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Thank you for the new photos and information on CD138 stain. This case is a B cell lymphoma. The neoplastic cells are somewhat unusual in not showing high grade cytology - nuclei are relatively uniform and small. I do not see plasmacytic features (basophilic cytoplasm, eccentric nuclei) on the new HE photos. 

 谢谢马老师,今天加做了CD138,阴性.请HE：第1副是20X，后几副是40X

以下是引用mjma在2009-7-6 22:09:00的发言： Can you also do CD138? Or is it possible for you to take more HE high power photos from the cellular areas? For some reason I am very suspicious for plasmacytic differentiation in the neoplastic lymphoid cells.

谢谢马老师！那我就再加做一个CD138吧，高倍的HE我会尽快传上来。谢谢大家的关注。根据目前的免疫组化我倾向弥漫大B，尽管HE看到这些肿瘤细胞形态不是很大。

Can you also do CD138? Or is it possible for you to take more HE high power photos from the cellular areas? For some reason I am very suspicious for plasmacytic differentiation in the neoplastic lymphoid cells. 

 

 有意思有病例，前5张图片考虑为恶性淋巴瘤，后5张间质血管类似血管周细胞瘤的图象，但间质内浸润的细胞类似前5张，因此从总体上看还是考虑为恶性淋巴瘤，选择一张同时具有两种图象的切片来做IHC，若无，则同时选两个蜡块来作IHC，以明确诊断。

Figures 1-5 show a somewhat different histopathology from that in Figures 6-10. The first five photos show a very cellular neoplasm that consists of mononuclear cells with plasmacytic features admixed with small lymphocytes (judging from the photos I think histologic sections are cut too thick). This makes me think of plasmacytoma and plasmacytic lymphoma, which could be easily confirmed by immunohistochemistry (CD138, kappa and lambda light chains, CD45, CD20, CD3). The last five photos show a lesion with irregular spaces between sparsely cellular tissue. They do suggest hemangiopericytoma, but cells between spaces are not very cellular and I am not sure how to put these areas together with the lymphoplasmacytic neoplasm. I do not think this is medulloblastoma or hemangioblastoma. Please see if you can have thinner sections cut and stained for better photography. Thank you.

 血管网织细胞瘤

 HPC

 血管母细胞瘤

 成人髓母？