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Case 294 - Discussion

Hematopathology Case

 

CK AE1/3

P63

 

EBER-ISH

 
 
  • This patient had no clinical history of nasopharyngeal carcinoma (NPC);

  • The major differential diagnosis based on the morphology includes:

    • Anaplastic large cell lymphoma (ALCL): ALCL often presents with sinusoidal pattern, although in this case the tumor cells are not "anaplastic";

    • Metastatic melanoma, which may present with sinusoidal pattern;

    • Metastatic carcinoma, especially NPC. Patients with NPC may present with cervical lymphadenopathy first; however it is very unusual that the tumor cells in this case show predominantly sinusoidal infiltration. The cytological features are good for NPC with syncitial growth, vesicular chromatin and prominent nucleoli;

    • Large B-cell lymphoma: intravascular DLBCL or intrasinusoidal CD30+ DLBCL

    • ALK+ large cell lymphoma: very rare

    • Reactive sinus histiocytes: The tumor cells in this case are larger than typical sinus histiocytes, and the cytoplasm is slightly blue-pinkish.

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