Lymphadenopathy - 华夏病理网论坛

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楼主发表于 2010-10-28 10:26|举报|关注(0)
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姓名：	×××	性别：	Female	年龄：	33
标本名称：	Lymph node
简要病史：	A 33 years old female was diagnosed with Hodgkin lymphoma 3 years ago at an outside hospital, and no outside slides were available for review. Recently she presented with abdominal pain due to umbilical hernia, and image studies revealed a periportal lymph node of 3.9 cm. The lymph node was excised.
肉眼检查：

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×参考诊断

T-Cell/Histiocyte-Rich Large B-Cell Lymphoma

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1 楼发表于2010-10-28 18:08:00举报|引用
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符合HD

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: 嫁人就嫁灰太狼，学习要上华夏网。

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2 楼发表于2010-11-01 10:09:00举报|引用
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本帖最后由于 2010-11-01 10:10:00 编辑

再传几张低倍镜图片。

何杰金淋巴瘤的确是重要的鉴别诊断之一。

该病例哪些地方不符合何杰金淋巴瘤？

还有哪些重要的鉴别诊断？

哪些免疫组化染色有助于鉴别诊断？

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3 楼发表于2010-11-01 15:46:00举报|引用
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朗格汉斯组织细胞增生症？

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: 刀锋上的蚂蚁

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4 楼发表于2010-11-01 22:30:00举报|引用
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以下是引用panzenggang在2010-11-1 10:09:00的发言：

再传几张低倍镜图片。

何杰金淋巴瘤的确是重要的鉴别诊断之一。

该病例哪些地方不符合何杰金淋巴瘤？

还有哪些重要的鉴别诊断？

哪些免疫组化染色有助于鉴别诊断？

first background looks like HL,but the especial cell is not enough large

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5 楼发表于2010-11-02 08:21:00举报|引用
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The background of HL usually contains lymphocytes, eosinophils and plasma cells. However, rare eosinophils and plasma cells are present in this cases.

The classic HL cells have abundant cytoplasm with large eosinophilic nucleoli,. The tumor cells in this case show a mixed morphologic features, including centroblastic, immunoblastic, and HL-like.

Hint: what other cells are present in the background in addition to lymphocytes?

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6 楼发表于2010-11-09 12:30:00举报|引用
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组织形态上要考虑富于T细胞的大B细胞性淋巴瘤，只是年龄稍小了些。鉴别诊断主要是结节性淋巴细胞为主型HD。前者缺乏模糊的结节，肿瘤性大细胞散在分布，肿瘤细胞数量较少。

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7 楼发表于2010-11-15 05:20:00举报|引用
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本帖最后由于 2010-11-15 05:22:00 编辑

1. CD20

2. CD15

3. CD30

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8 楼发表于2011-02-23 23:39:00举报|引用
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Final diagnosis: T-Cell/Histiocyte-Rich Large B-Cell Lymphoma

http://enjoypath.com/hp/hp-145.htm

T-Cell/Histiocyte-Rich Large B-Cell Lymphoma

CLINICAL FEATURES

A variant of DLBCL with prominent CD8+ T cells and histiocytes
M:F=2:1, 60-70 years of age
Mostly in lymph node, but more frequently presents with high-stage disease (about two thirds in stage III-IV) in bone marrow and spleen, compared with conventional DLBCL

MICROSCOPIC FINDINGS

Diffuse effacement of lymph node with polymorphic cellular population, lack of nodular pattern or sclerosis
Scattered large tumor cells, <10% of the cellular population, dispersed singly, without the formation of discrete aggregates or sheets
Morphology of tumor cells: centroblasts, immunoblasts, pleomorphic, LP (or L&H) cells, or Reed-Sternberg cells
Background: small lymphocytes with mostly CD3+CD8+ T cells; variable numbers of histiocytes; scant plasma cells or eosinophils

DIFFERENTIAL DIAGNOSES

	T-Cell/Histiocyte Rich Diffuse Large B-Cell Lymphoma	Nodular Lymphocytic Predominant Hodgkin Lymphoma	Classic Hodgkin Lymphoma
Cell origin	Germinal center B-cell	Germinal center B-cell	Non-germinal center B-cell
Location	Mostly nodal, frequent extranodal	Mostly nodal	Mostly nodal
Age	60-70	40-50	20-30, >60
Histopathology
Architecture	Diffuse	Macronodular	Nodular with or without sclerosis
Tumor cell distribution	Scattered, no sheets or aggregates	Scattered or small aggregate	Mostly scattered, may form sheets
Tumor cell morphology	Variable, centroblast, immunoblast, pleomorphic, LH or RS like	LH cells with popcorn nuclei	RS or variants
Background cells	Mostly CD8+ T cell and histiocytes	Mostly B-cells	Mixed, with frequent eosinophils
CD21+ meshwork	None	Present	None
CD57 T-cell rosettes	None	Present	None

