Large Lymphoid Cells Research Articles

Clinicopathological analysis of elderly Epstein-Barr virus-positive diffuse large B-cell lymphoma of Han and Uygur in Xinjiang Uygur Autonomous Region

Objective To analysis the clinical features of elderly diffuse large B-cell lymphoma (DLBCL) patients with Epstein-Barr virus (EBV) infection and their prognostic factors. Methods 250 cases of DLBCL were retrospectively studied by in situ hybridization (ISH) to detect the EBV and by immunohistochemical to evaluate the histological type and Ki-67 protein. Results 36 cases with EBV positive included 28 elderly (aged ≥ 60 years), of which 21 cases were Han, 15 cases were Uygur, male/female ratio was 2∶1. There were 23 cases with nodal presentation only, 13 cases with extra-nodal presentation. Twenty-nine patients presented with advanced disease (Ann Arbor stage Ⅲ/Ⅳ), 30 patients were found with high lactate dehydrogenase (LDH), 22 patients with high IPI score (3-5). Histological observation showed a diffuse and polymorphic proliferation of large lymphoid cells with varying degrees of reactive components. These tumor cells were frequently characterized by a broad range of B-cell maturation, containing centroblasts, immunoblasts, and Hodgkin-and Reed-Stemberg (HRS)-like giant cells. Immunohistochemical studies showed that tumor cells were positive for CD20 and (or) CD79a in almost cases, most of the cases had a high proliferative index. CD10, bcl-6, Mum-1 performed histological type, 31 cases were non-germinal center. Except the age and location (P 0.05). Conclusion The incidence of elderly EBV+ DLBCL is low, it has some unique clinical and pathological features with poor prognosis. Key words: Herpesvirus 4, human; Elderly; Lymphoma, B-cell; In situ hybridization; Differential diagnosis

Human herpesvirus 8-negative primary effusion lymphoma-like lymphoma with t(8;14)(q24;q32)

Primary effusion lymphoma (PEL) is a large B-cell lymphoma proliferating only in the body cavity effusion. It often occurs in advanced AIDS patients and is associated with human herpesvirus 8 (HHV-8). On the other hand, HHV-8 negative effusion lymphoma, which is different from PEL in many ways, has also been reported and is referred to as HHV8-unrelated PEL-like lymphoma. This lymphoma is very rare and its clinical characteristics have not yet been fully clarified. We therefore report an HIV seronegative elderly patient with HHV8-unrelated PEL-like lymphoma. An 89-year-old woman was admitted to our hospital due to general fatigue and dyspnea. The patient presented with left pleural effusion in the absence of lymphadenopathy and tumor masses. The pathological examination of the pleural effusion showed proliferation of atypical large lymphoid cells, which were positive for CD19, CD20, CD10, CD38, CD7, BCL2 and BCL6 but negative for CD5, CD30, MUM1, surface immunoglobulin, HHV-8 and EBV. Cytogenetic analysis showed a complex karyotype including t(8;14)(q24;q32). The pleural effusion decreased in response to monotherapy with oral low-dose etoposide, but recurrence was detected 7 months later. Rituximab was transiently effective for the recurrent pleural effusion, but the patient died of lymphoma exacerbation 13 months after the diagnosis.

Pseudocarcinomatous hyperplasia in anaplastic large cell lymphoma, a mimicker of poorly differentiated squamous cell carcinoma: report of a case and review of the literature

Pseudocarcinomatous hyperplasia can occasionally be observed in biopsies of CD30-positive lymphoproliferative disorders. It is important to be cognizant of this association, because epithelial hyperproliferation can overshadow large atypical lymphoid cells, leading to an erroneous diagnosis of squamous cell carcinoma (SCC) or keratoacanthoma. Herein, we present a case of anaplastic large cell lymphoma (ALCL) with pseudocarcinomatous hyperplasia simulating a poorly differentiated carcinoma and review the literature on this subject. Immunohistochemical staining with p63 helped delineate the infiltrating tongues of pseudocarcinomatous hyperplasia from the malignant infiltrate. We present this case to raise awareness of the potential for pseudocarcinomatous hyperplasia to occur in the setting of CD30+ lymphoproliferative disorders. Clinicians and dermatopathologists should consider the possibility of ALCL or lymphomatoid papulosis when examining lesions with features of inflamed SCC, especially if the tumor presents on a site or in a patient that is not typical of SCC.

