CASE IS OPEN FOR DISCUSSION:  
 
71 yrs old male with RIGHT iguinal (fragmented) LN biopsy.  
On PET sacan: positive RIGHT inguinal area+ some positivity in LEFT tonsil/neck LN.  
Aspirate FLOW (BM)L negative. No leukaemia present.  
 
FIRST LOOK IMPRESSION: As transformed into blastoid conventional MCL.  
 
HISTO: Binnary architecture with irregular FDC suported PALE nodules of higher ~3b grade, surounded by smaller "MCL like" DARK lower grade (1-2-3a) population (dispersed larger cells from nodules).  
Immunoprofile 1 (HIGH GRADE/PALE): CD20+ > CD22+; Bcl2+; CD43+; CD10+; Bcl6+; IgM+; p27(-); CyclinD1/Sox11/CD21/CD23/IgD(-); Ki67 index high up to 90%.  
Immunoprofile 2 (LOWER GRADE/DARK): CD20+ > CD22+; Bcl2+; CD43+; p27+; Bcl6(-); IgM+; CD10+; CyclinD1/Sox11/CD21/CD23/IgD(-); Ki67 prolif. index 20%;  
BCL2 (18q21) break absent, but POSSIBLE 18p amplification (in both components).  
Bcl6 break: PENDING.  
 
DIFFERENCES IH: DARK SMALL: p27+; Bcl6(-); Ki67 lower; LARGE PALE: Bcl6+; p27(-); Ki67 higher.  
 
PROPOSAL: Follicular lymphoma (binnary, follicular and diffuse) in lymph node.  
SOME INTERESTING FEATURES: IH difference (p27-Bcl6 split) and "interfollicular"/diffuse component lower grade than nodular one.  
 
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tzankov 2019-06-17 07:30	I totally agree with your final interpretation of a transformed FL
ugnius 2019-06-17 15:20	Thanx. Just FL low into FL high or questioned DLBCL? Please find CD35 FDC networks in nodules (pale).
tzankov 2019-06-17 17:17	bec ause of the retained FDC - FL low in FL high
ugnius 2019-06-18 13:59	Thanx x2.
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