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DLBCL (nodular) vs FL3? (441993)

DLBCL (nodular) vs FL3?
Subtitle: B12-30378

Type:
HEMA

Sender:
ugnius

2012-09-27 10:41
INCTR - EBMWG Hematopathology Online

73 yrs. male with history of actinic therapy for prostatic carcinoma and TUR for urothelial carcinoma. Nowadays: general malaise, febrility 39C°, visceral lymphadenopathy and hepatosplenomegaly. Inguinal small node biopsy was performed.

HISTO: Vaguelly nodular medium- large cell infiltrate in the cortical zone with admixture of T cells and CD21/CD23 FDC hyperplastic networks; Medullary zone: AILT like picture with small- medium T lympho's, HEV's and slightly irregular nuclei.

IH: large B cells, vaguelly nodular: CD20+ Mum1+ > Bcl6+ Bcl2+ (patchy) LMO2+ (!) Ki67 about 70%. Large amount CD30+ RS like cells. T zone: usual T phenotype: CD3+ CD4+ > CD8+, but FAINT Bcl2! and large B immunoblastic aggregates (as in AILT): CD30+/CD15(-).

MOLEC's: IgH/K clone. TCR polyclonal.

PROPOSAL: Visually seems like FL grade 3, but neoplastic cells (mainly immunoblasts) scant enough with reminescent of GCB IH... So version is: DLBCL (nodular), maybe evolving from AILT (or T LPD with secondary DLBCL) (?). I presumed EBV (age asociated LPD/ DLBCL etc.), but EBV LMP1/EBER completelly negative. So conventional arguments moves me into FL... (?)

imported on 2012-09-27 10:41:34 originally owned by ugnius

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tzankov 2012-09-28 14:08	Indeed in the Cd21 staining one can see rather hyperplastic but regular FDC proliferation. The cytology is rather immunoblastic and a DLBCL can initially spread to a LN respecting the preexistent FDC. The rather regular FDC proliferation makes a background AITL unprobable. How do CD10 and MUM1 look like?
ugnius 2012-09-28 14:46	Thank you, Alex. Please find Mum1 pattern- corresponding regular interstitial (secondary) nodular infiltration. DLBCL from AILT version for me evloved from HE so regular and medium cellular picture with slightly expanded FDC network. T clone is absent, EBV is absent, so this sub-idea is dead:)
tzankov 2012-09-28 17:23	Thank you. For me, it is not the typical cytological pattern of FL G3, thus I would designate it as DLBCL.
ugnius 2012-09-29 11:58	Thanx. CD10 is negative (except several small lymphos)- it's because absent in pictures/scans. FORMALLY the caliber of the cells is heterogenous and maybe too small (medium- large) for "pure" DLBCL? Anyway it seems the best solution.
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Last modified: 2012-09-28 08:21:42