Angioimmunoblastic T-cell lymphoma

11350964 林X陽

Age: 65 Sex: M PATHOLOGIC DIAGNOSIS: Lymph node, inguinal area, left; incisional biopsy: Angioimmunoblastic T-cell lymphoma. MICROSCOPIC FINDING: Section shows total effacement of the nodal architecture by dense infiltration of lymphoid cells and proliferation of arborizing high endothelial venules. There is a polymorphic infiltrate, which is composed of small to medium-sized atypical lymphocytes with clear cytoplasm and distinct cell membranes, admixed with small numbers of small lymphocytes, immunoblasts, eosinophils and neutrophils. Increased follicular dendritic cell meshworks are noted and highlighted by CD21 staining. These atypical lymphocytes are positive for CD3, CD4, PD-1 and focal positive for CD10 but negative for CD20. CD8 stains some cells. EBER in situ hybridization shows only scattered positive cells (<1%). Addendum

Immunohistochemically, the tumor cells are negative for CD30.

Anaplastic large cell lymphoma, ALK-negative

00309113 王X財

PATHOLOGICAL DIAGNOSIS: 1.Lymph node, neck, group II, left, dissection: ANAPLASTIC LARGE CELL LYMPHOMA. 2.Lymph node, neck, group Ia, Ib, III, IV, V, dissection: Negative for malignancy. GROSS FINDING: The specimen consists of 6 bottles of lymph node, labeled as "Ia", "Ib", "II", "III", "IV", and "V". A lymph node measuring 3.5 x 3 cm in found in "II" with central necrosis. Submitted in part in 15 cassettes: 1) "Ia"; 2) "Ib"; 3, A1-9) "II"; 4) "III"; 5) "IV", and 6) "V". MICROSCOPIC FINDING: The lymph node shows aggregation of large lymphoid cells in a diffuse pattern. The tumor cells are characterized by finely dispersed nuclei and recognizable nucleoli with plasmacytoid features. Immunohistochemically, the tumor cells are negative for CD3, CD20, CD138, EBER, CD79a and PAX-5. The proliferative index with Ki-67 is 90%.

Additional staining of LCA, BCL-2, MUM-1 is positive, c-myc shows positivity of 80-90%, and CD10, BCL-6, ALK-1, HHV-8, CD138, and EBER on section A4 are negative.

Since B-cell clonality has been done and the result was negative, we reviewed the slides and put the case into the list of LCA+/CD3-/CD20- category. Thus, we further performed immunostains of CD30, CD43, CD68, MPO, Kappa and lambda. The tumor cells are positive for CD43 and CD30, but negative for other markers, consistent with anaplastic large cell lymphoma.

LCA+/CD3-/CD20-

BCL-2, MUM-1: for B cell but not specific CD43: T-cell CD30: Activated B cells, T cells, and monocytes MPO: to rule out myeloid scarcoma

檢體採檢日:20160330 Specimen:Paraffin-embedded tissue (號碼:16-4648-A4)DNA Quality:300 bp (primers detection range 100~400 bp) [Method]Multiplex PCR and heteroduplex analysis [Result for each test] IGK:Tube A:Polyclonal,Tube B:Polyclonal IGL:IgL:Polyclonal [T/B cell clonality tests-Integrated report] B-cell antigen receptor, IGK subunit (IGK):Polyclonal B-cell antigen receptor, IGL subunit (IGL):Polyclonal Note: Precaution to the clinical application of clonality results: A polyclonal test result does not exclude the possibility of neoplasia. Up to 5% of clinically confirmed B-cell lymphoma would show false-negative polyclonal test results. Clinical judgment is required for final diagnosis. 以下為測試相關之技術資料 Combined detection rate(DNA quality dependent) T cell gene rearrangement:60-70% B cell gene rearrangement:95% [Analytical performance for each test] Based on percentage of positive control cell line in a polyclonal background IGK:Tube A:no control,Tube B:no control IGL:IgL:no control [Clinical performance for each test] Based on 40 paraffin-embedded tissue samples 20 lymphoma and 20 lymphoid hyperplasia (DNA quality from 100-400 kbp) [Detection rate] IGK:Tube A:50%,Tube B:35% IGL:IgL:20% [False positive rate] IGK:Tube A:0%,Tube B:0% IGL:IgL:0%

PTCL, NOS

18384084 陳X芳 Age: 54 Sex: M

Bone marrow, iliac crest, core biopsy: Peripheral T-cell lymphoma

MICROSCOPIC FINDING:

The bone marrow shows hypercellularity with hemopoietic components accounting for about 80% of the marrow space, and M/E ratio of 4-5:1. Megakaryocytes are normal in quantity but show cellular atypia. No evidence of excess of blast is noted. There are patchy infiltration of small angulated lymphocytes with histiocytic infiltration and fibrosis. Immunohistochemical study shows these cells are positive for CD3, PD-1, but negative for CD20, CD30, CD163. Mixed CD4- and CD8-positive T cells are noted but CD8+ cells outnumber. The EBER-1 in situ hybridization shows scattered positive cells. Acid-fast and GMS stains fail to reveal any specific etiology. Mycobacterial immunostain is negative. The BM aspiration also reveals hypercellular marrow with some atypical lymphocytes. Together with the morphology and the result of immunohistochemical study, a case of peripheral T-cell lymphoma, probably TFH or lymphoepithelioid type is considered.