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MOSCMC CPC 28102019 - Follicular Lymphoma

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CPC 28102019 - Follicular Lymphoma

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MOSCMC CPC 28102019 - Follicular Lymphoma

  1. 1. CPC Session 28/10/2019
  2. 2. Patient details • Male 59 years • Hospital No: 1627484 • Biopsy no: 2811/19 • Clinical Diagnosis : ?Lymphoma • Nature of Specimen : Left inguinal lymph node .
  3. 3. Gross Features • Received a single nodular grey white soft tissue mass measuring 2 x 1.5 x 1cm. • External surface showed mild congestion. • Cut surface showed pale white nodular areas.
  4. 4. Microscopic Features Lymph node architecture effaced by a neoplasm arranged as vague nodules Normal lymph node architecture
  5. 5. Microscopic Features Neoplasm infiltrating the perinodal adipose tissue.
  6. 6. Is it Hodgkin’s or Non-Hodgkin(NH)’s Lymphoma? The lymph node architecture is effaced by variable numbers of Reed-Sternberg (HRS) cells admixed with a rich inflammatory background. This classic Reed-Sternberg cell is binucleated, with prominent eosinophilic nucleoli, producing the so-called owl's eye appearance.
  7. 7. Microscopic Features Neoplasm with follicular and diffuse architecture Follicular architecture Diffuse architecture
  8. 8. Microscopic Features Follicular areas Diffuse areas
  9. 9. Is it B-cell or T-cell NH lymphoma? Immunohistochemistry Type of lymphoma CD3+, CD20- T-cell NH lymphoma CD3-, CD20+ B-cell NH lymphoma
  10. 10. B-cell NH Lymphoma Differential Diagnosis – Follicular lymphoma – Mantle cell lymphoma – Marginal zone lymphoma
  11. 11. Cell morphology in NH Lymphoma
  12. 12. Microscopic Features Intermediate sized neoplastic cells with moderate clear to eosinophilic cytoplasm and angular vescular nuclei devoid of nucleoli
  13. 13. Microscopic Features Proliferation of capillary sized vessels
  14. 14. Impression Biopsy of left inguinal lymph node showing histopathological features of Non-Hodgkin’s Lymphoma. Possibilities considered are : - 1. Mantle cell Lymphoma 2. Diffuse Large B-cell Lymphoma Immunohistochemistry is required for confirmation.
  15. 15. Differential Diagnosis Nodal marginal zone lymphoma Lymphoma with follicular growth pattern with pale cells that focally surround portions of reactive germinal centres. Lymphoma composed of a proliferation of small cells growing between a reactive germinal centre and an attenuated mantle zone.
  16. 16. Differential Diagnosis Diffuse Large B-cell Lymphoma Diffuse large B-cell lymphoma (centroblastic monomorphic) Neoplastic cells have a polymorphic and multilobated appearance
  17. 17. Immunohistochemistry IHC Marker Result CD3 Non-immunoreactive, score 0 in neoplastic cells CD20 Immunoreactive, score 4+ in neoplastic cells CD21 Non-immunoreactive, score 0 in neoplastic cells. Highlights follicular dendritic meshwork. BCL-6 Immunoreactive, score 4+ in neoplastic cells BCL-2 Immunoreactive, score 4+ in neoplastic cells Score 4+ => Immunoreactive in 76-100% of cells Impression : Follicular Lymphoma
  18. 18. Follicular lymphoma grading
  19. 19. Final Impression Follicular Lymphoma Grade 2 with follicular and diffuse architecture

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