73 yrs old male with known "lymphocytosis" and gastric tumor- biopsied now.  
HISTO: Diffuse "immunoblastic" discohessive infiltration of large cells in the lamina propria.  
IH (scarse): ONLY POSITIVES: CD68+; CD10+; CyclinD+; CMYC+; CD138+ (focal); Bcl2+ faint focal; INI1+; CD99+ (faint); Synaptophysin+ (dirty/artefacts?); Ki67 HIGH 85%.  
 
Other CARCINOMA SARCOMA LYMPHOMA MELANOMA markers complettelly absent:  
PanCK/Cam5.2/S100/MelanA/PLAP/EMA/BerEp4(-); MPO/CD56(-); Ig kappa/lambda(-);Pax5/CD20/CD3/CD30/CD79a/LCA/CD43(-); CD34/TdT/CD117/HLADR/CD123(-); EBER(-); CD1a/Langerin/Lysozyme/CD4(-); Desmin/Myogenin/PLAP(-).  
 
Molecs: NON CLONAL; BRAF(-).  
 
PROPOSALS/QUESTIONS:  
 
1. B plasmablastic lymphoma (CyclinD1+ CD138+ EBER(-) Ig kappa/lambda(-) Mum1(-))- probably transformed from possible B CLL/SLL;  
2. Myeloid sarcoma; CD68+ CD10+ CD34/TdT/CD117/Bcl/HLA DR(-);  
3. Histiocytic lymphoma: CD68+ S100/CD1a/Lysozyme/CD43(-)...  
 
Thankyoubeeingsoclose.

tzankov 2015-05-18 12:34	poorly differnetiated, discohesive tumor, probably hemato-lymphoid NPL... CD43? CD163? if CLL suspect - CD5? CD23? LEF1?
ugnius 2015-05-21 08:13	Thanx. add ins: CD43(-), CD99+ faint, very strange Synaptophysin+ (probably artefacts?) with strong singnal on normal glands and Chromogranin A(-).   Unfortunatelly nothing about CLL (CD5/CD23(-); LEF1 absent)...   Carcinoma is not excluded 100%...
tzankov 2015-05-22 08:09	the known knowns are excluded, with both CD45 and CD43 negativity a lot (almost all) hemato-lymphoid tumors are excluded. what does the imaging and staging tell us? is there a tumor elsewhere? how does this tumor metastasize (if at all)? what did clonality testing reveal?
ugnius 2015-05-22 08:15	The patient hopefully will be evaluated in hematoonco dept. (peripheral hospital without any knowledge in detail). BRAF(-). POLYclonal. So, malignant tumor with some hypothetic ideas about differentiation... I'm afraid of dealing with "silent" IH carcinoma...
tzankov 2015-05-26 08:21	at the end of the day, a hematolymphoid tumor can not be verified, also melanoma, the tumor does not look like sarcoma, but expresses CD138, which is expressed by lot of carcinomas... and cyclin D1, which is also + in NSCLC, prostate cancer etc.... the tumor spread (on CT) could be helpful in giving a more proper name to the neoplasm
ugnius 2015-05-29 12:38	Final thanx. In the face of new data: i'll be back.
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