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A hugh polypoid endometrial mass (354430)
A hugh polypoid endometrial massclosed
Subtitle: in a-67-year-old female		 Type:
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semir 		2011-03-02 14:10
INCTR - EBMWG Hematopathology Online

Sorry for the late update, but I was not able to post the necessary data here.
The tumor presented as a huge tumor mass protruding from the cervix. The tumor measured 11x7x6.5 cm, mimicking a large polyp. Histopathology revealed a diffuse lympho-plasmacytic infiltration confirmed by immunohistochemistry. Detailed IHC panel was performed: AE1-AE3 (-), desmin (-), SMA (-), c-Kit (CD117) (-), CD56 (-), Synaptophysin (-), Chromogranin (-). Of the hematologic markers, CD79alpha was positive (not shown here) whereas Bcl-6 was negative.

Thank you for your comments.

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bvrugt
2011-03-02 16:30
I consider a DLBCL or a plasmablastic lymphoma. CD20 is not convincing. I would be interested in CD138, MIB-1 and EBER as well.
armpath
2011-03-02 19:18
I would support the diagnosis of plasmablastic lymphoma. Would be nice to see the Tdt reaction as well, along with PAX5 in order to exclude the possible Pre-B ALL.
semir
2011-03-03 07:14
Thanks for your comments.
diane.c.farhi
2011-04-01 17:47
I agree that it is a B-cell neoplasm. The main differential diagnosis, from a clinical and treatment point of view, is between pre-B acute lymphoblastic leukemia/lymphoma and B-cell lymphoma. I am not confident about resolving this from the morphology; the cells just seem small and dark to me. The immunostains provided do not distinguish between these two possibilities. CD38 is non-specific and the kappa and lambda both appear positive, probably a background reaction. I think the most important step is to stain for TdT. If this is not possible, then pre-B ALL should be excluded by examining the peripheral blood and bone marrow. If the PB and BM are negative for ALL, then pre-B lymphoblastic lymphoma is still a possibility, but is very unlikely in this age group, leaving B-cell lymphoma as the probable diagnosis. If the PB and BM show B-cell lymphoma, then the diagnosis is more certain. The classification of B-cell lymphoma is hard to do on the images provided, and is probably not critical from a clinical point of view.
SergeyN
2011-04-10 22:43
I would second the Professor Farhi's request: blood picture and staging data could be very helpful. Atypical cells in blood or significant cytopenia, M-gradient status, tumor dissemination pattern, etc.
hoellers
2011-05-22 15:52
to sum up the case:  
 
Based on the morphology and immunophenotype shown here this is a PAX5, CD79a, CD10 and CD38 positive B-cell neoplasm.  
 
TdT and screening of the peripheral blood are recommended for a B-ALL work-up  
 
Kappa/Lambda is not informative and EBER might be of interest (because of CD20 negativity)
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Last modified: 2011-03-03 07:13:49