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Nodular NHL: FL vs DLBCL (436554)
Nodular NHL: FL vs DLBCLnew
Subtitle: B12-25487
Type:
NODE
Sender:
ugnius
2012-08-24 07:50
INCTR - EBMWG Hematopathology Online

42 yrs old healthy male with lymphadenopathy, noticed after 10 days (fast progression?): isolated bilateral neck (up to 10cm left). Hepatosplenomegaly absent. LDH normal. CRB elevated 63mg/l.

HISTO: Nodules with some interfollicular diffuse areas, large amount of large cells, but admixture of small lymphos and large centrocyte like cells- its not fit into DLBCL level.

IH: CD20/BCL6/MUM1/BCL2/IgM/Ig Kappa+, IgD-/+, CD21/CD23/CD10/LMO2(-). Interestingly CD23/CD21 network more disrupted, than regular (as DLBCL or MZL infiltrating follicles). Ki67 high up to 70%.

PROPOSAL: B NHL with follicle/node formation: follicular (Bcl6+ Mum1+ CD10-) vs marginal zone lymphoma with blast access (aberant Bcl6) or DLBCL with nodular pattern/ occupation of follicles?

Thank you for continous education.

 

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tzankov
2012-08-27 07:06
Hi Ugnius,  
This is an obviously blastic, nodular growing B-cell lymphoma with disrupted FDC networks and a rather unspecific phenotype. There are some arguments for FL G3b, but the tumor rather disrupts and pushes the FDC aside. A blast-rich MZL is a good idea as well, but I do not see a typical MZL pattern. Finally, and from the practical point of view, most importantly the morphology, the proliferation and the clinical presentation best fit to a DLBCL with a nodular pattern. I think that such a designation will straight forward lead to the only adequate therapeutical decision for the clinical colleagues as well. I have seen at least two cases of full blown DLBCL in one lymph node showing a similar pattern of "early", nodular involvement in adjacent lymph nodes, so that I speculate that such an "early" involvement might explain what you see. I am curious if the patient has a low stage (II) disease?  
ugnius
2012-08-27 07:25
Thank you a lot. Up to date a patient comes for therapy, so maybe additional data wil be cleared up. It seems to be low stage and good performance. Another idea was not stated as possibility: just FL in transformation with the same meaning of DLBCL... Admixture of cc like cells slightly blurr the clear cut pattern of disease.
tzankov
2012-08-27 07:41
Since CD10 and LMO2 are negative I would rather consider FL not as diagnosis of first choice.
Last modified: 2012-08-25 17:20:57