IX. Is it only about MYC? How to approach the diagnosis of diffuse large B-cell lymphomas.

Keywords: diffuse large B-cell lymphoma; cell of origin; genetic alterations; double hit; double expresser; MYC; BCL2; BCLU

Lymphoma's Musculoskeletal Manifestations.

Tumors arising from lymphoid cells can affect almost any part of the body, including musculoskeletal sites that orthopaedists evaluate and manage. Because lymphomas can be either localized or systemic, they should be included in the differential diagnosis for certain patients presenting with orthopaedic complaints. This month’s “Case Connections” investigates several challenges that orthopaedists face when dealing with musculoskeletal manifestations of lymphoma. In the April 22, 2015 issue of JBJS Case Connector, Ibrahim et al. present the case of a seventy-eight-year-old woman who developed primary large B-cell lymphoma of the proximal part of the tibia five years after a successful total knee arthroplasty (TKA). She presented with knee pain and swelling but no constitutional symptoms. Radiographs revealed permeative destruction of the proximal part of the tibia surrounding the tibial component, and an MRI indicated that the mass extended into nearby soft tissue. Histologic and cytologic analyses from a needle biopsy revealed sheets of large lymphoid cells with prominent nucleoli (Fig.1), leading to a diagnosis of large B-cell lymphoma. CT imaging revealed no evidence of regional or systemic disease, and the patient was referred for staging and treatment. Fig. 1 Sheets of large lymphoid cells with prominent nucleoli led to a diagnosis of diffuse large B-cell lymphoma. After chemotherapy and radiation therapy, restaging studies indicated complete remission. However, six months after the initial presentation, the patient returned with recurrent knee pain, knee deformity, and an unsteady gait. Radiographs revealed a fracture of the proximal part of the tibia, despite no apparent lymphoma recurrence. Plans to revise the knee with …

Hematologic lesions in urine cytology

Bladder infiltration by leukemia or lymphoma is rare and can mimic benign processes such as follicular cystitis (FC). Eight benign and malignant hematologic diseases encountered in urine cytology were retrospectively reviewed for clinical, radiographic, and cytologic findings. There were 2 cases of acute myeloid leukemia, 2 cases of diffuse large B-cell lymphoma, and 4 cases of FC. The most common presenting symptom was hematuria. Imaging findings included echogenic debris within the bladder or an adjacent soft tissue mass in acute myeloid leukemia cases and bladder wall thickening in diffuse large B-cell lymphoma cases. No FC cases had any imaging abnormalities. Cytologic material of the leukemia cases showed numerous myeloid blasts with markedly increased nuclear-to-cytoplasmic ratios, centrally located nuclei, inconspicuous nucleoli, nuclear indentations, and some irregular nuclear membranes. The background showed sparse urothelial cells and histiocytes. Both lymphoma cases showed a discohesive population of atypical large lymphoid cells with irregular nuclear borders and prominent nucleoli. The FC cases had a background lymphoid cell population with a maturation spectrum from small lymphocytes to large lymphoid cells (immunoblasts) and histiocytes including tingible body macrophages. Additionally, there were many mature squamous cells and reactive urothelial cells. Bladder leukemia, lymphoma, and FC are infrequently encountered on urine cytology. FC can be distinguished from a hematologic malignancy by the presence of a lymphocytic maturation spectrum and tingible body macrophages. Radiologic abnormalities are associated with malignant processes; however, discrete bladder masses are usually not identified.

