HISTORY: 68 yrs woman underwent LN biopsy in 2005 September. PathoDGN 1 was DLBCL. After specific chemotherapy in 2007 June gastric biopsy was performed. PathoDGN 2 was: B low grade lymphoma (CyclinD1-). In 2008 due to inguinal/femoral lymphadenopathy LN biopsy was performed.  
HISTO: 1. (2005) on on the slides. 2. (2007) on the slides. 3 (2008) on the slides.  
IH: 1. (2005): .2. (2007). 3 (2008).  
Virtual slides:  
2005: http://193.219.87.170:82/imageserver/LT_TELEPATHOLOGY/Ugnius/Studentams/B05-22942_Difuzine_dideliu_B_lasteliu_limfoma.svs/view.apml?  
 
2007: http://193.219.87.170:82/imageserver/LT_TELEPATHOLOGY/Ugnius/Studentams/B07-16855_Skrandzio_zemo_histologinio_laipsnio_B_limfoma.svs/view.apml?  
 
2008: http://193.219.87.170:82/imageserver/LT_TELEPATHOLOGY/Ugnius/Studentams/B08-37367_Difuzine_dideliu_B_lasteliu_limfoma_su%20_likutiniu_B_mantijos_limfomos_komponentu.svs/view.apml?  
 
PROPOSED DIAGNOSIS: B mantle cell lymphoma (classic and blastoid/pleomorphic; nodullar and diffuse pattern) with transformation to DLBL CyclinD1+.  
SPECIAL QUESTS: Limits of and criteria for diagnosis of BLASTOID PLEOMORPHIC MCL.  

yethuwin 2009-01-18 15:44	can not access virtual slide
ugnius 2009-01-19 08:46	Dear Collegues, sometimes your access to virtual slides are aggravated by local technical or local/international connection speed problems. Please be patient and try these links one more time. Thank you. Due to this reason I always submit classic photos of HE and IH. In minutes all graphics will be placed in.
tzankov 2009-01-19 09:49	It would be interesting to know additional infos on the expression of CD20, CD79a, CD5... the main question is if you would like to call it transformation of MCL or a progression of MCL, me personally, I would call it progressive blast-rich MCL. the most important topic is to stess that the underlying disorder is MCL, since it matters considering (in)curability and probably the choice of future chemotherpy regimens.
hurwitz 2009-01-20 11:19	I just joint the group and i am here with nina and after aquick look at this case I would favour a diagnosis of Blastic mantle cell lymphoma but please add CD5 immunostaining   Lorenzo Leoncini
ugnius 2009-01-20 14:48	Please find CD5 faintly positive in some areas and 2005 (LN biopsy), 2007 (gastric biopsy) materials. In 2005 CyclinD1 was not done, in 2007 biopsy NEGATIVE.
hurwitz 2009-02-17 20:49	I fully agree with Dr.Tzankov and Prof. Leoncini. Morphology and results of immunohistochemistry on the 2008 biopsy (CD5+, Cyclin D1+) support the diagnosis of blastic mantle cell lymphoma.   These tumors have a worse prognosis than primary DLBCL.
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