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Follicular lymphoma in situ presenting as dermatopathic lymphadenopathy (a case report)
IAP 2014 ABSTRACTS
Conclusions: Eight miRNAs are aberrantly expressed in PTCLNOS, which might be involved in the molecular regulation in the pathogenesis of PTCL-NOS; the underlying mechanism is relevant to many target genes and complicated signaling pathways.
Hematopathology: Poster#197 FOLLICULAR LYMPHOMA IN SITU PRESENTING AS DERMATOPATHIC LYMPHADENOPATHY (A CASE REPORT) Nnamdi Orah1, Uche Igbokwe2, Akinde Ralph1 and Adekunbiola Banjo1 1Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital, Lagos, Nigeria, and 2Department of Cellular Pathology, Queen’s Hospital, Romford, United Kingdom Introduction: Follicular lymphoma in situ (FLIS) is a recently described entity with few cases recognized worldwide. To our knowledge, this is the first FLIS reported from West Africa. Case presentation: We present the case of a 48-year-old civil servant with axillary lymphadenopathy discovered on routine mammography. On histology, a predominant reactive change with aggregates of melanophages was seen, prompting a diagnosis of reactive dermatopathic lymphadenopathy. Immunohistochemistry revealed secondary follicles with germinal centres that were variably colonised by small CD 10 and Bcl-6 positive cells that also overexpressed Bcl-2. The involved follicles had a low proliferation fraction as determined by Ki67. S100 stained the increased numbers of inter-follicular dendritic cells. These features indicated an intra-follicular neoplasia/in situ follicular lymphoma. Conclusion: This highlights the use of immunohistochemistry in lymph node pathology, a resource which is very limited in SubSaharan Africa.
Hematopathology: Poster#198 FOXP3(þ) PTCL-NOS: A CLINICAL AND PATHOLOGICAL ANALYSIS OF 10 CASES Akira Satou1, Seiichi Kato1, Naoko Asano2 and Shigeo Nakamura1 1Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan, and 2Department of Clinical Laboratory, Nagano Prefectural Suzaka Hospital, Suzaka, Japan Treg phenotype of CD4þCD25þFOXPþ was almost exclusively reported in ATLL. However, this phenotype has not been well addressed on PTCL-NOS, because of the rarity, and its clinicopathological characteristics still remain unknown. Here, we report 10 cases of FOXP3(þ) PTCL-NOS with Treg phenotype. The median age of the 10 cases was 65 (59–80 years) and all of the patients were male. At the time of diagnosis, 7 patients (78%) had lymphadenopathy including 5 with extranodal involvement, and 2 (22%) had localized disease of the extranodal sites. Seven patients (78%) showed stage III/IV disease, and 5 (55%) were categorized as high-intermediate/high-risk group according to IPI. All cases were negative for HTLV-1 antibody in sera. Immunostaining pattern for CD4 and CD25 was as follows: CD4þCD25þ n ¼ 4; CD4þCD25- n ¼ 3; CD4-CD25þ n ¼ 3). Eight cases were positive
S101
for TCRb, and all of the cases were negative for cytotoxic molecule (GranzymeB, TIA-1 and Perforin). Survival data were available for 8 cases; 4 patients died of disease (within 5 months in 3), 1 patient died of therapy-related infection, and 3 patients were alive (2 patients were under first-line treatment). In conclusion, PTCL-NOS with Treg phenotype is rare, and might have aggressive clinical course.
