< | up | >
Mesenteric Lymph node (350268)
Mesenteric Lymph nodenew
Type:
Sender:
munafdesai
2011-01-31 14:42
INCTR - EBMWG Hematopathology Online
F/72 yrs, known case of non- hodgkin's follicular lympmhoma, on treatment, presented with intestinal obstruction, mesenteric LN sent for HPE, size of lymph node 1x1 cm
Annotations » Add comment (Login)
diane.c.farhi
2011-01-31 22:51
This appears to me most consistent with reactive follicular hyperplasia. Immunostains for T and B cells, if available, may help in the evaluation; I would anticipate that they would show the expected normal distribution of T and B cells.
tzankov
2011-02-01 08:13
I agree that the architecture appears normal. There is a follicular hyperplasia, a widening of the marginal zones and a monocytoid B-cell hyperplasia. Since the patient suffers from follicular lymphoma, a BCL2 stain to exclude follicular colonization should be done. A B- and a T-cell marker should be done as well, as suggested by Dr. Farhi. An IgD stain would be a nice way to look for the border between mantles and marginal zones.
munafdesai
2011-02-03 22:18
Immuno images added
bvrugt
2011-02-04 08:26
The findings in the Bcl-2 suggest a follicular lymphoma but the morphology / overall architecture favor a follicular hyperplasia. Since the cell turnover in the latter is generally high a Ki-67 would be very helpful.
tzankov
2011-02-04 11:28
At least some of the follicles appear colonized by BCL-2 weakly positive B-cells. The pattern is strongly suggestive of a partial involvement by follicular lymphoma. Ki-67 may additionally support the diagnosis.
diane.c.farhi
2011-02-04 17:22
Partial follicular colonization by lymphoma is possible, but may be difficult to prove by IHC. PCR of this node, or flow cytometry of a subsequent node, may be more informative. Even if a clonal population can be identified, the clinical significance of this finding, in a node only 1 x 1 cm, is unclear. What was the cause of the intestinal obstruction? This may be more pertinent to deciding the clinical approach to this patient.
hoellers
2011-02-07 10:43
The intensity of bcl2 in the "nodes" is very high normally in follicular lymphoma there is a difference in intensity from the mantle zone/reactive T cells to the neoplastic compartment. I would highly recommend to go back to the H&E in the same area to rule out a primary follicle.
SergeyN
2011-02-07 14:43
CD10 seems to be negative in these nodular structures; a lot of CD5+ cells inside. Look like primary follicles, don't they? CD10-negative FL lymphoma in this setting looks a bit far-fetching.  
 
I would second the question about the obstruction nature to be completely sure.
tzankov
2011-02-07 17:20
In bcl201.jpg and bcl203.jpg as well as bcl205.jpg (left margin), there is a BCL2-positivity in structures that are definitely not primary follicles, which could not be explained by intrafollicular T-cells. I thinkt that an intense BCL2-positivity like in FL in situ is not a prerequisite in partial lymph node involvement of FL from other sites, which is the case in that patient.
hoellers
2011-02-07 18:21
I agree, that there are in addition some scattert follicles in which there could be a faint (specific?) bcl-2 staining.  
A high magnification picture of those follicles (to see, which cells are positiv) and Ki67 (which must show a decrease in FL) may help.  
» Add comment (Login)
Last modified: 2011-02-07 17:58:27