1. 80yrs man was operated (resection of skin and soft tissue) with clinical diagnosis "Sarcoma dorsi".  
MACRO: 6,3 cm lobulated irregular brown tumor nodule in subcutis.  
PTHO DGN.: Diffuse large B cell lymphoma in soft tissue and derma. Immunophenotype: FC activated: CD20+,Bcl6+/-(30%),Bcl 2+/-(20%),CD10-,Mum1+( 90% ), Ki67 95%, p53+ (80%).  
2. Skin biopsy was performed due to papular rush.  
PATHO DGN.: DLBCL with exceptionally intravascular spread. Immunophenotype is identical to primary.  
QUEST: Sometimes convenient DLBCL has minimal intravascular component. But some cases are described when DLBCL has progressed exclussivelly like intravascular form. It seems similar to this case.  
THANK YOU FOR COMMENTS.

hurwitz 2005-11-29 09:51	I Forgot to congratulate you and your technicians on the high quality of your histology and your immunohistochemistry.   True that intravascular spread is not a prominent feature of BLBCL, however it can be seen in particular in cases associated with immunodeficiency. We have collected (but never published) a large series of lymphomas in the elderly, most of them DLBCL, extranodal and many with intravascular spread
ugnius 2005-11-29 10:03	Thank you dr.Hurwitz: for compliments and for opinion:)
hublerm 2005-11-29 19:48	the quality of your histology is brilliant!
ugnius 2005-11-29 19:57	Thank you, Mrs.Monica. Lab technology ok, but what about diagnostics? :):):) Compliments to all creators and moderators of iPath2. It's very strenght and usefull instrument (esp. interface).
ugnius 2005-11-29 19:58	I've used iPath2 for my students today- the same cases for different purposes. Attractive and simple.
hublerm 2005-11-30 08:11	may be, you are interested to have a look at the iteach. at the moment there is only the german version available. i can give you the link http://teleteach.patho.unibas.ch/. for more information please contact prof. oberholzer moberholzer@uhbs.ch.   regards monika
ugnius 2005-11-30 08:23	Thanx. But it requires password?
hublerm 2005-11-30 09:31	you have to registrate too.
ugnius 2005-11-30 11:44	ADDITIONAL info: primary DLBCL was located in skin of the back and spreading to soft tissue without intravascular growth. Some single tumor cells were detected in veins, but one can find it in every case of DLBCL. Immunophenotype was similar. BM is intact. It seems it's not pirmary INTRAVASCULAR LBCL.   So, final diagnosis would be DLBCL (primary?) with progressing intravascular DLBCL form in skin.
franco 2005-11-30 15:36	Excellent case. Nothing to add.
ugnius 2005-11-30 16:00	Thank you for collaboration.
ugnius 2005-12-05 07:32	Add data: The lessions on the legs were persisted together with tumor in the skin (synchronous lessions: DLBCL and intrvascular LBCL). The patient was insisting that there are bruises after trauma.
Went 2005-12-06 11:53	under the prerequisite that this tumor is primarly cutaneous, i would classify it according a recent publication in blood (106(7):2491-97) as "cutaneous large B-cell lymphoma, leg type", as it is composed of round bcl2+ large cells. The prominent intravascular tumorspread is extraordinary. The patient has several prognostically unfavourable factors: age, MUM1/ FoxP1/ BCL2 positivity and histologic type.
Went 2005-12-06 11:54	sorry, FoxP1 was not done in this case, but it's positivity would also indicate unfavourable prognosis.
ugnius 2005-12-06 12:29	About "DLBCL leg type": I'm still not sure: cells are Bcl 2+, but not diffuselly and faint enough; the cells are pleomorphic enough too. And criteria of "leg type" primary DLBCL are do cloudy (for me), esp. in upper parts of body:)   And one more quest: does cutaneous DLBCL (CB or IB types), other than leg type and intravascular or plasmablastic, exist at all in skin???   In this case diagnosis: DLBCL (if primary) with intravascular spread was suposed.   Another actual problem (maybe geographic?) in my area: a relativelly small amounts of nodal FL at all and FCL in skin.   Thank you for comments, dr.Went
hurwitz 2005-12-11 19:58	I agree with DR.Mickys diagnosis, DLBCL,probably primary in skin with secondary intravascular spread.
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