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Case 176 - Discussion

Hematopathology Case

 

CD20

CD20

CD3

CD3

PAX5

CD21

CD15 CD30
BCL6 BCL6

 

CD57

 

 

T-Cell/Histiocyte-Rich Large B-Cell Lymphoma
CLINICAL FEATURES
  • A variant of DLBCL with prominent CD8+ T cells and histiocytes
  • M:F=2:1, 60-70 years of age
  • Mostly in lymph node, but more frequently presents with high-stage disease (about two thirds in stage III-IV) in bone marrow and spleen, compared with conventional DLBCL
MICROSCOPIC FINDINGS
 
  • Diffuse effacement of lymph node with polymorphic cellular population, lack of nodular pattern or sclerosis
  • Scattered large tumor cells, <10% of the cellular population, dispersed singly, without the formation of discrete aggregates or sheets
  • Morphology of tumor cells: centroblasts, immunoblasts, pleomorphic, LP (or L&H) cells, or Reed-Sternberg cells
  • Background: small lymphocytes with mostly CD3+CD8+ T cells; variable numbers of histiocytes; scant plasma cells or eosinophils
DIFFERENTIAL DIAGNOSES
   
  T-Cell/Histiocyte Rich Diffuse Large B-Cell Lymphoma Nodular Lymphocytic Predominant Hodgkin Lymphoma Classic Hodgkin Lymphoma
Cell origin Germinal center B-cell Germinal center B-cell Non-germinal center B-cell
Location Mostly nodal, frequent extranodal Mostly nodal Mostly nodal
Age 60-70 40-50 20-30, >60
Histopathology
    Architecture Diffuse Macronodular Nodular with or without sclerosis
    Tumor cell distribution Scattered, no sheets or aggregates Scattered or small aggregate Mostly scattered, may form sheets
    Tumor cell morphology Variable, centroblast, immunoblast, pleomorphic, LH or RS like LH cells with popcorn nuclei RS or variants
    Background cells Mostly CD8+ T cell and histiocytes Mostly B-cells Mixed, with frequent eosinophils
    CD21+ meshwork None Present None
    CD57 T-cell rosettes None Present None
Immunohistochemical stains
    CD45 + +
    CD20 + + −/+
    CD79a + +
    PAX5 + +
    BCL6 + +
    CD15 +
    CD30 −/+ (40%+) +
    EBV +/−
    EMA −/+ +
    MUM1 + +
    OCT2, BOB1 + +
B-symptoms Frequent Typically no Some cases
Stage at diagnosis III-IV in 67% cases Mostly localized III-IV in 50% cases
IMMUNOHISTOCHEMISTRY AND SPECIAL STAINS
 
  • Tumor  cells: pan-B+, CD30, CD15, EMA+/−, BCL6+/−
  • Background lymphocytes: CD3+, CD8+
  • Background histiocytes: CD68+
  • Lack of large CD21+ meshwork as seen in NLPHD
REFERENCES
  • WHO Pathology & Genetics. Tumours of Haematopoietic and Lymphoid Tissues. IARC Press, Lyon 2008
  • Hematopathology Clinical Pathologic Guidelines. Hematopathology section, University of New Mexico
  • Hematopathology. Elaine Sarkin Jaffe, MD, Nancy L. Harris, MD, James Vardiman, MD, Elias Campo, MD, and Daniel Arber, MD. 2010