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DLBCL ex FL? (657914) » 2015 Panorama.jpg
Filename: 2015 Panorama.jpg
[DLBCL ex FL?]
80 yrs male with core biopsy of axillary lymph node. Previously was diagnosed as DLBCL in 2003 and refuse treatment (for 13 yrs NOT TREATED at all).  
HISTO 1 (primary 2003) 03/1/1012: Large and small (involuted Castlemann like) follicles with immunoblastic cell aggregates. Massive polytypic IgG+ plasmacytosis like in plasma cell variant of Castlemann (IgG4/IgG scattered only, <1/10).  
IH1 (large cells): CD20+; EBER(-); CD10(-); Bcl2(+/-); CMYC+; Bcl6/Mum1+; CD23/CD21/CD138/CD30/CD5(-); HHV8(-); Ki67 up to 80%; IgM/IgD/Ig kappa/Ig lambda(-).  
HISTO 2 (relapse 2015) B15-18682: Core with NO NODULAR architecture, scattered "lacunar" and interstitial large cell aggregates with more irregular lobated nuclei and similar IH.  
IH2 (large cells): CD20/Pax5+; CD30/CD5/CD23/CD21/Cyclin D1(-); Ki67 up to 90%.  
DIFFERENCES (IN IH, 2003 old blosk restained): Higher Ki67? More Bcl2+ ? Diffusse? The same ABC: CD10(-) Bcl6+Mum1+ CMYC+...  
MOLECS: NOT CLONAL, borderline quality from 2003, scant 2015...  
DIAGNOSTIC VERSION: FL (3b), "treated" by biopsy (with "germinothropic DLBCL" or Castlemann DLBCL features) with progression into DLBCL (enriched by T cells).  
LAST CT: Right biceps assimetry, possibly infiltration. Small right lung nidus S6. Axillar conglomerate of LN. Liver S4a small calcinate in the surface. Spleen: several small focci. Left adrenal with infiltration. Rektosigma: polypoid lesion.  
 
Thank you for your attention and kind heart/brain.
Sender: ugnius
2015-06-02 11:11
INCTR - EBMWG Hematopathology Online

Last modified: 2015-06-02 11:11:18