< | up | >
HL like lymphoma (1652)
HL like lymphomanew
Subtitle: HEMATO
Type:
Surg
Sender:
ugnius
2006-03-16 15:04
INCTR - EBMWG Hematopathology Online
Lymph node and liver biopsies were performed to 30 yrs old male (Consultation case). Later the splenectomy and regional lymph node biopsy was performed due to splenomegaly. Threpine biopsy does not show any involvement of tumor.  
HISTO/IH: presented bellow.  
DIFFERENTIAL DIAGNOSIS: Hodgkin's lymphoma vs OTH.?
Annotations » Add comment (Login)
franco
2006-03-17 07:26
I think that, on the basis of displayed pictures, one can consider the differential diagnosis between HL and peripheral T-cell lymphoma, which sometimes can have large CD15/CD30+ cells. For this distinction, in my opinion it is important morphology (clear evidence of R-S cells) and immunohistochemistry (large cells should be LCA-/Cd30+ for HL diagnosis). I am slightly in favour of the diagnosis of HL.
ugnius
2006-03-17 12:22
Thanx. But EMA+ CD30- (definitelly) and superstrong and expanded CD20+ population? Maybe DLBCL diagnosis is not so extreme in this case? LCA interpretation is still difficult, but there is positive rim (by my eys) in photo- added additionally.
aorazi
2006-03-17 15:00
A bit of a dilemma. I am surprized that the large cells do not express CD30. Are you sure? Overall, this case resembles cases that have been described as "Large B-cell lymphoma with Hodgkin's features" by Garcia et al in Histopathology (2005 Jul;47(1):101-10)or as T cell rich B cell lymphoma (TCRBCL) by others but with an important difference: your case shows CD15 positivity which is highly unusual in cases of TCRBCL. I cannot tell on the pics. whether the CD15 positive cells correspond to the CD20 positive one or maybe are histiocytes?  
 
To complete the work-up, I would probably add Alk-1 and EBV. Clinically: is this patient immunocompetent?  
 
In conclusion based on what I have seen so far (and lacking molecular analysis -- IgH chain gene and TCR rearrangement analysis is really mandatory in cases of gray zone lymphomas)I would favor an uncommon (i.e. CD15 pos.) variant of TCRBCL.
ugnius
2006-03-17 15:59
Thank you, CD15+CD30-CD20+EMA+ cells are CLEARLY atypical. I may append CD30 reaction- it usually works more effective then CD15 usually in our lab (for instance in HL). So it looks surprisingly for sure. But we would like <10% large cells for qualifying T/H reach DLBCL. In this case CD20+ large cell population is more prominent.  
One more comment: we have had a meeting today with collegues from Baltic countries(Estonia and Latvia). SURPRISINGLY incidence of FOLLICULAR lymphoma in our area (in all 3 countries) is more rare event and incidence of DLBCL more dominating, than in Western countries...And immunophenotypes of DLBCL are often mixed of activated. GC type DLBCL are rare enouh- maybe one case is presented before (tumor in cervix uteri). Have you any wxplanation of this phenomena? I was afraid about diagnostic problems, but if so- it's identical to 3 different countries:)
hurwitz
2006-03-22 14:27
I am very happy with Attilios suggestion of TCRBCL. The clear CD15+ cannot be explained. Regarding HL, there are too many arguments against this diagnosis.
» Add comment (Login)
Last modified: 2006-03-16 15:04:26