Indolent fibrin-associated EBV-positive large B cell lymphoproliferative disorder in a lower extremity aneurysmal hematoma: a case report

Epstein-Barr virus (EBV) is known to play a key role in the development of several lymphoproliferative disorders (LPD), ranging from indolent lesions to highly aggressive lymphomas. Here, we describe an incidentally detected unique case of a localized EBV-positive large B cell LPD within a popliteal artery aneurysmal hematoma of a 91-year-old male. Histopathologic examination of an expanding right thigh mass demonstrated organizing hematoma with microscopic clusters of atypical large lymphoid cells with a non-germinal center B cell immunophenotype, a high proliferation rate by Ki-67 staining, and strong positivity for EBV-encoded RNA (EBER) by in situ hybridization. An 18-month follow-up revealed no evidence of disease progression. The presence of cytologically malignant EBV-positive large B cells supports a LPD, with a differential diagnosis that includes a spectrum of EBV-associated lesions, including diffuse large B cell lymphoma (DLBCL) of the elderly, DLBCL associated with chronic inflammation, as well as a variety of recently described indolent EBV-associated large B cell proliferations occurring in cardiac fibrin thrombi, atrial myxomas, and other unusual sites. This case is the first report of an indolent fibrin-associated EBV-positive LPD occurring in an aneurysmal hematoma of the extremity. This lesion may represent the indolent end of the spectrum of EBV-associated large B cell proliferations, and recognition of such lesions may prevent unnecessary aggressive treatment.

A Case of Cutaneous Diffuse Large B-cell Lymphoma.

Received/Gelis tarihi : June 10, 2013 Accepted/Kabul tarihi : September 4, 2013 To the Editor, We report the clinical findings of a 55-year-old woman who presented with purple-reddish nodules on her face diagnosed as primary cutaneous diffuse large B-cell lymphoma (PCLBCL), which is very rarely seen in this area. A 55-year-old woman applied to our oncology department after a brief episode of fever, general weakness, and erythematous patches and plaques in the facial area (Figure 1). Other associated symptoms and signs were general malaise and weight loss of 5 kg in 1 month. She had previously been well. A diagnostic biopsy showed an infiltration of large lymphoid cells staining positively for CD20, BCL-6, BCL-2, and PAX5, suggesting a diagnosis of diffuse large B-cell lymphoma (Figure 2). The cells were negative for CD5 and CD10. Renal and liver functions were normal. Bone marrow aspiration and biopsy showed no evidence of lymphoma. There was no other systemic organ involvement. The patient began receiving systemic chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. After 3 cycles of treatment, the large tumor showed no gradual improvement; this was suggestive of a lack of response. Rituximab plus ifosfamide, carboplatin, and etoposide chemotherapy (R-ICE) were therefore initiated. The patient was treated with 3 cycles of R-ICE chemotherapy. The patient declined additional treatment because her condition remained progressive despite the treatment, and she died soon after. Infomed consent was obtained. PCLBCL is a rare primary cutaneous lymphoma characterized by a diffuse proliferation of large B cells consisting of centroblasts and immunoblasts, occurring most commonly on the legs [1]. PCLBCL affects elderly population with a female predominance. This type of lymphomas tend to develop on the lower limbs, predominantly as large dermal nodules or tumors, which are either solitary or multifocal and rapidly enlarging [1]. PCLBCL can also rarely occur at other cutaneous sites [2]. The prognosis of PCLBCL is poor, with a 5-year survival of 41%-58%

Benefits of skin biopsy of senile hemangioma in intravascular large B-cell lymphoma: A case report and review of the literature.

Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of B-cell lymphoma characterized by selective growth of clonal B-cells in the lumen of the small vessels of various organs including the liver, spleen, lungs, skin, brain, and kidney. An 86-year-old male presented with weight loss, fever and night sweats (known as B symptoms). Blood examination revealed pancytopenia, high lactate dehydrogenase and high soluble interleukin-2 receptor, suggesting hematopoietic malignancy. However, there were no abnormal hematopoietic cells in the peripheral blood. No lymph node swelling was identified on examination by whole-body computed tomography scan. Therefore, IVLBCL was suspected, and random skin biopsies and a skin biopsy from a senile hemangioma were carried out. A small number of large atypical lymphoid cells resided in the small blood vessels in the deep dermis and subcutaneous tissue of the random skin biopsies, and numerous atypical lymphoid cells were identified in the small vessels of the senile hemangioma. These results suggest the usefulness of skin biopsy from senile hemangiomas in the diagnosis of IVLBCL.

