M/50yrs, laparoscopic bx from retroperitoneal lymph node mass, h/o undescended testis,  
CT Abdomen: Multiple enlarged nodes in retro-peritoneum, in paraaortic peripancreatic, & mesenteric region. Mediastinal & hilar lymphadenopathy, enlarged lymph nodes in paratracheal , subcarinal and hilar region, findings are s/o lymphoma.  
 
CRP: >150mg/l, serum LDH: 789 U/L, serum calcium: normal CBC: Total WBCs: 5400/cumm, Poly 71%, Ly 20%, Mo 5%, Eo 4%, Platelets: 387,000/cumm, Hb 13.4 g/dl  
 
I think this is NHL, pl give your opinion  

hurwitz 2006-12-28 22:23	The lymphnode structure is destroyed by an infiltrate of large lymphoid cells with irregular nuclei. A vague follicular structure can be recognized. Some follicles are surrounded by a narrow rim of small lymphoid cells, others contain a mixture of small and large lymphoid cells.   I agree, this is an aggresssive large cell lymphoma. Based on morphology, the possibly of high grade transformation of a preexisting low grade follicular lymphoma has to be considered, however, this suggestion should to be confirmed by immunohistochemistry and/or molecular studies.
hurwitz 2006-12-28 22:32	Sorry I forgot to mention, that a bone marrow biopsy should be performed as staging procedure. In case there is really a preexisiting low grade follicular lymphoma, the low grade part might appear on the biopsy.
sirje 2006-12-29 07:51	In this case the high grade transformation of marginal zone lymphoma is possible.
anpo 2006-12-29 22:29	Morphology is suggestive of diffuse large B-cell lymphoma. Without at least reticulin stain it is difficult to judge if there is real follicular pattern. I did not see any convincing picture with low-grade component. Of course, as Nina pointed out it the diagnosis has to be confirmed by immunostainings.   Happy New Year to everybody!
munafdesai 2007-01-01 00:09	Thank you Dr Hurwitz, Dr Sirje & Dr Anna for your comments. The blocks will be sent for immuno & I will post the result once I get it.
Mueller-Hermelink 2007-01-01 16:34	This is a nice example of a multilobated DLBCL with some nodular areas that are reminiscent of follicles . However, since reactive follicles are persistent and surrounded by large cell lymphoma I suppose it is a primary ( de novo) large cell lymphoma rather than a transformed follicular lymphoma. Multilobated large cell lymphoma are regularly GBC - like DLBCL.
FFalko 2007-01-09 16:16	I agree that this is large cell lymphoma with multilobated (centroblastic) morphology. The presence of remnant reactive (?) follicles speaks against transformation from FL.
munafdesai 2007-01-16 04:41	The immunohistochemistry report from referral laboratory is as follows,     CD45 & CD20 are positive. CD3, PLACENT ALK PHOS, AFP & CD30 are negative.   Diagnosis: Malignant lymphoma, large cell, B-cell phenotype     Regards
hurwitz 2007-01-18 21:08	Thanks Munaf for the results of immunohistochemistry, which confirm the diagnosis of DLBCL.
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