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Case 185 - Discussion

Hematopathology Case

 

  • Other Markers:

    • CD3          -

    • CD20        -

    • CD43        -

    • CD45        -

    • PAX5        -

    • CD138     +

    • Kappa      -

    • Lambda   +

    • EBER      +

    • HHV8       -

    • S100         -

CK AE1/3

 

 

Plasmablastic Lymphoma of Oral Cavity

  • Striking male predominance, 70% stage I disease

  • Predilection for the oral cavity

  • Mostly seen in immunodeficiency (HIV), but also iatrogenic immunosuppression, autoimmune or immunocompetent patients

  • Histopathology:

    • Diffuse infiltrate of large cells with “starry sky” pattern

    • Tumor cells appear cohesive and have a squared-off appearance

    • Morphologic features of plasmablasts: eccentric nuclei; single, centrally located, prominent nucleoli or multiple peripheral nucleoli; abundant basophilic cytoplasm; and paranuclear hof

    • Mitotic activity is brisk, and apoptotic bodies are numerous

  • Immunophenotype:

    • Positive: CD38, CD138, MUM1, VS38c

    • CD79a+/−; usually high Ki-67, >90%

    • Negative: CD45, CD20, PAX5

    • Most cases EBV+ (~75%) but HHV8−

  • Poor prognosis, median interval 6-7 months

  • DDX: anaplastic/plasmablastic plasmacytoma and Burkitt's lymphoma