Pediatric Case of Primary Cutaneous Eosinophil-Rich CD30+ Anaplastic Large-Cell Lymphoma With Follicular Mucinosis

We report a pediatric case of primary cutaneous CD30 anaplastic large-cell lymphoma showing a combination of rare histopathologic features. The patient was a 14-year-old boy who had a solitary 2 × 1-cm ulcerated nodule with purulent discharge and undermined borders located in the right preauricular area that had been present for 3 weeks. Histopathologically, there was a dense, nonepidermotropic multinodular to diffuse infiltrate involving the reticular dermis and, focally, the subcutis. The infiltrate was composed of numerous eosinophils, neutrophils, small well-differentiated lymphocytes, and large pleomorphic and anaplastic cells. Eosinophils dominated the infiltrate. Focally, the infiltrate was accentuated around hair follicles, many of which manifested features of follicular mucinosis and/or collections of neutrophils in the follicular epithelium. Occasional hair follicles were partly destroyed by the infiltrate. A conspicuous feature was a prominent myxoid change in the stroma surrounding the hair follicles and eccrine glands. Immunohistochemically, the large lymphoid cells expressed CD2, CD3, CD4, and CD30.

Tandem triplication of the BCL2 gene in CD5-positive intravascular large B cell lymphoma with bone marrow involvement

Dear Editor, Intravascular large B cell lymphoma (IVLBCL) is a rare subtype of diffuse large B cell lymphoma (DLBCL) characterized by the selective growth of lymphoma cells within the lumina of vessels [1]. Cytogenetically, the majority of IVLBCL cases demonstrated complex karyotypes with multiple numerical and structural changes, and the most frequent duplicated regions were shown to be the 11q13→qter region and all of chromosome 18 [2, 3]. On the other hand, triplications of chromosome segments other than 1q have been rarely found in hematological malignancies [4–8]. Here, we describe an unusual case of IVLBCL with a tandem triplication of the BCL2 gene at 18q21. An 82 year-old female was admitted because of fever. Computed tomography scans revealed hepatosplenomegaly without lymphadenopathy. Peripheral blood (PB) examination showed hemoglobin 105 g/L, platelets 52×10/L, and leukocytes 10.1× 10/Lwith 15% abnormal lymphocytes. Serum levels of lactate dehydrogenase (LDH) and soluble interleukin-2 receptor were 6,382 IU/L (normal range, 115~217) and 8,429 U/mL (124~ 466), respectively. Bone marrow (BM) was normocellular with 42.4 % abnormal lymphocytes positive for CD5, CD19, CD20, and HLA-DR (Fig. 1a). Pathological examination of the BM revealed a focal and sinusoidal growth pattern of large lymphoid cells, indicating a diagnosis of IVLBCL (Fig. 1b). Immunohistochemistry demonstrated that they were positive for CD5, CD20, BCL2, and MUM1, but negative for CD10 and BCL6 (Fig. 1c, d). The patient received R-CHOP therapy and achieved hematological complete remission. However, 12 months later, she relapsed and died of progressive disease. G banding and spectral karyotyping of BM cells showed 47,XX,del (2)(q?),+del(3)(p?),der(10)t(10;20)(q24;?), dup(17)(q21q23),dup(18)(q11.2q23) [20] (Fig. 1e). Unexpectedly, fluorescence in situ hybridization (FISH) detected three BCL2 signals on the dup(18)(q11.2q23), indicating a tandem triplication of BCL2 (Fig. 1f). Namely, the short 18q fragment containing BCL2 attached to the dup(18). FISH on interphase nuclei confirmed four BCL2 signals. According to the Mitelman Database, nine cases of hematological malignancies with duplication/triplication of 18q (duplication, eight; triplication, one) in the stem-lines have been described [4, 9, 10]. All cases were diagnosed with B lymphoid malignancies. The duplicated regions in two cases of acute lymphoblastic leukemia did not contain 18q21, whereas those in seven cases of B cell lymphomas (DLBCL, four; IVLBCL, one; Burkitt lymphoma, one; mantle cell lymphoma, one) retained 18q21. Thus, duplication/triplication of 18q including 18q21 seems to be specifically associated with B cell lymphomas and suggests the significance of BCL2 in their pathogenesis. Among these, one case with trp(18)(?q21q23) exhibited a tandem triplication of BCL2 [2]. This 62-year-old male was diagnosed as having IVLBCL with BM/PB involvement, thrombocytopenia (34×10/L), and high LDH (2,266 U/L). Lymphoma cells were positive for K. Yamamoto (*) :A. Okamura :K. Yakushijin :H. Matsuoka : H. Minami Division of Medical Oncology/Hematology, Department of Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan e-mail: kyamamo@med.kobe-u.ac.jp