Hematopathology: Poster#199 HEMATOPATHOLOGIC FEATURES OF LARGE GRANULAR LYMPHOCYTIC LEUKEMIA Liu En Bin, Ru Kun, Zhang Pei Hong, Li Zhan Qi, Sun Qi, Zhang Hong Ju, Yang Qing Ying, Sun Fu Jun, Ma Yue and Xian Mu Department of Hematopathology, Hospital of Blood Diseases, Chinese Academy Medical Sciences (CAMS) and Peking Union Medical College, China Aim: To explore the hematopathologic features of large granular lymphocytic leukemia (LGLL). Methods: Peripheral blood smears, bone marrow aspirates and bone marrow biopsies were studied. Immunophenotypic analysis was carried out by flow cytometry. T-cell receptor g gene rearrangement was studied by PCR method. Results: Of 38 patients, 25 were T-LGLLs and 13 were NKLGLLs. Large granular lymphocytes (LGLs) were observed in 24 of 38 (63.2%) peripheral blood smears and 21 of 38 (55.3%) bone marrow aspirate specimens. The most frequent pattern of lymphoid distribution in bone marrow sections was interstitial (25/25 in T-LGLLs and 11/13 in NK-LGLLs, respectively) and intravascular distribution was seen in 10 cases of T-LGLLs. Flow cytometry showed an immunophenotype of CD3þ CD4- CD8þ CD56CD57þ of the tumor cells in 19 cases of T-LGLLs (19/25). The immunophenotype of NK-LGLLs was CD2þ sCD3- CD4- CD56þ CD57-. Clonal T-cell receptor g gene rearrangement by PCR was detected in 16 cases of T-LGLLs (16/25), while a germline configuration was revealed in all the NK-LGLL cases. Discussion: Hematopathologic features of most LGLLs are distinct. Morphologic, immunophenotypic and molecular analysis of both peripheral blood and bone marrow specimens are essential and complementary in the diagnosis and differential diagnosis of LGLLs.
Hematopathology: Poster#200 HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS – AN UNUSUAL PRESENTATION OF TUBERCULOSIS IN HEMODIALYSIS PATIENTS Sindhura Lakshmi Koulmane Laxminarayana1, Shankar Prasad Nagaraju2, Ravindra Attur Prabhu2, Rajeevalachana Parthasarathy2, Chethan Manohar3 and Brahmaiah Chari1 1Department of Pathology, Melaka Manipal Medical College, Manipal University, 2Department of Nephrology, Kasturba Medical College, Manipal, Manipal University, and 3Department of Pathology, Kasturba Medical College, Manipal, Manipal University, Karnataka, India We report a series of three patients with end stage renal disease on maintenance hemodialysis presenting with hemophagocytic
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Conclusions: Eight miRNAs are aberrantly expressed in PTCLNOS, which might be involved in the molecular regulation in the pathogenesis of PTCL-NOS; the underlying mechanism is relevant to many target genes and complicated signaling pathways.
Hematopathology: Poster#197 FOLLICULAR LYMPHOMA IN SITU PRESENTING AS DERMATOPATHIC LYMPHADENOPATHY (A CASE REPORT) Nnamdi Orah1, Uche Igbokwe2, Akinde Ralph1 and Adekunbiola Banjo1 1Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital, Lagos, Nigeria, and 2Department of Cellular Pathology, Queen’s Hospital, Romford, United Kingdom Introduction: Follicular lymphoma in situ (FLIS) is a recently described entity with few cases recognized worldwide. To our knowledge, this is the first FLIS reported from West Africa. Case presentation: We present the case of a 48-year-old civil servant with axillary lymphadenopathy discovered on routine mammography. On histology, a predominant reactive change with aggregates of melanophages was seen, prompting a diagnosis of reactive dermatopathic lymphadenopathy. Immunohistochemistry revealed secondary follicles with germinal centres that were variably colonised by small CD 10 and Bcl-6 positive cells that also overexpressed Bcl-2. The involved follicles had a low proliferation fraction as determined by Ki67. S100 stained the increased numbers of inter-follicular dendritic cells. These features indicated an intra-follicular neoplasia/in situ follicular lymphoma. Conclusion: This highlights the use of immunohistochemistry in lymph node pathology, a resource which is very limited in SubSaharan Africa.
