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- 这是什么？－会3257
陈国章教授的反馈信息：
Dear Dr. Zhou,
This is a most puzzling LYMPH NODE for which I cannot reach a clear-cut
diagnosis.
The node shows patchy fibrous bands. There are abnormal large cells located
in the sinuses. These cells have round or oval nuclei, distinct nucleoli,
and pale or retracted cytoplasm. Nuclear atypia/pleomorphism is mild to
moderate. The background lymph node parenchyma is rich in plasma cells.
Certainly there is some resemblance to Rosai-Dorfman disease, but the
cytoplasm is not as abundant. I in fact favor an interpretation of a
malignant neoplasm. Since the cells are apparently cohesive in areas (but
may be due to packing within the sinuses rather than genuine cellular
cohesion), carcinoma is seriously considered.
We have performed panels and panels of immunostains to cater for various
possibiltiies ranging from carcinoma to melanoma, large cell lymphoma of B
or T cell lineage, Hodgkin lymphoma, histiocytic and dendritic cell
neoplasms and germ cell tumor, but unfortunately nothing stains. I even
ventured the possibility of a sinus-lining cell tumor by staining for
Langerin.
(1) Eptihelial markers - cytokeratin CAM5.2, cytokeratin AE1/AE3, BerEP4
(2) Melanoma markers - S100
(3) Histiocytic and dendrtic cell markers - CD68, CD163. S100
(4) Sinus lining cell - Langerin
(5) Hodgkin lymphoma - CD30
(6) B cell lymphoma, including ALK+ large B cell lymphoma - CD20, Oct-2,
ALK1
(7) T cell lymphoma - CD3, CD2, CD7
(8) Germ cell tumor - Oct3/4
Since LCA/CD45 is negative, I cannot even be sure whether this is a
hematolymphoid neoplasm.
In summary, I am not sure what it is, but would consider this an
UNDIFFERENTIATED MALIGNANT NEOPLASM (sinusoidal large cell malignancy).
Many thanks for sharing this most difficult case with me.
Best personal regards,
John
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本帖最后由 于 2009-01-15 14:06:00 编辑
| 以下是引用Elizabeth在2009-1-10 7:05:00的发言： Interesting case,thanks for sharing.Looking forward for the final results. |
| 以下是引用yangjun在2009-1-4 17:34:00的发言： 一个肉芽肿性病变，图1中应是“明暗相间”的图像。大量浆细胞、多核巨细胞，其中多核巨细胞内有星状小体（这一般是在结节病中可见）。最后一张HE图见淋巴窦内大细胞，核仁清晰，像肿瘤细胞，间变有可能，但CD30阴性，基本排除了。可以考虑的病变好像都不好解释，如Rossi-Doffman，有明暗相间图像，有大量浆细胞，可是又没有窦组织细胞吞噬淋巴细胞的现象，且R－D中应没有含有星状小体的多核巨细胞；如果是结节病，首先结节病是一个排除性诊断的疾病，以T细胞增生为主，有那么多的浆细胞吗？图6中的大细胞也无法解释。请各位指教！ |
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