persisting unexplained lymphadenopathy
ugnius 2006-08-07 09:09	Thank you a lot.
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