Cutaneous CD8-positive gamma/delta T-cell lymphoma

A 44-year-old female presented with ulcers and plaques on the trunk for two months.The lesions began as red plaques,and rapidly developed into ulcers.Histopathology revealed an infiltrate of middle to large atypical lymphoid cells throughout the dermis and subcutaneous fat layer along with epidermotropism.Immunohistochemically,the atypical cells showed positive staining for CD3,CD8,CD56,granzyme B,perforin,but negative staining for the α/β chain of T cell receptor,CD4,CD5,CD20 and CD79α.Epstein-Barr virus-encoded RNA (EBER) was undetected.PCR confirmed the rearrangement of TCR-γ gene.According to the above findings,a diagnosis of cutaneous γ/δ T-cell lymphoma was made.The patient gave up therapy,and died 20 months after the onset of disease. Key words: Lymphoma, T-cell; CD8-positive T-lymphocytes; Case reports [Publication types]

Diffuse Large B-Cell Lymphoma, Not Otherwise Specified, in The Palate

Diffuse large B-cell lymphoma (DLBCL) is the most frequent non-Hodgkin's lymphoma (NHL) found in oral and maxillofacial regions. Large numbers of cases are biologically heterogeneous and are commonly defined as DLBCL, not otherwise specified (NOS), by the World Health Organization. The case report concerns an 85-year-old patient who had an ulcer with raised and irregular edges located between the hard and soft palate that evolved over 2 weeks. The incisional biopsy specimen had a proliferation of large lymphoid cells suggestive of diffuse large cell lymphoma.

Primary ALK positive Anaplastic large cell lymphoma of T-cell type of jejunum: Report of a rare extranodal entity with review of literature

The gastrointestinal tract (GI tract) is the most common site for extranodal lymphomas with the majority of the non-Hodgkin's B-cell type. It involves any part of the GI, the most frequent sites in the order of occurrence are the stomach, small intestine, and ileocecal region. A 17-year-old male presented with intermittent abdominal pain, altered bowel habits associated with vomiting of 1 month duration. Computerized tomography of the abdomen revealed an eccentric mass in the jejunum with significant luminal narrowing. Limited resection of jejunum showed an intraluminal polypoidal growth with a homogenous cut surface. Microscopic examination of the mass revealed a diffusely infiltrating monotonous population of large lymphoid cells with round to oval vesicular nucleus, prominent nucleoli and moderate to scanty cytoplasm, admixed with few multinucleated giant cells with wreath like arrangement of nuclei, binucleated cells, and atypical mitosis. The tumor was involving the submucosa, infiltrating the muscularis propria and extending into the sub serosa. Immunohistochemistry showed diffuse positivity for CD45, CD30, anaplastic lymphoma kinase-1 (ALK-1), and focal positivity for CD43. The immunohistochemical stains for B-cell lineage CD20, CD79a, T-cell markers CD3, CD2, CD4, CD8, CD7, and other markers namely bcl2, bcl6, CD5, CD138, CD56, Mum1, and PAX-5 were negative. Six lymph nodes isolated showed features of reactive follicular hyperplasia and were free of tumor. A diagnosis of primary ALK positive anaplastic large cell lymphoma of T-cell type of jejunum was made. Patient has completed three cycles of chemotherapy comprising of cyclophosphamide, prednisone, vincristine, and doxorubicin and is in remission until the last follow-up.

