45 yrs male with recurrent orbital/lacrimal gland low grade B NHL.
In 2014 on primary event called (by myself) as FL grade 2 (75% follicular)(Bcl6+ CD10-).
in 2014 in CUTANEOUS THORACIC core biopsy changed into B MZL diagnosis (mainly interfollicular CD20+ IgM+ population with scattered nodules of Bcl6+: different from IgM+ nodules in 2021 relapse).
In 2021 (ocular relapse) the same picture as in primary: close to B FL.
IH (attenuated)(2021): CD20+; Bcl2+; Ig kappa+; IgM+ >> IgD+; MUM1/FoxP1+; LMO2+/-(weak); GCET1/Bcl6/CD10(-); CD5/CD43/CyclinD1/MNDA1/CD21/CD23/CD30(-); EBER(-); Ki67 index up to 35%.
Bcl2 break (FISH): absent.
MOLECS (clonal comparison): ND yet (old 2014 material).
VULSK sonoscopy (2020 July): GEN LYMPHADENOPATHY
RIGHT inguinal LN 9 x 5 mm, LEFT- 13 x 6 mm. LEFT NECK LN 13 x 6 mm, RIGHT- MULTIPLE up to 30 x 18 mm. RIGHT SUBCLAVICULAR LN iki 20 x 12 mm. AXILAR LN: normal.
LDH 2020 (U/L) 197 normal (125-243)
CT (2014): Subcutaneous masses left thoracis area and left inquinal zone mass and lymph node. Paraesophageal enlarged LN.
PET (2014): the same.
PROPOSAL: Systemic disease: B FL (in all 3 biopsies, not represented in skin biopsy (interfolicular area?) vs 2 diseases?
PROBLEM: Bcl6+ CD10(-) and Mum1/LMO2/FoxP1+ immunophenotype...
Low grade B NHL orbit with various diagnoses FL-MZL