case 1 & 2
TRANSCRIPT
WELCOME TO KMIO
CYTOLOGY DIVISION
DEPARTMENT OF PATHOLOGY
All learning begins with the simple
phrase ldquoI donrsquot knowrdquo
Case 1
53yF who attended health checkup camp Pap smear
IMPRESSION
H S I L
Case 2
Smear for interpretation
Case 1
1 HSIL2 ASCUS3 Reactive Changes4 Atropic Smear with inflammationASCUS5 Inflammatory smear ndashTV with dysplasia6 Inflammatory smear-SO of Herpes
Simplex Inflammation
Case 2
1 Mixed Vaginosis ndash TV + shift in veginal flora( cocco bacilli)
2 Mixed inflammation ndash Bact Vaginosis + TV3 Negative for SIL ndash TV4 TV Reactive Cellular Changes Assoc with
Inflammation5 TV Infection6 SCC Cx
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
All learning begins with the simple
phrase ldquoI donrsquot knowrdquo
Case 1
53yF who attended health checkup camp Pap smear
IMPRESSION
H S I L
Case 2
Smear for interpretation
Case 1
1 HSIL2 ASCUS3 Reactive Changes4 Atropic Smear with inflammationASCUS5 Inflammatory smear ndashTV with dysplasia6 Inflammatory smear-SO of Herpes
Simplex Inflammation
Case 2
1 Mixed Vaginosis ndash TV + shift in veginal flora( cocco bacilli)
2 Mixed inflammation ndash Bact Vaginosis + TV3 Negative for SIL ndash TV4 TV Reactive Cellular Changes Assoc with
Inflammation5 TV Infection6 SCC Cx
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 1
53yF who attended health checkup camp Pap smear
IMPRESSION
H S I L
Case 2
Smear for interpretation
Case 1
1 HSIL2 ASCUS3 Reactive Changes4 Atropic Smear with inflammationASCUS5 Inflammatory smear ndashTV with dysplasia6 Inflammatory smear-SO of Herpes
Simplex Inflammation
Case 2
1 Mixed Vaginosis ndash TV + shift in veginal flora( cocco bacilli)
2 Mixed inflammation ndash Bact Vaginosis + TV3 Negative for SIL ndash TV4 TV Reactive Cellular Changes Assoc with
Inflammation5 TV Infection6 SCC Cx
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
IMPRESSION
H S I L
Case 2
Smear for interpretation
Case 1
1 HSIL2 ASCUS3 Reactive Changes4 Atropic Smear with inflammationASCUS5 Inflammatory smear ndashTV with dysplasia6 Inflammatory smear-SO of Herpes
Simplex Inflammation
Case 2
1 Mixed Vaginosis ndash TV + shift in veginal flora( cocco bacilli)
2 Mixed inflammation ndash Bact Vaginosis + TV3 Negative for SIL ndash TV4 TV Reactive Cellular Changes Assoc with
Inflammation5 TV Infection6 SCC Cx
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 2
Smear for interpretation
Case 1
1 HSIL2 ASCUS3 Reactive Changes4 Atropic Smear with inflammationASCUS5 Inflammatory smear ndashTV with dysplasia6 Inflammatory smear-SO of Herpes
Simplex Inflammation
Case 2
1 Mixed Vaginosis ndash TV + shift in veginal flora( cocco bacilli)
2 Mixed inflammation ndash Bact Vaginosis + TV3 Negative for SIL ndash TV4 TV Reactive Cellular Changes Assoc with
Inflammation5 TV Infection6 SCC Cx
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 1
1 HSIL2 ASCUS3 Reactive Changes4 Atropic Smear with inflammationASCUS5 Inflammatory smear ndashTV with dysplasia6 Inflammatory smear-SO of Herpes
Simplex Inflammation
Case 2
1 Mixed Vaginosis ndash TV + shift in veginal flora( cocco bacilli)
2 Mixed inflammation ndash Bact Vaginosis + TV3 Negative for SIL ndash TV4 TV Reactive Cellular Changes Assoc with
Inflammation5 TV Infection6 SCC Cx
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 2
1 Mixed Vaginosis ndash TV + shift in veginal flora( cocco bacilli)
2 Mixed inflammation ndash Bact Vaginosis + TV3 Negative for SIL ndash TV4 TV Reactive Cellular Changes Assoc with
Inflammation5 TV Infection6 SCC Cx
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
IMPRESSION
L S I L + Trichomonos Vaginitis
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
PAP Test
THE BETHESDA SYSTEM
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Adequacy of smear
Cell spread more than 10 of the slide surface
8000 to 12000 cells in conventional pap smear5000 cells in liquid based preparation
Presence or absence of endocervical TZ component - 10 well preserved endocervicalor metaplastic cells in singly or in cluster
If abnormal cells seen never categorize as unsatisfactory
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
LSIL- cells in singlesheets
- similar to superficialintermediate cell
- cytoplasm abundant eosinophilic
cyanophilic
- clear cell border
