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Clear cell variant of diffuse large B-cell lymphoma: a case report.

Manxhuka-Kerliu S, Petrusevska G, Kerliu I, Kryeziu E, Ahmeti F, Devolli-Disha E, Sahatciu-Meka V, Loxha S, Shahini L - J Med Case Rep (2011)

Bottom Line: Staining for cytokeratins was negative.These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).Our patient is undergoing R-CHOP chemotherapy treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, Institute of Pathology, University of Prishtina, Mother Theresa Street NN, 10 000, Prishtina, Kosovo. skerliu@hotmail.com.

ABSTRACT

Introduction: Diffuse large B-cell lymphoma is a diffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to or exceeding the normal macrophage nuclei. We report a case of a clear cell variant of diffuse large B-cell lymphoma involving a lymph node in the neck, which was clinically suspected of being metastatic carcinoma.

Case presentation: A 39-year-old Caucasian ethnic Albanian man from Kosovo presented with a rapidly enlarging lymph node in his neck, but he also disclosed B symptoms and fatigue. A cytological aspirate of the lymph node revealed pleomorphic features. Our patient underwent a cervical lymph node biopsy (large excision). The mass was homogeneously fish-flesh, pale white tissue replacing almost the whole structure of the lymph node. The lymph node biopsy showed a partial alveolar growth pattern, which raised clinical suspicion that it was an epithelial neoplasm. With regard to morphological and phenotypic features, we discovered large nodules in diffuse areas, comprising large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. In these areas, there was high mitotic activity, and in some areas there were macrophages with tangible bodies. Staining for cytokeratins was negative. These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).

Conclusion: According to the immunohistochemical findings, we concluded that this patient has a clear cell variant of diffuse large B-cell lymphoma of activated cell type, post-germinal center cell origin. Our patient is undergoing R-CHOP chemotherapy treatment.

No MeSH data available.


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Marked sclerosis and hyalinization in diffuse large B-cell lymphoma (hematoxylin and eosin stain; original magnification, × 20).
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Figure 1: Marked sclerosis and hyalinization in diffuse large B-cell lymphoma (hematoxylin and eosin stain; original magnification, × 20).

Mentions: The lymph node biopsy showed a partially alveolar growth pattern, marked sclerosis and hyalinization (Figure 1), which raised clinical suspicions of an epithelial neoplasm. The morphological and phenotypic features comprised large nodules in diffuse areas, composed of large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells, as well as sheets of large cells with abundant pale cytoplasm separated by collagenous fibrosis. The nuclei were round (centroblast-like) or sometimes multi-lobulated (Figure 2). These areas displayed high mitotic activity, and some areas contained macrophages with tangible bodies. Staining for cytokeratins (CK) was negative. These areas disclosed the following phenotype: cluster designation marker 20 (CD20) expressed strong positivity (Figure 3), B-cell lymphoma (Bcl)-2 expressed cytoplasmic staining (Figure 4), Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative (PSA-), human melanoma black marker 45-negative (HMB45-), melanoma marker-negative (Melan-), CK7- and multiple myeloma marker 1-positive (MUM1+) in about 30% of cells and Ki-67 expressed a high proliferation index of 80%. (Figure 5).


Clear cell variant of diffuse large B-cell lymphoma: a case report.

Manxhuka-Kerliu S, Petrusevska G, Kerliu I, Kryeziu E, Ahmeti F, Devolli-Disha E, Sahatciu-Meka V, Loxha S, Shahini L - J Med Case Rep (2011)

Marked sclerosis and hyalinization in diffuse large B-cell lymphoma (hematoxylin and eosin stain; original magnification, × 20).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117823&req=5

Figure 1: Marked sclerosis and hyalinization in diffuse large B-cell lymphoma (hematoxylin and eosin stain; original magnification, × 20).
Mentions: The lymph node biopsy showed a partially alveolar growth pattern, marked sclerosis and hyalinization (Figure 1), which raised clinical suspicions of an epithelial neoplasm. The morphological and phenotypic features comprised large nodules in diffuse areas, composed of large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells, as well as sheets of large cells with abundant pale cytoplasm separated by collagenous fibrosis. The nuclei were round (centroblast-like) or sometimes multi-lobulated (Figure 2). These areas displayed high mitotic activity, and some areas contained macrophages with tangible bodies. Staining for cytokeratins (CK) was negative. These areas disclosed the following phenotype: cluster designation marker 20 (CD20) expressed strong positivity (Figure 3), B-cell lymphoma (Bcl)-2 expressed cytoplasmic staining (Figure 4), Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative (PSA-), human melanoma black marker 45-negative (HMB45-), melanoma marker-negative (Melan-), CK7- and multiple myeloma marker 1-positive (MUM1+) in about 30% of cells and Ki-67 expressed a high proliferation index of 80%. (Figure 5).

Bottom Line: Staining for cytokeratins was negative.These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).Our patient is undergoing R-CHOP chemotherapy treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, Institute of Pathology, University of Prishtina, Mother Theresa Street NN, 10 000, Prishtina, Kosovo. skerliu@hotmail.com.

ABSTRACT

Introduction: Diffuse large B-cell lymphoma is a diffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to or exceeding the normal macrophage nuclei. We report a case of a clear cell variant of diffuse large B-cell lymphoma involving a lymph node in the neck, which was clinically suspected of being metastatic carcinoma.

Case presentation: A 39-year-old Caucasian ethnic Albanian man from Kosovo presented with a rapidly enlarging lymph node in his neck, but he also disclosed B symptoms and fatigue. A cytological aspirate of the lymph node revealed pleomorphic features. Our patient underwent a cervical lymph node biopsy (large excision). The mass was homogeneously fish-flesh, pale white tissue replacing almost the whole structure of the lymph node. The lymph node biopsy showed a partial alveolar growth pattern, which raised clinical suspicion that it was an epithelial neoplasm. With regard to morphological and phenotypic features, we discovered large nodules in diffuse areas, comprising large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. In these areas, there was high mitotic activity, and in some areas there were macrophages with tangible bodies. Staining for cytokeratins was negative. These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).

Conclusion: According to the immunohistochemical findings, we concluded that this patient has a clear cell variant of diffuse large B-cell lymphoma of activated cell type, post-germinal center cell origin. Our patient is undergoing R-CHOP chemotherapy treatment.

No MeSH data available.


Related in: MedlinePlus