Primary cutaneous anaplastic large-cell lymphoma - case report

Primary cutaneous anaplastic large-cell lymphoma is part of the spectrum of CD30+ lymphoproliferative cutaneous processes, characterized by single or multifocal nodules that ulcerate, are autoregressive and recurrent. Extracutaneous dissemination may occur, especially to regional lymph nodes. Histology shows a diffuse, non-epidermotropic infiltrate , anaplastic large lymphoid cells of immunohistochemistry CD30+, CD4+, EMA-/+, ALK-, CD15- and TIA1-/+. Prognosis is good and does not depend on lymphatic invasion. Radiotherapy, removal of the lesion and/or low-dose methotrexate are the treatments of choice. The present study reports the case of a 57-year-old-woman presenting Primary cutaneous anaplastic large-cell lymphoma with multifocal lesions. The pacient evolved with pulmonary involvement 7 years later. She showed a good response to the treatment with low-dose methotrexate prescribed weekly.

Concurrent Epstein Barr Virus Viremia and Hodgkin Lymphoma In Two Patients With Chronic Lymphocytic Leukemia

IntroductionChronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder (LPD) derived from mature B-cells with heterogeneous outcomes. High-grade lymphoma can arise from CLL in 3-10% of cases, a process known as Richter's transformation (RT). The majority of RT results in high grade B-cell lymphomas, though rarely transformation to Hodgkin lymphoma (HL) has been reported. Epstein Barr virus (EBV) viremia can arise in patients with CLL secondary to immunosuppression and can lead to an EBV driven LPD. In patients with CLL, this has been seen with fludarabine based treatments but has been reported with alemtuzumab. HL is also been associated with EBV virus in tumor cells but cases of HL and EBV viremia have not been reported. We report the first two cases in the English literature of CLL with EBV viremia and HL. CasesCase 1 A 66 year old male was diagnosed with a RAI stage I, del13q14, Zap-70 (-), IgvH mutated, CD38 (+) CLL in 2004. Worsening thrombocytopenia resulted in the initiation of treatment in April 2012 using Ofatumumab and high dose methylprednisolone followed by lenalidomide maintenance therapy (HiLOG clinical trial). The patient responded to induction therapy and was continued on lenalidomide maintenance for 12 cycles. In May of 2013 the patient developed progressive fevers, chills, cough, weakness, weight loss, and hypercalcemia. Evaluation revealed an EBV viremia with whole blood PCR titers of 484,550 copies/mL. Bone marrow biopsy was consistent with CLL and full body PET CT scan showed diffuse lymphadenopathy with max SUV of 30.7 and splenomegaly. Biopsy of a left external iliac node showed large atypical lymphoid cells that were surrounded by small lymphocytes. The large atypical lymphoid cells were CD30 (+), EBV (+), Pax-5 (+), CD 20 (-), CD15 (-), CD5 (-), and CD3 (-) confirming HL. The patient has currently received 4 weekly treatments with rituximab for EBV driven LPD and one cycle of Adriamycin, bleomycin, vinblastine, and dexamethasone (ABVD) for HL with resolution of symptoms and a whole blood EBV PCR to <500 copies/mL. Case 2A 68 year old male was diagnosed in England with an unknown stage del13q and IgVH unmutated CLL in 2002. He was started on treatment with 5 cycles of fludarabine, cyclophosphamide, rituximab in 2011 and achieved a complete response. His post therapy course was complicated with infection resulting in septic shock with renal failure resulting in dialysis. He stabilized but continued to have hypogammaglobulenemia and required intravenous immunoglobulin (IVIG) replacement. In April of 2013 he developed fevers to 104F, night sweats, weight loss and, fatigue. PET CT scan showed diffuse adenopathy with max SUV of 22.5, and bone marrow biopsy showed 60% CLL and a component of large cells that were CD 30 (+), CD15 (+), Mum1 (+), and EBER-ISH (+). The patient's whole blood EBV PCR was 276,600 copies/mL. Based on the clinical picture the patient was diagnosed with an EBV positive HL, EBV viremia, and chronic CLL. He has completed 4 weekly treatments with rituximab for EBV driven LPD and cycle 1 of ABVD for HL with resolution of symptoms and a whole blood EBV PCR of <500 copies/mL. DiscussionAlthough EBV viremia has been reported in CLL and EBV staining can be positive in HL, these two cases are the first to report CLL with EBV viremia and EBV positive HL. The high EBV viral load likely provided a base for an EBV driven LPD, in these cases HL. In patients with constitutional symptoms who have stable CLL disease burden, the clinician should screen for RT and EBV viremia. When a concurrent process is found, as in our cases, treatment against both the EBV driven LPD and HL should be initiated. Further research is needed to establish a biological relationship between EBV viremia and HL in patients with CLL. Disclosures:No relevant conflicts of interest to declare.