Immunohistochemical stains
CD45	+	+	−
CD20	+	+	−/+
CD79a	+	+	−
PAX5	+	+	−
BCL6	+	+	−
CD15	−	−	+
CD30	−/+ (40%+)	−	+
EBV	−	−	+/−
EMA	−/+	+	−
MUM1	+	−	+
OCT2, BOB1	+	+	−
B-symptoms	Frequent	Typically no	Some cases
Stage at diagnosis	III-IV in 67% cases	Mostly localized	III-IV in 50% cases

IMMUNOHISTOCHEMISTRY AND SPECIAL STAINS

Tumor cells: pan-B⁺, CD30^−, CD15^−, EMA^+/−, BCL6^+/−
Background lymphocytes: CD3⁺, CD8+

Background histiocytes: CD68+

Lack of large CD21+ meshwork as seen in NLPHD

Background lymphocytes: CD3⁺, CD8+
Background histiocytes: CD68+
Lack of large CD21+ meshwork as seen in NLPHD

REFERENCES

WHO Pathology & Genetics. Tumours of Haematopoietic and Lymphoid Tissues. IARC Press, Lyon 2008
Hematopathology Clinical Pathologic Guidelines. Hematopathology section, University of New Mexico
Hematopathology. Elaine Sarkin Jaffe, MD, Nancy L. Harris, MD, James Vardiman, MD, Elias Campo, MD, and Daniel Arber, MD. 2010

Final diagnosis: T-Cell/Histiocyte-Rich Large B-Cell Lymphoma

http://enjoypath.com/hp/hp-145.htm

T-Cell/Histiocyte-Rich Large B-Cell Lymphoma

CLINICAL FEATURES

A variant of DLBCL with prominent CD8+ T cells and histiocytes
M:F=2:1, 60-70 years of age
Mostly in lymph node, but more frequently presents with high-stage disease (about two thirds in stage III-IV) in bone marrow and spleen, compared with conventional DLBCL

MICROSCOPIC FINDINGS

Diffuse effacement of lymph node with polymorphic cellular population, lack of nodular pattern or sclerosis
Scattered large tumor cells, <10% of the cellular population, dispersed singly, without the formation of discrete aggregates or sheets
Morphology of tumor cells: centroblasts, immunoblasts, pleomorphic, LP (or L&H) cells, or Reed-Sternberg cells
Background: small lymphocytes with mostly CD3+CD8+ T cells; variable numbers of histiocytes; scant plasma cells or eosinophils

DIFFERENTIAL DIAGNOSES

	T-Cell/Histiocyte Rich Diffuse Large B-Cell Lymphoma	Nodular Lymphocytic Predominant Hodgkin Lymphoma	Classic Hodgkin Lymphoma
Cell origin	Germinal center B-cell	Germinal center B-cell	Non-germinal center B-cell
Location	Mostly nodal, frequent extranodal	Mostly nodal	Mostly nodal
Age	60-70	40-50	20-30, >60
Histopathology
Architecture	Diffuse	Macronodular	Nodular with or without sclerosis
Tumor cell distribution	Scattered, no sheets or aggregates	Scattered or small aggregate	Mostly scattered, may form sheets
Tumor cell morphology	Variable, centroblast, immunoblast, pleomorphic, LH or RS like	LH cells with popcorn nuclei	RS or variants
Background cells	Mostly CD8+ T cell and histiocytes	Mostly B-cells	Mixed, with frequent eosinophils
CD21+ meshwork	None	Present	None
CD57 T-cell rosettes	None	Present	None

Immunohistochemical stains
CD45	+	+	−
CD20	+	+	−/+
CD79a	+	+	−
PAX5	+	+	−
BCL6	+	+	−
CD15	−	−	+
CD30	−/+ (40%+)	−	+
EBV	−	−	+/−
EMA	−/+	+	−
MUM1	+	−	+
OCT2, BOB1	+	+	−
B-symptoms	Frequent	Typically no	Some cases
Stage at diagnosis	III-IV in 67% cases	Mostly localized	III-IV in 50% cases

IMMUNOHISTOCHEMISTRY AND SPECIAL STAINS

Tumor cells: pan-B⁺, CD30^−, CD15^−, EMA^+/−, BCL6^+/−
Background lymphocytes: CD3⁺, CD8+

Background histiocytes: CD68+

Lack of large CD21+ meshwork as seen in NLPHD

Background lymphocytes: CD3⁺, CD8+
Background histiocytes: CD68+
Lack of large CD21+ meshwork as seen in NLPHD

REFERENCES

WHO Pathology & Genetics. Tumours of Haematopoietic and Lymphoid Tissues. IARC Press, Lyon 2008
Hematopathology Clinical Pathologic Guidelines. Hematopathology section, University of New Mexico
Hematopathology. Elaine Sarkin Jaffe, MD, Nancy L. Harris, MD, James Vardiman, MD, Elias Campo, MD, and Daniel Arber, MD. 2010