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Case 28 - Discussion

Hematopathology Case

 

 

CD3

CD5

CD20

CD79a

CD21

BCL2

BCL6

CD10

 

KI67

 

  Summary of paraffin immunohistochemical stainings:

  • CD20: Positive.

  • CD79a: Positive.

  • CD10: Weakly positive.

  • BCL2: Negative.

  • BCL6: Positive.f

  • CD3: Negative.

  • CD5: Negative.

  • ALK: Negative.

  • Ki-67: 80% positivity.

  • CD21: positive in follicular dendritic cells.

  • Diagnosis: Diffuse large B-cell lymphoma of spleen

  • Discussion: Splenic involvement by lymphoma/leukemia typically has three major patterns grossly:

    • Large white, solid and firm nodules: most commonly diffuse large B-cell lymphoma, and less commonly Hodgkin lymphoma. Sarcoidosis may also show similar pattern;

    • Diffuse small, white miliary nodules: typically small B-cell lymphoma involvement of the white pulps, including SLL/CLL, follicular lymphoma, mantle cell lymphoma, and splenic marginal zone lymphoma;

    • Homogeneous red and beefy without obvious nodules:: typically lymphoma/leukemia with red pulp involvement, including hairy cell leukemia, hepatosplenic T-cell lymphoma, extramedullary hematopoiesis, and some myeloid neoplasms.