Diffuse large B-cell lymphoma of the thyroid which caused esophageal fistula

We describe a rare case of thyroidal Epstein–Barr virus-positive diffuse large B-cell lymphoma of the elderly (EBV+DLBCLe) in which diagnosis was difficult and spontaneous esophageal fistula developed. A 79-year-old woman presented with acute swelling of the anterior neck with tenderness, general fatigue, and continual fever. Malignant lymphoma of the thyroid was suspected. Histologically, the thyroid lesion showed extensive necrosis, including a few Ziehl–Neelsen-positive substances. No evidence of tuberculosis was detected by any other examinations. While performing examinations, left recurrent nerve palsy and a tumorous lesion in the pharynx appeared. Computed tomography and gastrointestinal fiberscopy revealed esophageal fistula. Biopsy specimens from the pharyngeal lesion showed diffuse proliferation of large atypical lymphoid cells that were strongly positive for CD20 and EBV early RNAs. The final diagnosis was thyroidal EBV+DLBCLe with infiltration of surrounding organs. The esophageal fistula had healed 6 months after beginning treatment of EBV+DLBCLe.

Breast Implant Related Anaplastic Large Cell Lymphoma ALK- (ALCL ALK-) – Case Report

Case presentationA 29 underwent bilateral cosmetic breast augmentation 10 years previously (McGhan Textured Round 400 mL implants). Six months before, she developed slowly progressive right breast pain and inflammatory signs associated with fluid collection around the right breast that was drained. A yellow cloudy fluid was examined and showed atypical large lymphoid cells. The cell block prepared in another institution showed numerous lymphoid cells including large atypical cells with lobated nuclei. PET CT scan was negative, same as bone marrow aspirate and trephine for lymphoma infiltration. Following bilateral removal of the breast implants, further histopathology studies showed no infiltration by lymphoma of the breast capsules or scar tissue. However, right breast peri prosthetic fluid microscopy showed a population of single malignant cells with scanty cytoplasm, numerous mitosis, and nuclei showing single and multiple nucleoli. Some cells showing horseshoe nuclei. The malignant cells were positive for CD30 and LCA and negative for CD20, CD68, AE1-3, and ALK 1. FISH for ALK was not possible (Fig 1) [Display omitted] DiscussionPrimary breast lymphomas are very rare conditions; they represent less than 1% of all NHL and less than 0.7% of all breast malignancies. There have been some cases reported in the medical literature of ALCL ALK- associated with breast implants. All the cases have been described in patients with textured implants, such as in this case and the reason is unknown. There are two main types of ALCL of the breast based on published case reports: a mass and an effusion. Primary breast effusion associated ALCL portends a good prognosis despite the fact that they are ALK-. The development of ALCL proximal to breast implants suggests that they are the result of an immune reaction to the silicone. Whether they represent true malignancy or a localised reactive phenomenon is not entirely clear yet. In previous case series, the condition has been described as indolent. However, given the low incidence of this condition and the limited literature available; it is difficult to know what the best treatment approach is. Following confirmation of the diagnosis, treatment options were discussed with the patient and the preferred option was active treatment with local radiation after removal of breast implants. Disclosures:No relevant conflicts of interest to declare.

Unusual case of metachronous EBV‐associated B‐cell and NK/T‐cell lymphoma mimicking polymyositis‐diagnostic challenges and pitfalls

Unusual case of metachronous EBV‐associated B‐cell and NK/T‐cell lymphoma mimicking polymyositis‐diagnostic challenges and pitfalls

PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA INTERACTING WITH A PRE–EXISTING CEREBRAL AMYLOID ANGIOPATHY DEMONSTRATED AS AN OLD RIGHT FRONTAL HAEMORRHAGE ON IMAGING

Primary CNS Lymphoma is rare aggressive malignancy that originates entirely in the central nervous system. It represents a diagnostic challenge to clinicians as symptoms are frequently non–specific, and overall represents...