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Diffuse Large B-Cell Lymphoma (5324)
Diffuse Large B-Cell Lymphomaclosed
Subtitle: B08-6717
Type:
Endometrium
Sender:
ugnius
2008-04-08 14:18
INCTR - EBMWG Hematopathology Online
23 yrs female underwent DC procedure due to bleeding.  
HISTO: More expansive CD20+ infiltrate with DLBCL quality.  
IH: Ki67+ 80%, CD20+ 100%, CD30+ 5%, Bcl6+ 80%, CD10/CD3/CyclinD1/Bcl2/TdT/CD43(-), Mum1+30%, Ig kappa(+++) slightly > Ig lambda. Ig M+ plasmoid cells. IgD(-).  
Pending: CD138  
PCR: IgH OLIGOCLONAL  
 
PROPOSAL: DLBCL vs "LIKE"  
 
DIFFERENCES WITH PREVIOUS CASE:  
1. More intensive/agressive infiltrate.  
2. IgH OLIGOCLONAL.  
3. LOW CYTO-QUALITY.
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tzankov
2008-04-08 18:36
generally, my comments for Part 1 apply also to Part 2. I do not see enough evidence to call this lymphoma, particulalry in the light of the phenotype... extrafollicular blasts activation would be a particular explanation for the morphological changes seen.
hurwitz
2008-04-10 20:15
This case seems somehow different to the previous one (ID168731), the lesion is more diffuse, less well circumscribed and shows destruction of endometrial glands, in addition there is cellular atypia. I find it difficult to diagnose a clearcut DLBCL, but the lesion is worrisome. I would suggest to repeat the curretage and to do a minimal staging. It might be also worthwhile to repeat the PCR for IgH clonality.
diane.c.farhi
2008-04-10 22:20
I'm sorry, but I'm confused. Is this the same patient as before? or a completely different patient?
ugnius
2008-04-11 08:44
2 different patients from different regions, different accessing numbers (PCR results are different too). We deal with such lessions from endometrium very rare and these 2 cases lay down on the table in pair. Starnge feeling. But really this case is more infiltrative and multifocal, than previous.
diane.c.farhi
2008-04-11 18:18
I am very concerned about this lesion. In the low-power slide labelled 'CD20 multifocal' is the pink tissue necrotic? It looks like it might be. This case has features lacking in the first case: wide involvement of the endometrium, gland destruction (very good idea to do the CK stain), and possibly necrosis. I would call this diffuse large B-cell lymphoma, and I think this patient needs staging and therapy rather than a wait-and-see approach. If the first patient has these findings after a repeat curettage, she will be in the same situation; that's why she needs re-evaluation for further biopsy and close followup.
torlakovic
2008-04-17 05:12
I agree with the diagnosis of DLBCL.
hurwitz
2008-04-21 21:18
Final diagnosis:  
 
Endometrium with Diffuse Large B-Cell Lymphoma  
 
Thanks for the submission of this instructive case and the discussion.
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Last modified: 2008-04-08 14:18:37