60 yrs female with core biopsy (not sufficient for full IH) and subsequent whole node biopsy (submandibular).  
PET scan: suspition for nasopharyngeal tumor, neck lymphadenopathy. Peripheral blood: NS.  
 
HISTO:  
- 60% diffuse and heterogenous blastic infiltrate (DLBCL);  
- The rest of: small lymphos zones with scattered small medium strongly Bcl2+ neo cells with the same IH and focally retained follicular structures with giant hyperlobated cells with "interstitial" infiltration pattern (FL?).  
 
IH (In sum)(DLBCL)(ABC/nonGCB): CD20/Pax5+; Bcl6/Mum1+; CD10/CD23(-); Bcl2+; CMYC+ 80% (IH "double"); CD5/CD21/CyclinD 1(-); IgM+; Ig lambda+ (restricton); IgD(-); Ki67 up to 80%.  
 
DIAGNOSIS: DLBCL, transformed ffrom FL (grade 3b?).  
SPECIAL QUESTs:  
1. Transformation vs DLBCL with folliculothropism?  
2. Grading of FL, when predominant "blasts" with hyperlobated polymorphic nuclei?  
 
Thank you beeing together.

tzankov 2014-09-29 09:11	You ask difficult questions.     Consdiering the negativity for CD10 and CD23 and the ABC-phenptype as well as the appearance of the KI67 staining in the follciales, I rather suggest colonialization of the follicles in a lymph node, which is still partially invloved by DLBCL. On the other hand the BCL2 staining is more intense in the follicles, which is not so typical for colonizing DLBCL. Helpful for the final deciison would be the eaxct appearance of the CD10 staining in/of the follicles, the presence of either disrupted or condensed CD21+ FDC in the follicles as well as the eventual presence of a FL-componetent in the staging bone marrow biopsy.
ugnius 2014-10-02 15:05	Thanx a lot.
ugnius 2014-10-05 13:28	please find CD21 and CMYC: CD10 totally homogenously negative.
tzankov 2014-10-06 08:30	all results are in my opinion more in favor of colonilaization
ugnius 2014-10-06 09:15	Thanx, at least infiltration sparse and IH complettelly comparable in both.
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