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Transformed DLBCL with CD5+ and discordant BM FL (450285)
Transformed DLBCL with CD5+ and discordant BM FLnew
Subtitle: B12-35712		 Type:
NODE		 Sender:
ugnius 		2012-12-01 14:41
INCTR - EBMWG Hematopathology Online

80yrs old female was threpine-biopsied due to suspition of MDS with blast access. Clinically: pancytopenia, dominent anemia Hb 69g/l; neuthropenia, mild trhombocitopenia.

BM (will be scaned soon):  B FL (~II° PSO?) spred 30%. IH: CD20+; Bcl6+; Bcl2+; CyclinD1/CD23/CD5(-). Fibrosis MF-1. Clinical correlation pending.  NOTE: Discordant  FL spread sometimes is seen, having transformed FL-DLBCL in periphery.

After that node biopsy was taken. Clinically add: lymphadenopathy and absolute lymphocytosis.

NODE: 3 nodes with paracortical nodules od T zone and inbetween spreading interstitial medium- large cell diffuse infiltrate with ovoid/irregular large nuclei (cb). close to it- nodules/follicles, composed of medium sized cells with wrincled nuclei (cc) 

IH: Interestingly, "LARGE CELL DIFFUSE" component different in IH from CC nodules.

PROPOSAL: 1. BM involvement of FL. 2. CD5+ DLBCL (70%) CD20+;CD5+;CD10(-); Bcl6+; LMO2(+/-); IgM+ > IgD+; Ig lambda+) in node with residual FL (CD20+; CD5(-); CD10(-); LMO2+; Bcl6(-); IgM/IgD(-); Ig kappa/lambda(-)):

SPECIAL QUESTS: 1. Abberant CD5 expression as a sign of aggressiveness or transformation. 2. Difference in IH: FL and DLBCL. 3. Bcl6 and CD10 downregulation in FL.

Thank you beeing together.

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tzankov
2012-12-03 07:45
Dear Ugnius,  
 
unfortunately I can not open the scanned HE slide. Are you sure that these are not para/extrafollicular blasts? Is there a evidence of clonality beyond Lambda? Please have a look at:  
 
PMID: 15982328  
 
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, Müller-Hermelink HK, Rüdiger T.
ugnius
2012-12-26 16:23
Sorry for delay: pleased find BM infiltration (CD20+ Bcl6+, pleomorphic with large cells) attached. Primary diagnosis was FL in BM, but in node CD5+ diffusse infiltration is seen with reminescent of FL.
Last modified: 2012-12-01 16:23:39