Hematopathology: Poster#198 FOXP3(þ) PTCL-NOS: A CLINICAL AND PATHOLOGICAL ANALYSIS OF 10 CASES Akira Satou1, Seiichi Kato1, Naoko Asano2 and Shigeo Nakamura1 1Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan, and 2Department of Clinical Laboratory, Nagano Prefectural Suzaka Hospital, Suzaka, Japan Treg phenotype of CD4þCD25þFOXPþ was almost exclusively reported in ATLL. However, this phenotype has not been well addressed on PTCL-NOS, because of the rarity, and its clinicopathological characteristics still remain unknown. Here, we report 10 cases of FOXP3(þ) PTCL-NOS with Treg phenotype. The median age of the 10 cases was 65 (59–80 years) and all of the patients were male. At the time of diagnosis, 7 patients (78%) had lymphadenopathy including 5 with extranodal involvement, and 2 (22%) had localized disease of the extranodal sites. Seven patients (78%) showed stage III/IV disease, and 5 (55%) were categorized as high-intermediate/high-risk group according to IPI. All cases were negative for HTLV-1 antibody in sera. Immunostaining pattern for CD4 and CD25 was as follows: CD4þCD25þ n ¼ 4; CD4þCD25- n ¼ 3; CD4-CD25þ n ¼ 3). Eight cases were positive
S101
for TCRb, and all of the cases were negative for cytotoxic molecule (GranzymeB, TIA-1 and Perforin). Survival data were available for 8 cases; 4 patients died of disease (within 5 months in 3), 1 patient died of therapy-related infection, and 3 patients were alive (2 patients were under first-line treatment). In conclusion, PTCL-NOS with Treg phenotype is rare, and might have aggressive clinical course.
Hematopathology: Poster#199 HEMATOPATHOLOGIC FEATURES OF LARGE GRANULAR LYMPHOCYTIC LEUKEMIA Liu En Bin, Ru Kun, Zhang Pei Hong, Li Zhan Qi, Sun Qi, Zhang Hong Ju, Yang Qing Ying, Sun Fu Jun, Ma Yue and Xian Mu Department of Hematopathology, Hospital of Blood Diseases, Chinese Academy Medical Sciences (CAMS) and Peking Union Medical College, China Aim: To explore the hematopathologic features of large granular lymphocytic leukemia (LGLL). Methods: Peripheral blood smears, bone marrow aspirates and bone marrow biopsies were studied. Immunophenotypic analysis was carried out by flow cytometry. T-cell receptor g gene rearrangement was studied by PCR method. Results: Of 38 patients, 25 were T-LGLLs and 13 were NKLGLLs. Large granular lymphocytes (LGLs) were observed in 24 of 38 (63.2%) peripheral blood smears and 21 of 38 (55.3%) bone marrow aspirate specimens. The most frequent pattern of lymphoid distribution in bone marrow sections was interstitial (25/25 in T-LGLLs and 11/13 in NK-LGLLs, respectively) and intravascular distribution was seen in 10 cases of T-LGLLs. Flow cytometry showed an immunophenotype of CD3þ CD4- CD8þ CD56CD57þ of the tumor cells in 19 cases of T-LGLLs (19/25). The immunophenotype of NK-LGLLs was CD2þ sCD3- CD4- CD56þ CD57-. Clonal T-cell receptor g gene rearrangement by PCR was detected in 16 cases of T-LGLLs (16/25), while a germline configuration was revealed in all the NK-LGLL cases. Discussion: Hematopathologic features of most LGLLs are distinct. Morphologic, immunophenotypic and molecular analysis of both peripheral blood and bone marrow specimens are essential and complementary in the diagnosis and differential diagnosis of LGLLs.
Hematopathology: Poster#200 HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS – AN UNUSUAL PRESENTATION OF TUBERCULOSIS IN HEMODIALYSIS PATIENTS Sindhura Lakshmi Koulmane Laxminarayana1, Shankar Prasad Nagaraju2, Ravindra Attur Prabhu2, Rajeevalachana Parthasarathy2, Chethan Manohar3 and Brahmaiah Chari1 1Department of Pathology, Melaka Manipal Medical College, Manipal University, 2Department of Nephrology, Kasturba Medical College, Manipal, Manipal University, and 3Department of Pathology, Kasturba Medical College, Manipal, Manipal University, Karnataka, India We report a series of three patients with end stage renal disease on maintenance hemodialysis presenting with hemophagocytic
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.