54 yrs lady with biopsied "MALToma". Case resent to hemato for reevaluation.  
CLINICAL HISTORY: 2013 radical resection of cervical squamous carcinoma with lymphonodectomy.  
Gastric PALPABLE pyloric circular tumor with sonoscopically detected spread into anterior abdominal wall with hepatic hilar lymphadenopathy.  
PB: isolated anemia. No generalized lymphadenopathy present.  
HISTO: bicomponent DLBCL in gastric mucosa: component A more interglandular DIFFUSE, component B more solid and NODULAR.  
IH: complettelly divergent:  
SUMMARY: (nonGCB/ABC): EBER(-); CD20+; CD30+; Mum1/Bcl6/lmo2/GCET1/FoxP1+; CMYC+; CD5/Bcl2/CD10/CD138/CyclinD1(-); Ki67 prolif. index 70%.  
A: Mum1+; CD10(-); CD30+; Bcl6/LMO2(+/-); GCET1(-); FoxP1+;  
B: Mum1(-); CD10(-); CD30(-); Bcl6/LMO2+; GCET1+; FoxP1+;  
 
DIAGNOSIS: DLBCL, but probably biclonal?  
 
SPECIAL QUEST: Summarising DLBCL, ABC (by IH). But component A- pure ABC, B- more close to GCB.  
 
ThankYouALot.

tzankov 2018-12-03 07:46	Were there HP present?   Since this might be either a transformed MZL or a HGBCL (e.g. MYC and BCL6 rearranged), this may explain why COO by IHC does not work...   If you want, you may add FISH (for MYC, and later on - for BCL6 and, if BCL2 is + with the E17 clone, also for BCL2) or look by NGS for MZL-tpyical mutations (e.g. TNFAIP3, BCL10 etc.) and by FISH for MZL-typical tranlocations (e.g. MALT1 etc.) in order to reach an exact diagnosis. On the other hand, since R-CHOP would probably be the way to anyhow go, all above might be a simple luxury...
ugnius 2018-12-03 07:58	Thanx. I will rethink all Your proposals:) We just trying to establish NGS from parafin, because Illumina located in opposite side of road (Hemato/Onco depth). HP was absent.
ugnius 2018-12-03 12:50	Pleas find added ALL I HAVE DONE: FoxP1/LMO2/GCET1...
tzankov 2018-12-04 16:49	well, at the end of the day, we may be facing a "biclonal" evolution of a DLBCL...
ugnius 2018-12-06 14:45	Thanx. When we move to paraffin DNA extracted NGS- it would be interesting to prove...
tzankov 2018-12-07 10:40	I am very curious about the unifying mutations and even more on the subclone-specific ones
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