66 yrs old female with serious illness: fever, anemia (susp. "hemophagocytic s."), splenomegaly, paraortic lymphadenopathy. Inguinal biopsy was performed. STEROIDS do not improve a situation!  
HISTO: The clusters of CD20+ Bcl6+ large atypical cells (IB and H/RS like) with lobated irregular nuclei. Similar cells in perinodal vessels. The archtecture of lymph node is completelly intact.  
VIRTUAL SLIDES: Aperio.  
PHOTOS: snapshots from VS.  
IH: Atypical cells: CD20+; Bcl2+; Bcl6+; CD10(-); Ki67 substancially high; Mum1+; CD5(-).  
 
SIMILAR case in the skin (T cells): https://telemed.ipath.ch/lithuania/object/view/163711  
Commentaries on this case: https://www.ipath-network.com/ipath/object/view/4968  
 
DIAGNOSIS: ATYPICAL B CELLS IN THE MARGINAL SINUS AND VESSELS: MINIMAL SPREAD OF DLBCL vs REACTIVE STATE/EXTRAFOLLICULAR ACTIVATION?  
Thank you for being 2gether.

tzankov 2009-11-02 12:19	This is the typical picture of an intravascular (angiotropic) DLBCL. Such patients have often involvement of the skin and a variety of CNS manifestations (microangiopathy, could be seen in CT). Phenotypicylly such lymphomas often express CD5. Nice case.
anpo 2009-11-02 15:42	I agree with Alexander this is DLCB - probaly the patient has more lymphoma in the spleen
ugnius 2009-11-16 17:57	Thanx, CD5(-) and Mum1+ (repeated). Clonaliy pending. I will inform you soon about that. Threpine shows any lymphoma spread.
hurwitz 2010-01-03 13:01	I think there is little doubt about the diagnosis of minimal spread of DLBCL. We can neither exclude nor prove an agiotropic lymphoma.   Lets close the case with the diagnosis: Minimal predominantly intrasinusoidal spread of DLBCL to inquinal lymphnode.   Results of the pending molecular studies can be added later.
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