69 yrs male with cervical lymphadenopathy (from April; up to 6cm) and whole LN biopsy.
STORY: Weaknes, 10 kg loss. Herpetic eruption on the neck skin (2015 March). No hepatosplenomegaly, edemas or B symptoms.
BLOOD: 18.57 LEU; Blasts ~80%.
MOLECS: pending.
Threpine: The same infiltration of T LBL with small lympho- histiocytic nodule with S100+Lysozyme+ and CD123 cell admixture.
HISTO: Binary: "dark" LBL (T) infiltration with intermingled "clear" histyoid areas of S100+ only cells. Some DC2 cell nodules around (CD123+ strong).
IH: "DARK" LBL (T): CD3+/- faint; CD7+; CD5+; TdT+; MPO(-); CD34/CD117+ weak; Ki67 high.
"CLEAR" HISTYOID CELLS: S100+; Bcl2+ weak; TdT(-); CD1a/Langerin(-);
DC2 nodules: CD123+ strong; TdT(-)?.
PROPOSAL: COMPOSITE BLASTOID TUMOR:
NODE: 1) T LBL+ 2) Interdigitating dendritic cell tumor (vs dendritic undetermined?)+ 3) plasmacytoid dendritic cell proliferation, probably reactive.
BM: The same T LBL infiltration with small nidus of interdigitating cell tumor with concommitant DC2 cell infiltration (reactive).
COMMENT:
1. A case quite similar to discussed before (link and paper attached there), including reactive DC2 (plasmacytoid dendritic) cell nodules (in previous case- within BM).
2. Some scattered MPO+ immature cells within TdT+ dark blast population? Some (same?) myeloid component on FLOW.