Abstract
IntroductionDiffuse 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 presentationA 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%).ConclusionAccording 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.
Highlights
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
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
And radiographically, the mediastinum was clear. This case has been reviewed by the authors (SMK and GP), who arrived at the final diagnosis of a clear cell variant of Diffuse large B-cell lymphoma (DLBCL)
Summary
Diffuse large B-cell lymphoma (DLBCL) displays striking heterogeneity at the clinical, genetic and molecular levels [1]. This case has been reviewed by the authors (SMK and GP), who arrived at the final diagnosis of a clear cell variant of DLBCL. Histological and phenotypic findings 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 nuclei were round (centroblast-like) or Figure 2 Sheets of large cells with abundant pale cytoplasm separated by collagenous fibrosis. Our first thought was the possibility of primary mediastinal large B-cell lymphoma (PMBCL), but clinically no tumor mass was found in the mediastinum. The differential diagnosis following the first round of IHC included uncommon, undifferentiated large-cell carcinoma, malignant melanoma,. In the second round of IHC, we considered the possibility of DLBCL. (The morphological variants are centroblastic, immunoblastic, T-cell- and histiocyte-rich, anaplastic, plasmablastic, DLBCL-anaplastic lymphoma kinase-positive and PMBCL.) Our final diagnosis was of a clear cell variant of DLBCL
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