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Interdigitating cell tumor (373671)

Interdigitating cell tumor
Subtitle: B11-20623

Type:
NODE

Sender:
ugnius

2011-06-29 16:05
INCTR - EBMWG Hematopathology Online

72 yrs old male axillary 4 cm firm nodule was biopsied with suspition of lymphoma.

HISTO: Perifollicular epithelioid interstitial and confluent ("targetoid") atypical "histioid" infiltration with lobated/wrincled (but not grooved nuclei with eo nucleoli) with the smaller dermatopathic lymphadenopathy areas enreached with Langerhans cells.

IH (Langerin is absent there, sorry): Histiocytic population: S100(+++)(citopl. r-ja) 100%, CD68(-), Ki67 ~30% (++), CD1a(-)(LC dermatopatic zones +), CD20(-), CD3(-)(intratumoral T lymphos +), PanCK(-), CD30(-), ALK1(-), Melan A/HMB45(-), CD23/CD21(-), CD4(-)(LC dermatopatic zones +), EMA(-), HLA DR(++) 100%, CD45RO/MPO(-), CD15(-), LCA(-), CD34(-). TdT+ infiltration absent. Multiple intertumoral CD138+ polytypic plasmacytes present.

PROPOSALS FOR DISCUSSION:

1. Langerhans cell histiocytosis/tumor/sarcoma: S100+; CD68(-); CD1a(-); CD4(-); CD23/CD21(-); HLA DR+; LCA(-); CD10+/-; Ki67 ~30% (++)?

2. Interdigitating cell tumor/sarcoma (epithelioid): S100+; CD68(-); CD1a(-); CD4(-);CD23/CD21(-); HLA DR+; LCA(-); CD10+/-; Ki67 ~30% (++)?

Thankyouforbeeingclose.

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ugnius 2011-06-29 16:11	The case is open for review. Thanx.
tzankov 2011-06-30 20:22	Nice and difficult case. At the end of the day there are no realistic DD to interdigitating dendritic neoplasm. I do not see arguments for a Langerhans histiocytosis. Have you done a Masson-Fontana stain? Is there a specific cutaneous lesion in the draining region of the lymph node (e.g. melanoma or something that can explain the dermatopathic features and the tumor)?
ugnius 2011-06-30 20:28	Thanx. Interestingly, at first look I have had an idea of ALCL with "key cells". The patient will be hopefully redirected to hemato dept and I will have a possibility to complete a case.
ugnius 2011-07-01 15:11	IH upgraded: any news: multiple intertumoral polytypic plasmacytes present. I will inform about next evaluation/therapy (residual mass resection?) steps.
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Last modified: 2011-09-12 10:30:28