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