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Agressive B-cell lymphoma (25499)

Agressive B-cell lymphoma
Subtitle: B10-29403

Type:
GI

Sender:
ugnius

2010-11-04 10:43
INCTR - EBMWG Hematopathology Online

84 yrs old female underwent large intestinal resection due tu v. ascendens tumor. CLIN. DGN.: "Ca coli ascendentis cT4NxM0, penetrans ad partis rectosigmatis, ilei terminale et ureteris sin.

HISTO: on the virtual slides amd photos. Underfixed, quality not optimal

IH: Pax-5(+++) 100% , CD20(+/++) 70% (low quality), CD79a/LCA(++)100% Ig kappa+ (esp. Ig inclussions)>> Ig lambda+; Ki67 95%; Bcl2(+/++) 80% , Mum1(+/++) 60%, IgM(+/++) 60% slightly > IgD+, Bcl6(++) 80% CD10(+/-)(faint, inconclussive, artefactual?) 60%, CD3(-), ALK1(-), CD138(-), CD4(-), CD56(-), CD30(-), EMA(-), EBER(-), Ig kappa CISH+ (single cells) > >> Ig lambda CISH(-).

PROPOSED DGN: B aggressive lymphoma with plasmacytoid features: B plasmablastic lymphoma with plasmacytic differentiation in c. ascendens.

SPECIAL REMARKS: 1. CD138(-); Mum1+; CD20+; IgM+; EBER(-) phenotype in extranodal HIV(-) plasmablastic lymphoma? 2. VISUAL plasmacytic differentiation more obvious, than on IH and Ig CISH? Differential with transformed MzL with plasmacytoid differentiation?

Thankyoubeeingtogether.

Gallery:

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tzankov 2010-11-04 13:24	In my opinion this is a plasmablastic lymphoma. In the last time, at least in our institution, the bowel seems to be the site most commonly involved by plasmablastic lymphomas. Is the lady immunosuppressed? Consdiering your second question, I am not aware that MALT lymphomas specifically transform to plasmablastic lymphomas.
ugnius 2010-11-04 14:34	Thanx. IH is uploaded. WHAT IS THE REASON FOR INABILITY TO OPEN VIRTUAL SLIDES?
tzankov 2010-11-04 16:44	in this case the virtual slides functioned, they did not properly function the previous case
ugnius 2010-11-04 16:51	Please, test the previous case/virtual slides. The "adress code" seems to be the same as in this case...
hurwitz 2010-12-12 15:18	There is certainly plasmablastic differentiation, however tumor cells are CD138-, and clearly CD20+, they are also MUM1+. I would prefer to call this lesion DLBCL with plasmablastic differen-tiation. I am puzzeld by the large amount of protein deposits, I wonder what is the experience of others in high grade lymphomas? Ugnius has raised the question of transformation from low grade lymphoma, I doubt that at this stage and with the given data we can comment on this. Worth mentioning is the possible role of age associated immunodeficiency for the genesis of this neoplasm.
hoellers 2010-12-29 11:09	I would like to sum up the case: Agressive B-cell lymphoma. Differential diagnosis between DLBCL (with plasmablastic differentation)(no EBV assosiation, no CD138 expression, CD20 positivity)and plasmablastic lymphoma (extranodal site, very high proliferation fraction, CD20 faint, MUM1 positive). In my opinion I would favor plasmablastic lymphoma.
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Last modified: 2010-11-04 11:22:51