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Case 180 - Discussion

Hematopathology Case

 

LCA

LCA

CD3

CD20

Cytokeratin

CD138

CD30

CD30

EMA

ALK

ALK

ALK

 

 

ALK Positive Large B-Cell Lymphoma

  • Median age 36 years, 30% in pediatric patients, M:F=3:1

  • Commonly present at high-stage, over survival ~11 months

  • Not associated with immunosuppression

  • Histopathology:

    • Common sinusoidal infiltration

    • Tumor cells: immunoblastic or plasmablastic, large red nucleoli

    • May be deceptively cohesive

  • Immunophenotype:

    • Positive: CD45, EMA, IgA, CD138

    • ALK1: cytoplasmic granular pattern

    • Often CD4+ (64%) and CD57+ (40%)

    • Negative: CD20, CD79a, CD30, cytokeratin

    • All cases EBV negative

  • Mostly t(2;17)(p23;q23), CLTC/ALK, cytoplasmic granular; rarely t(2;5)(p23;q35), NPM/ALK