Hematopathology Case 02

CD15 positive diffuse large B-cell lymphoma

by Mona Elsakka, MD

PGY-4 Pathology Resident, St. Joseph’s Hospital and Medical Center, Phoenix, AZ

Mohamed Salama, MD

Assistant Medical Director, Hematopathology, ARUP Laboratories, and Associate Professor (Clinical) of Pathology, University of Utah School of Medicine

and

Rodney R. Miles, MD, PhD

Staff Hematopathologist, ARUP Laboratories, and Assistant Professor of Pathology, University of Utah School of Medicine

Editor: Benjamin L. Witt, MD

Medical Director, Cytopathology, ARUP Laboratories, and Assistant Professor of Pathology, University of Utah School of Medicine


A 49 year old male presented with left supraclavicular lymphadenopathy. An excisional biopsy was performed and the slides and block were referred for consultation.

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Description:

Pathology Findings:

  • Hematoxylin & Eosin stained sections of the left supraclavicular lymph node showed complete effacement of the architecture (fig. 1) by sheets of predominantly large, mononuclear cells characterized by irregular nuclear contours, vesicular chromatin and variably prominent nucleoli (fig. 2).
  • In addition, there were scattered very large, anaplastic cells that showed occasional bi-nucleation and multi-nucleation with occasional Reed-Sternberg (RS) type cells (fig. 3).
  • The involved areas did not show nodular growth pattern or significant sclerosis.
  • The cellular background consisted of small lymphocytes and occasional histiocytes without significant numbers of eosinophils or plasma cells.

Immunophenotype Findings:

  • Immunohistochemical stains for CD45, CD20, CD3, CD10, BCL6, CD15, CD30, CD4, CD8, ALK, OCT-2, PAX-5, BOB.1 and CD79a with appropriately reactive controls were reviewed.
  • The atypical large cell population as well as the anaplastic and RS type cells strongly expressed CD20 (fig. 4), CD79a (fig. 5), PAX-5 (fig. 6), and OCT-2 (fig. 7) with weaker BOB.1 expression(fig. 8).
  • The scattered anaplastic and RS-like cells showed weak and variable reactivity with CD45 (fig. 9) as well as variable reactivity with CD30 (fig. 10) and CD15 (fig. 11).
  • CD30 was weak to moderate on some of the large cells while many were negative.
  • CD15 was strong in some of the large cells while others were negative.
  • ALK was negative.
  • CD3 highlighted background T lymphocytes, which included a mixture of CD4 and CD8 subsets.

Final Diagnosis & Discussion



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