- Nucleus - increase in size 3 times the
nucleus of intermediate cell
slight irregularity of nuclear outline
hyperchromasia Uniform and granular
chromatin well defined nuclear margin
No nucleoli
Management followup colposcopy HPV test
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
HSIL
Cell size smaller than the LSIL
Cells in singlysheetssyncitial
Nuclear abnormalities resemble parabasalmetaplastic cell
coarse granular chromatin no nucleoli
nuclear margin irregular decreased cytoloplasm
increased NC ratio
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
ASC
ldquoCellular ASC
Cellular changes that are more
marked than those attributable to
reactive changes but that
qualitatively and quantitatively fall
short of definitive diagnosis of
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
ASC
Human Papilloma Virus (HPV)
Vaccine
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
1 Screening test
2 ldquo PAP Test ldquo ldquoVIArdquo ndash Good Screening Test
3ldquo ASC ldquo -
4Ancillary Tests ndash Colposcopy HPV test
These are required for management of women with Cervical Cytological abnormality
This depends on a good communication between the Clinician and the Cytopathologist
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 3
15yboy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus USG FNA of
the mass done
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
1 GCT2 GCT with Embryonal Carcinoma3 GCTALCL4 Testicular GCT5 Pleomorphic Adenocarcinoma-Pancreas6 HCC7 High Grade Malignant Tumour8 ALCL GCT
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Review smears - Poorly differentiated tumourAdv Repeat test at KMIOPoorly differentiated tumour - GCT
ALCLCase will be reviewed after workup
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Hrsquogram ndash NmlBiochemistry ndash Nml LDH ndash 1674 ( 450-N)Tumour markers ndash AFP β-HCG ndash within NmlHBsAg amp HIV ndash Non-reactiveUSG Abdomen ndash Enlarged multiple abdominal
mesenteric lymphnodes largest 3x4x25cm (FNA node) with mild splenomegalyScrotal scan ndash NAD
No peripheral LymphadenopathyAdvised IHC on cell blockLymphnode Biopsy done
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
LCA
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
CD3 CD20
CD30
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
ALK+
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
PAX5 CD34
CD138
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
MUM1
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Kappa Lamda
Ki67
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
EMA
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
CD4
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
A young boy
Abdnominal lymphnodes++
Non- immunocompramised
HampE- high grade lesion
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
IHCLCA+ CD20-CD3- CD30-EMA+ CD34-CK- CD4 + ALK+(Granular) LMP1-CD68- LMP1 CD138- MUM1+Kappa+ Lamda-Ki67-65 Pax5 focal+
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
DIAGNOSIS
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
ALK Positive Diffuse Large bull B- Cell Lymphomabull1997 ndash Delsol workers ndash Delsolrsquos Tumour
bullMedian Age ndash 36yrs Paed ndash 30
bullHigh Stage Nodal Disease
bullNo Assoc with immunosuppression
bullPoor prognosis ndash 11months
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
MORPH Immunoblasticplasmablastic
Sinusoidal infiltration
Appear deceptively cohesive ndash DD Ca
IHC LCA + 75 CD+ 3 (weak amp focal)CD79a+ 16 EMA+ 100 CD30+ 6 (weak amp focal)
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
IHC contd
ƛƙ+ 90 (IgA) CD138+- CD4+ 64CD57+ 40 CK+ rareALK+ usually granular cytoplasm
Cytg t(217)(q23q23) ndash Fusion of CLTC(clathrin) gene with ALK genet(25)(q23q35)(NPMALK) ndash Rare
EBV ndash Neg
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
NEOPLASIAALK-positive diffuse large B-cell lymphoma is associated with Clathrin-ALK rearrangements report of 6 casesRandy D Gascoyne Laurence Lamant Jose I Martin-Subero Valia S Lestou Nancy Lee Harris Hans-Konrad Muuml ller-HermelinkJohn F Seymour Lynda J Campbell Douglas E Horsman Isabelle Auvigne Estelle Espinos Reiner Siebert and Georges Delsol
Blood 20031022568-2573
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
