68yrs old male with retroperitoneal core biopsy.  
CLINICALLY: Back pain and walking disabilities. Sonoscopically: retroperitoneal tumor. The patient los for foolow up and does not reach hemato dept after diagnosis.  
HISTO: On the slides.  
PHOTOS: from Apperio virtual slides taken.  
IH: CD138(+++) 100%, Mum1(+++)100%, Ig lambda(++)100%, CD4(+/++) 80%, EBV (EBER)(-), Pax5(-), CyclinD1(-), CD79a(-), CD20(-), Ki67 100% (+++), CD3(-), Ig kappa(-), Bcl2(-), CD10(-), Bcl6(-), ALK1(-), CD30(-).  
QUALITY: small biopsy: a lot of overstaining and marginal artefacts: CD38/ Ig/ etc. Appologies.  
 
PROPOSAL: B plasmablastic DLBCL.  
 
Thankyouforbeeing2gether.

tzankov 2010-05-31 13:24	There are many argiments favoring your diagnosis, but EBV is negative, thus I would perform a CD56 stain in order to have more arguemnts to exclude a plasmablastic plasmacytoma. Did the patient had a history of CLL, since some Richter's migh look like that case?
ugnius 2010-05-31 13:40	Thanx. Any hemato data present. Really I usually dont use CD56- it practically never works on plasma cell neo.
bvrugt 2010-05-31 13:55	I thought that the only discriminating factor between a plasmablastic lymphoma and a plasmablastic plasmacytoma - both CD138 positive, CD20 negative, and with a high Ki-67 fraction -would be the EBV positivity. Since EBV is negative I would prefer a plasmablastic variant of a plasmacytoma.
tzankov 2010-06-01 06:20	Dear Bart Vrugt, at least in my opinion (I know he paper in Mod Pathol, saying that the only discriminator is EBV), expression of all CD4, CD30 and PAX5 and negativity for CD56 (and CD19) as well as a proliferation of more than 80%, without CRAB criteria and an M-gradient are all in favor of a plasmablastic lymphoma (PBL) rather of a plasmablstic plasmacytoma; but in occasional cases the differential is not really 100% possible. Some CLL transform also to PBL...
ugnius 2010-06-01 16:34	CD56 completelly negative (I do not believe in my CD56:))
diane.c.farhi 2010-06-02 16:32	Given the patient's history of back pain and walking disability, and given the plasma cell characteristics of this tumor, I think we should consider the possibility of plasma cell (multiple) myeloma extending from the vertebrae into the retroperitoneal space. The morphology does not exclude this diagnosis. Before assigning a definite diagnosis, the patient should have a more complete workup, at a minimum including bone x-ray or other imaging, serum calcium, and serum and urine immunoglobulin levels with immunofixation, if SPEP is positive.
hurwitz 2010-06-02 21:12	I am afraid we will not solve this dilemma because as stated in the clinical data, the patient has disappeared so no clinical information to help with the DD will be available. I agree with Diane that the morphology is suggestive of plasmablastic myeloma.
leoncini 2010-06-11 11:26	I would prefer a plasmablastic variant of a plasmacytoma because there are many mture plasmacells and is EBV negative.
hurwitz 2010-06-12 14:26	A clear cut diagnosis might be difficult to reach, there are arguments for both DLBDL, plasmablastic type, and plasmablastic variant of plasmacytoma. Integrating the results, in particular the morphology, which shows a large number of clear cut atypical plasma cells, I would strongly favor the diagnosis of plasmacytomy, plasmablastic variant.
	» Add comment (Login)