44 yrs female: lymph node biopsy. CLIN DGN. IV stage NHL.  
HISTO: There are bright irregular nodules, darker serpentines between and bright sinus zone. The cells: medium sized with cc like nuclei.  
IH: There is CD21 disrupted network in the nodules, small nodular proliferations and diffuse sinus proliferation. CD10+ cells in the periphery of the nodules, associated with Ki67+ activity. All populations Bcl2+ and the nodules are a little bit brighter. The sinus cells Mum1+ CD10-. The similar clear cell population invades the centers of follicles/nodules. CyclinD1 is completelly (-).  
BM: There is nodular and linear peritrabecular infiltration of CD20+CD10+ cells with oval and cleaved nuclei.  
DIAGNOSIS: FL with marginal differentiation vs ...?  
Thank you in advance. A lot of appologies for photos from a little bit different sites- L/N was small enough and the sections were slightly of different appearance.  
Special quest: MUM1+ some FL cells or totally marginal cells?

dirnhofer 2006-04-11 12:44	difficult case, would like to see cd20 (or cd79a or pax5) and bcl6 before dd
ugnius 2006-04-11 20:21	Dear Stephan, I always try do not pollute the net with undoubtelly positive stains. CD20 is totally pos. I will apend it tomorrow.   Thank you for urgent comments. For the instance the strange feeling, that I cannot discriminate the NEOPLASTIC population appears: is the tumoral growth nodular or serpantines between them:)(For example MAYBE MARGINAL ZONE LYMPHOMA with dislocation of CD10 follicles is playing with me???). But after I've found MICRONODULES CD10+ and with CD23 network- some time ago I've found the similar micronodules in the mantle cell lymhoma...
ugnius 2006-04-11 20:24	One more question: sometimes it's dificult enough to find the same area in different stains to demonstrate the definite lession. Maybe you have some advice? In case we have nodule- it's ok. But in the diffuse "forest" of wild similar lympho's anybody can be lost:)
ugnius 2006-04-12 06:05	CD20 is arrived:)
ugnius 2006-04-12 12:52	Add info: BM biopsy: typical for FL.
ugnius 2006-04-14 12:39	Add: Bcl6" neoplastic usual and inverted follicles.
Went 2006-04-19 10:41	Dr. Dirnhofer and I discussed the case. We think it's a FL with marginal zone differentiation (BCL6+/CD10+/BCL2+ and the typical infiltration pattern of FL in the BOM). Morphologically, there is not the typical aspect of centrocytes and there are only few centroblasts shown in the pictures with cytologic details, which is somewhat surprising as these FL's tend to have a poorer outcome. In the original paper by Falini et al (Blood 2000), describing MUM1p, there is 1 FL positive for MUM1.
ugnius 2006-04-19 11:40	Thank you for discussion. Maybe Mum1+ areas more correspond marginal differentiation zone. The strange enough is irregularity of follicles, often inverted ones. Is an attractive case, don't you?
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