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PTCL like CHL CD30/CD15+ (458471)
PTCL like CHL CD30/CD15+new
Subtitle: B13-644		 Type:
NODE		 Sender:
ugnius 		2013-01-25 09:24
INCTR - EBMWG Hematopathology Online

THE CASE COMPLETED/UPLOADED:

36 yrs old Lady with lateral neck lymph node biopsy (with intraoperative consult).

HISTO: A lot of clustered in nodules mononuclear giant cells with cHL IH: LCA(-)(?); OCT2/BOB1(-); CD20(-); CD30/CD15+. Background- slightly pleomorphic T cells with focal CD23 FDC nodular networks and HEV's. IH: fully retained T (CD3/CD2/CD/CD7+; CD10(-); Bcl6+ (focal). EBV LMP1/EBER(-).

STRANGE THINGS: Ki67 index much more distributed, than GIANT CELLS. Bcl2 signal FAINT and WEAK in T population. CYTOLOGICALLY T population abnormal and larger than usual. LCA doubtfull, CD3 golgi like (positive) in giant cells (?). "Nishing" in CD7 and CD3(?).

MOLECS: Clear B clone !!!

MY DOUBT: T NHL (AILT like) with cHL like cells.

Thank you.

Gallery:
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tzankov
2013-01-31 07:32
I agree with the working hypothesis of AITL; this is not the first AITL with CD30-psotivity. Plase ad PD1 and/of ICOS stains!
ugnius
2013-01-31 08:13
Thank you. It's clear (T NHL): but Pax5 faint+, CD15/CD30+, LCA- (?) and only dot like Golgi+ (T Ag's: CD3/CD7)) on larger cells were impressive as B clone too.  
 
PD1 will be implemented soon (months), but not today:)
tzankov
2013-02-04 16:53
Is the EBER ready?
ugnius
2013-02-05 12:59
EBV LMP1/EBER (-).
tzankov
2013-02-06 06:13
Well the negativity for EBER, your observed lacking expression of LCA and the full Hodgkin phenotype of the giant cells (CD30+, CD15+, PAX5 dim, OCT2-, BOB1-) as well the fully reatined T-cell pahenotype of the background cells, without T-cell clonality, should force us to reconsider the hypothesis of AITL, also the age of the lady is not typical for AITL, but rather for cHL. I admit that I have not found Reed-Sternberg cells, but some of the giants classify for Hodgkin cells. What is the clincial presentation? Does the lady have a syndrome? At the moment I would hypothesize cHL.
ugnius
2013-02-07 11:36
Thanx. Despite this I'm aware that BACKGROUND population is clearly atypical too (except large cells not fullfilling "giant cell" criteria fully).
tzankov
2013-02-08 06:28
Look at that...  
 
Br J Haematol. 2008 Apr;141(1):124-6. doi: 10.1111/j.1365-2141.2008.07004.x.  
'Precursors' of classical Hodgkin lymphoma in samples of angioimmunoblastic T-cell lymphoma.  
Naresh KN, Menasce LP, Shenjere P, Banerjee SS.  
 
But this is an exceptionally rare observation. I still have some doubts how to classify the case. We need PD1!  
 
I can not open the scanned HE slide to profoundly study the details. Would you be so kind to ask your IT to re-upload it.
ugnius
2013-02-08 08:35
Dear Alex, we've checked availability with username guest- it works. Sometimes the system (Internet Explorer/Wondows) alert you about "insecurity": just push thumb "show all content". Additional sometimes IT alerts, that service temporary unavailable- but just try to open another slides- it must work and the problem seems to appear temporary and gone after some time. Thank you for the patience.  
If not- please send me printscreen of error seen by you on the screen in a moment of the opening the virtual slide.
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Last modified: 2013-02-08 07:30:31