American Journal Clinical Pathology (2011) Clinical Pathology 136 183-194
Plasmablastic Lymphoma and Related Disorders
Eric D Hsi MD1 Robert B Lorsbach MD PhD2
Falko Fend MD3 and Ahmet Dogan MD PhD4
+Author Affiliations1From the Department of Clinical Pathology Cleveland Clinic Cleveland OH
Department of Pathology University of Arkansas for Medical Sciences Little
Rock 3Institute of Pathology University Hospital Tuebingen Eberhard-Karls
University Tuebingen Germany and 4Department of Laboratory Medicine a
and Pathology Mayo Clinic Rochester MN
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 4
28yF presented BL cervical lymphnodes of 1 ndash 4cm in size of 6months duration FNA of lymphnodes done
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Cytology Cellular smear
Lymphoid cells histiocytesmacrophages
A few large cells with monobinucleate with prominent nucleoli RS cells
Numerous eosinophils occ Plasma cells
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
DIAGNOSIS
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 4
1 Histoplasmosis Kimurarsquos Disease2 Lymphoproliferative Diease3 HD ndash Mixed Cellularaity4 LCH5 HD ndash Lypmphocytic Predominance6 SHML with Eo7 SHML with LCH8 Kimurarsquos disease
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
IMP Positive Malignancy ndash1 Malignant lymphoma HDALCL2 Metastatic Undifferentiated
CarcinomaCase will be reviewed after H amp N workup
H amp N workup was normal
FINAL IMP1 Malignant lymphoma HDALCL2 Histiocytic Lesion
Advised LN Bx and IHC study
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
CD1a
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
S100
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
CD30
CD15
CD30
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
CD15
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Final diagnosis
Hodgkin Lymphoma-syncial type with LCH
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
LCH ndash Systemic or single organ diseaselung bone lymphnode skin etc
Cytology findings
Histomorphology ndashsinusoidal pattern + IHC
LCH+Lymphoma ndash Focal Langerhan Cell Histiocytic Hyperplasia rather than LCH
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
J Res Med Sci 2010 Jan-Feb 15(1) 58ndash61
Langerhans cell histiocytosis following Hodgkin lymphoma a case report from Iran
Nahid Reisi Dehkordia Parvin Rajabib AzarNaimic and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma is seen in less than 03 of cases
It can occur before after or simultaneously with Hodgkin Lymphoma
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Korean J Intern Med Dec 2012 27(4) 459ndash462
Langerhans Cell Histiocytosis Followed by
Hodgkins Lymphoma
IK Soo Park1 In Keun Park1 Eun Kyoung
Kim1 Shin Kim1 Sang Ryong Jeon2 Joo RyungHuh3 and Cheol Won Suh 1
This condition should be considered in the differential diagnosis of recurrent lymphoma
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Case 5
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
bull 15yrs boy treated for ALL 6yrs back
bull Regular follow-up
bull BL submandibular cervical lymphadenopathy2x3cm
bull FNA of the lymphnode done
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
List of Differentials
bull Reactive lymphoid hyperplasia
bull Hemophagocytic lymphohisticytosis
bull Recurrent ALL
bull Secondary neoplasm DLBCL
bull NHL
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Reactive lymphoid hyperplasia
Significant lymphadenopathy
Clinical history
Clinically 2-3cm LN soft to firmpatient in remissionPS normal LDH normalToxoplasma negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
IHC to exclude focal involvement
Tdt Negative
Correlating clinical serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Progressive Transformation of Germinal Centre
bull Benign reaction pattern in lymph nodes
bull Florid or focal
bull 35 of non specific lymphadenitis
bull Pathogenesis premature arrest at an early transition between primary and secondary follicles because of incomplete blastictransformation of B cells
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Progressive Transformation of Germinal Centre
Non hodgkins
bull Malignant lymphoma
Hodgkins NLPHL
bull Reactive lymphadenitis
bull Immunocompromised
bull IgG4 related lymphadenopathy
Thank youhellip
Thank youhellip