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Case 34 - Discussion

Hematopathology Case

Paraffin Immunohistochemical Staining:

The  tumor cells are positive for BCL2, BCL6, CD5, CD20, CD45, CD79a, and are negative for CD3, CD10, CD30, NSE and PLAP. Nearly 100% of the tumor cells are positive for Ki-67.
 

UNMC MOLECULAR DIAGNOSTICS:
A clonal Immunoglobulin Heavy chain gene rearrangement is detected by DNA amplification. An extra copy of IgH with a deletion of the 5' (telomeric) portion is present in 89% of the interphase cells from this tissue section. Additional studies were negative for rearrangements of the C-MYC (8q24) region in this tissue section.

 

Diagnosis: Diffuse large B-cell lymphoma of testis

Diffuse Large B-Cell Lymphoma of Testis

  • Often seen in old male

  • The most common bilateral testicular neoplasms in old patients are lymphoma

  • The most common type of lymphoma is diffuse large B-cell lymphoma

  • Morphologically, the tumor cells diffusely involve testicular parenchyma with intertubular and intratubular infiltration. The tumor cells are large in size and have irregular nuclei and moderate amount of cytoplasm.

  • The major differential is seminoma, which typically has incomplete fibrous septa with mixed reactive small lymphocytes; the tumor cells are larger with round nuclei and one prominent central inclusion-like nucleolus; the cytoplasm is abundant and clear.Seminoma cells are positive for PLAP, CD117, and OCT3/4 with no expression of cytokeratin, CD45, and CD20.