The D&C procedure (curreting of endometrium) and the removal of endocervical polyp were performed for 54yrs old woman. CLIN DGN.: Myomatosis uteri. Cervical polyp. Premenopausal bleeding. The last menses 01 20. HISTO of polyp is presented on photos below.  
IH: CD20(+) 95%, Bcl 2(-), CD3(-)(except small T lympho's), Bcl 6(+) 80%, Mum1(-)(single cells and plasmo's +), CD10(+) 30%, Ki67 (average) ~70%(clear zones- 20% and "blastic" zones-90%), CD30(+) 5% (esp. perivascularly and in the surface), CD138/CD23/EMA(-)(except plasmo's), ALK1(-).  
PROPOSED DIAGNOSIS/QUESTION: B lymphoproliferation: "LYMPHOMA LIKE LESSION" (Chlamydia, etc???) >>> DLBCL.  
COMMENT: CD20+ Bcl 6+ Bcl 2-Mum1- CENTROBLASTIC population with marginal like areas visually seems to be DLBCL on HE slides, but in this localisation the reactive lessions are more common. Is more activated immunophenotype of DLBCL more likely if it would place there?  
Thank you for comments.

Went 2006-03-14 06:55	Dear Mickys: this is a diffuse proliferation of blastic B-lymphocytes with destruction of the normal histology. A reactive lesion is therefore unlikely and I would strongly recommend the diagnosis of a DLBCL and go for lymphoma staging. As a rare coincidence, we recently saw a DLBCL primarly manifesting as a tumor in the vagina (staging is not yet completed) in a woman of about the same age.
franco 2006-03-15 07:58	I agree with Dr. Went diagnosis of DLBCL. One can rule out reactive lesion (completely absence of follicles with reactive germinal centers).
kunze 2006-03-15 14:50	I support the diagnosis of a DLBCL (at an uncommon site).
ugnius 2006-03-15 15:41	Thank you. The most confusing in this situation is pure follicular immunophenotype (Bcl2-, Bcl6+, CD10+, Mum1-) in extranodal localisation, unproven monoclonality (please, look additional kappa/lambda- I do not belive in it:)). I've had a similar situation (identical diffuse blastic proliferation with high proliferation fraction) in endometrium before and the patient was under watchfull waiting regimen for 2yrs without any signs of disease despite the classic DLBCL HE and IH picture. So, maybe additional evaluation would be essential in this case before agressive treatment for systemic disease?
hurwitz 2006-03-22 14:06	I also think that this lesion is a DLBCL. The immunophenotype might be unsual. I suppose that staging procedures will be performed, so probably a BMB as well. It might be worthwhile to search well for subtle paratrabecular infiltrates as a possible manifestation of a clinically silent low grade component.
ugnius 2006-04-10 16:09	Dears, the total histerectomy was performed (multiple layomyomas); I've found only 2 nidus of lymphoid infiltrate in endocervical stroma consisting of "blasts" remaining probably in the stalk of the polyp. How must we care the patient: like systemic DLBCL or with watchfull waiting only (I would prefer the latter with experience of older cases). Thank you.
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