Just signed a case two weeks ago and like to share it with all friends here.

Vulvar mass 5 cm. No previous malignant history.

Fig Key:

Fig 1. 2x

Fig 2. 20x juction

Fig 3. 20x tumor

Fig 4. 40x tumor

Tumor shows similar morphology in different areas.

Please give your differential dx and the requirement for IHC stains if it is your case. What is your favor diagnosis based on the H&E slides?

I will have few weeks vocation and will poster the immunostain photos or results after I come back.

Thnaks,

After the original dx of valvar lesion, an enlarged LN was found in pelvic area. FNA was performed.（外阴病变诊断后，发现盆部肿大淋巴结1枚，行FNA）

Fig 1-5 cytology of lymph node FNA. （图1-5为淋巴结FNA细胞学）

Fig 6: CD3

Fig 7: CD20

Fig 8: CD30

All other IHC results in cell block are the same as that in valvar lesion.

molecular analysis of ALK is negative. （细胞块其余IHC结果与外阴病变相同。分子学检测ALK阴性）

 谢谢Dr.cqzhao表扬，更谢谢您分享的好病例。对于疑难病例，我从中学到诊断思路，以及在实际工作中逐步逼进目标的诊断方式。

另外，我也想要这篇论文

abin@ipathology.cn

 thank all of you for your discussion. After I got the first IHC results, I sign-out the case as hemologic/lymphocytic malignancy and sent the case to our hemotopathologist for further evaluation. The final dx is ATCL , ALK neg.

Thank Abin's excellent analysis. I especially appreciate the first reviewer WY1992. You are great you can consider T cell lymphoma immediately. In fact Lymphoma is my last consideration. Ha ha.

I will present more follow-up data soon.

abin译：谢谢大家参与讨论。第一批IHC结果，我签发了造血/淋巴系统恶性肿瘤，然后转给我们的血液病理医生进一步分型。

最后诊断：ATCL，ALK阴性。

谢谢abin，分析非常好。特别赞赏第一个发表意见的WY1992，能立即考虑到T细胞淋巴瘤。实际上淋巴瘤是我的最后考虑，哈哈。我将提供更多随访资料。

 To: Shiyan:

I am an gyn/breast pathologists and cytopathologist, very short of knowledge in hematopath. I am sure that you know much more than I know. I find a good paper PTCL. I can email you the full paper if you want to and told me your email.

Am J Surg Pathol. 2008 Sep 5. [Epub ahead of print] onmouseout="PopUpMenu2_Hide();" href="javascript：PopUpMenu2_Set(Menu18779728);" target="_self">Links

 to楼上二位：部位是外阴。

ALCL经常累及淋巴结和结外，结外以皮肤最常见（外阴也算皮肤）。

 那Granzyme B,EMA,CD56呢？从T细胞的表达上，我认为CD20应该是真阴性，但是在所提供的图片中没有见到阳性信号，好像这个染色不是很漂亮了，呵呵。

这个部位的T细胞淋巴瘤还真是少见。我前一段时间总结了80多例ALCL，没有一例是在宫颈的。现在的免疫表型确实可以诊断ALCL，但是还是想知道其他的免疫表型。还有一个问题就是：ALK－ALCL和PTCL-NOS怎么鉴别？PTCL也是可以表达CD30的。不知道老师在美国是怎么鉴别的？

谢谢老师提供的好病例。不过现在回过头来重新看病例，我还是会首先想到DLBCL，不会马上定位到ALCL，即使一些细胞形态很像，我仍然会首先想到这个部位常见的肿瘤（有点死脑筋噢），呵呵。再次感谢老师！

 Other IHC stains:

Tumor cells are negative for CD21, CD23, CD79, CD15, CD1a, CD34, CD117 (C-kit) and ALK.

Now you know the final diagnosis.

Sorry for the delay. I need to find a time to take some photos.

Key:

1. CD2

2. CD3

3. CD4

4. CD20

5. CD30

6. CD43

7. CD68

以下是引用abin在2008-10-29 18:32:00的发言：  再次学习，并参考了陈国璋教授的讲课资料。 如果是淋巴造血系统肿瘤： LARGE CELL HEMATOLYMPHOID NEOPLASMS: Main considerations --Diffuse large B-cell lymphoma --Anaplastic large cell lymphoma --T or NK cell lymphoma predominated by large cells --Anaplastic plasmacytoma / plasmablastic lymphoma --Classical Hodgkin lymphoma predominated by large cells ==Histiocytic / dendritic cell neoplasm ==Pleomorphic variant of mantle cell lymphoma   Abundant pink cytoplasm: Histiocytic/ dendritic cell tumor

Abin has done great job on this case and I am with him for differential diagnoses.

澄泉兄，别掉我们的胃口了，给个结果吧，我们都望眼欲穿了。

于北京机场等机厅

 这些IHC可排除癌、恶黑和肌源性肉瘤，支持淋巴造血肿瘤。需要进一步IHC。

 Thank all of you who read the case and wrote your differential dx. I just came back from China last weekend and sorry for the delay.

IHC:

Vimentin Positive

Epithelial markers negaative: AE1/AE3, Cam 5.2, CK7, CK20

Melanoma markers negative: Melan-A, HMB-45, S-100

Muscle markers negative: SMA, Desmin,

LCA (CD45) See photo

 再次学习，并参考了陈国璋教授的讲课资料。

如果是淋巴造血系统肿瘤：

LARGE CELL HEMATOLYMPHOID NEOPLASMS: Main considerations
--Diffuse large B-cell lymphoma
--Anaplastic large cell lymphoma
--T or NK cell lymphoma predominated by large cells
--Anaplastic plasmacytoma / plasmablastic lymphoma
--Classical Hodgkin lymphoma predominated by large cells
==Histiocytic / dendritic cell neoplasm
==Pleomorphic variant of mantle cell lymphoma