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TCHR LBCL (373893)
TCHR LBCLnew
Subtitle: B11-20242		 Type:
NODE		 Sender:
ugnius 		2011-06-30 16:28
INCTR - EBMWG Hematopathology Online

50 yrs old female underwent right inguinal lymph node biopsy. CT: lymphadenopathy inguinal and in the pelvis, hepatomegaly present. Tonsilitis (resected) and nodular erythema diagnosed in 2006. Threpine biopsy taken: in progress.

HISTO: Large CD20+ Oct2+ EBER(-) cells in T cell background with admixture of CD68+ macrophages and medium sized B lymphos.

IH:  CD20(+++) 100%, CD30(+) 10% (faint), LCA(+)100%,CD79a(+++) 100%  Oct2(+++)100%, CyclinD1(-), CD10(-), Bcl6(++) 100% , Bcl2(+++) 100% , Mum1(+/++) 30%, CD138(-).
Multipe CD3+ lymphos and small/medium CD20+ lymphos. CD23/CD21+ FDC network absent. Multiple CD68+ macrophages.

PROPOSED DIAGNOSIS: T cell histiocyte reach large B cell lymphoma in the lymph node.

SPECIAL QUEST: The quantification (and IH difference) of scattered B blasts: the border between ordinar DLBCL and TCHR LBCL.

Thankyou.

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ugnius
2011-06-30 18:00
The case is open for review. Thanx.  
vrugt
2011-06-30 18:07
My first impression was also a TCHR LBCL, but according to the WHO classification the tumour cells should always be dispersed. Because the CD20 demonstrates small clusters of B-cells I favor a DLBCL rather than a TCHR LBCL. Because of the results in the EBER an EBV related lymphoproliferative disorder would be an important differential that has to be clarified by the clinician. An EBV positive DLBCL of the elderly seems unlikely because of the patient's age.
ugnius
2011-06-30 18:12
Thanx. EBER is completely negative and more colsed look lead to speculation, that really giant cell are scetterd with CD3+ rosetting and with some medium sized (rective) B lymphos?
tzankov
2011-06-30 20:18
The case nicely illustrates anothe grey zone. I agree with the points risen by Bart, but nevertheless I would classify the case as a TCRBCL. My arguments are: rather typical morphology with giant tumor cells, lots of T-cells and histiocytes, organomegaly.
ugnius
2011-06-30 20:30
Thanx for evening thoughts.
vrugt
2011-07-01 10:21
Dear Ugnius, I misread the information concerning the EBER.  
ugnius
2011-07-01 14:51
Thank you.
ugnius
2011-07-05 16:06
Please find Ki67: heterogenous/distributed, but in tumors large cells probably close to 100%. Interestingly, I've heard that Ki67 index is used for discrimination with NLP HL (diffuse variant). I've never use it for that.
diane.c.farhi
2011-07-05 22:16
I apologize for the late comment. I agree with the diagnosis of TCRBCL.
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Last modified: 2011-06-30 18:11:22