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Unusual immunophenotypic expressions of plasma cell neoplasm: a potential diagnostic pitfall
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PATHOLOGY 2011 ABSTRACT SUPPLEMENT
invasive carcinoma or designated as ‘papillary lesions’ along with benign intraduct papillomas and invasive papillary carcinomas. The anatomical pathology department at St Vincent’s Hospital extracted all breast FNB cases from its database over a 6 year period which had been reported as suggestive of intraduct carcinoma on fine needle biopsy and had surgical follow up. The cases of solid papillary intraduct carcinoma were analysed using a worksheet of cytological diagnostic criteria for low and intermediate grade intraduct carcinoma. This worksheet was designed based on criteria extracted from the literature in combination with diagnostic criteria used at St Vincent’s Hospital. Cytological criteria predictive for solid papillary intraduct carcinoma were analysed and will be discussed. These criteria include ‘glomeruloid’ capillary loops, high cellularity, moderate nuclear atypia and marked single cell dispersal. DETECTION OF MONOCLONAL IMMUNOGLOBULIN AND T CELL RECEPTOR GENE REARRANGEMENTS – THE UPS AND DOWNS OF FRAGMENT ANALYSIS Pamela J. Sykes, Duncan A. Holds, Naomi Macmillan, Bryone J. Kuss, Lesley E. Snell Department of Molecular Pathology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia Immunoglobulin and T cell receptor gene rearrangements can be helpful in identifying monoclonal populations of lymphoid cells in tissue samples. This information can then be used in association with clinical and other laboratory findings to aid in the differential diagnosis of lymphoid malignancies. The gene rearrangements can be detected using polymerase chain reaction (PCR) with analysis by gel electrophoresis. The limited resolution of gel electrophoresis can make interpretation highly subjective and monoclonality in duplicate reactions should be verified by a more accurate method, for example by sizing the PCR products using capillary electrophoresis and fragment analysis software (þ/– 1 base pair). This method can provide assurance that monoclonal populations are consistent in replicate samples. However, this approach can provide information about other lesser clonal populations which can complicate interpretation. Our experience indicates that it is important not to over-interpret this extra information. Specific examples will be presented.
Pathology (2011), 43(S1)
correlation with the past history of a myeloma followed by a subsequent supraclavicular mass biopsy revealing better preserved plasma cells with similar CD3 expression. Awareness of the ability of neoplastic plasma cells in expressing both B and T cell antigens in addition to careful light microscopic examination, performance of a panel of immunohistochemistry stains and correlation with clinical history is pivotal in establishing the correct diagnosis. CHILDHOOD INTRAMUSCULAR LIPOMA WITH A NOVEL THREE WAY TRANSLOCATION. A CASE REPORT Hui Sien Tay, Alan E. Mills Department of Anatomical Pathology, Bendigo Health Pathology Services, Bendigo, Vic, Australia Lipomas are common benign adipocyte tumours of adults, and frequently exhibit clonality, with karyotypic anomalies occurring in approximately two-thirds of adult cases. In contrast, lipomas are exceptionally rare in childhood. We describe an intramuscular lipoma in the back of a healthy 5-year-old boy, with the initial MRI examination showing features suspicious of rhabdomyosarcoma. An incisional biopsy and a subsequent excisional biopsy were performed and both confirmed the lesion to be a lipoma. Cytogenetic analysis demonstrated a three way translocation involving chromosomes 8q12, 17q25 and 13q14. The 8q11–13 breakpoints are common in lipoblastomas, but are rare in lipomas. It has been postulated that rearrangements involving this chromosomal breakpoint is associated with up-regulation of the PLAG1 gene. The 13q14 breakpoint is associated with a subset of lipomas, usually involving deletion of material from 13q with a minimal region of deletion identified in band 13q14. Our patient’s karyotype does not show a visible deletion, therefore a molecular technique would be required to investigate the possibility of submicroscopic deletion or rearrangement at this site. Lipomas in childhood are known to occur as part of the Bannayan-Riley-Ruvalcaba syndrome and Aicardi syndrome. Our patient is a normal, healthy 5-year-old child. MATERNAL DEATHS IN THE GREATER AUCKLAND REGION OVER A 10 YEAR PERIOD
UNUSUAL IMMUNOPHENOTYPIC EXPRESSIONS OF PLASMA CELL NEOPLASM: A POTENTIAL DIAGNOSTIC PITFALL
Daniela Vogel, Simon Stables Department of Forensic Pathology, Labplus, Auckland City Hospital, Auckland, New Zealand
Y. L. Tang, C. Y. P. Chau, C. N. L. Rao, W. M. Yap, K. L. Chuah Department of Pathology, Tan Tock Seng Hospital, Singapore
Introduction: A maternal death is one occurring between conception and 42 days of termination of pregnancy, and excludes coincidental deaths. Maternal deaths can be divided into direct and indirect deaths. Aims: To determine the number of maternal deaths and review the causes of death in coronial autopsy cases in the greater Auckland region from 2000 to 2010. Methods: A computerised search for maternal deaths and deaths in pregnancy was performed using the departmental database. Information recorded included demographic data, body mass index, gestational age and cause of death. The cases were divided into direct, indirect and co-incidental deaths based on autopsy findings and clinical circumstances. Late maternal deaths were not included. Results: A total of 30 maternal deaths, 18 direct and 12 indirect; and 7 co-incidental deaths were identified. The most common
A histological diagnosis of a plasma cell neoplasm is usually straightforward. We highlight two instances where the diagnosis of a plasma cell neoplasm was challenging due to unusual immunophenotypic expressions of the tumour, potentially mimicking a lymphoma. In the first case, a 68-year-old man presented with a neoplasm affecting T3-T5 of the spinal cord. On histology, the excised tumour disclosed a proliferation of malignant plasma cells with diffuse CD20 and cyclin D1 expressions, simulating a mantle cell lymphoma. In the second case, a 67-year-old Chinese man presented with gastric and duodenal tumour nodules. Superficial biopsy of the nodules disclosed poorly preserved large neoplastic cells in the lamina propria which resembled lymphoid cells and stained for CD3. A diagnosis of myeloma was only apparent after
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
PATHOLOGY 2011 ABSTRACT SUPPLEMENT
invasive carcinoma or designated as ‘papillary lesions’ along with benign intraduct papillomas and invasive papillary carcinomas. The anatomical pathology department at St Vincent’s Hospital extracted all breast FNB cases from its database over a 6 year period which had been reported as suggestive of intraduct carcinoma on fine needle biopsy and had surgical follow up. The cases of solid papillary intraduct carcinoma were analysed using a worksheet of cytological diagnostic criteria for low and intermediate grade intraduct carcinoma. This worksheet was designed based on criteria extracted from the literature in combination with diagnostic criteria used at St Vincent’s Hospital. Cytological criteria predictive for solid papillary intraduct carcinoma were analysed and will be discussed. These criteria include ‘glomeruloid’ capillary loops, high cellularity, moderate nuclear atypia and marked single cell dispersal. DETECTION OF MONOCLONAL IMMUNOGLOBULIN AND T CELL RECEPTOR GENE REARRANGEMENTS – THE UPS AND DOWNS OF FRAGMENT ANALYSIS Pamela J. Sykes, Duncan A. Holds, Naomi Macmillan, Bryone J. Kuss, Lesley E. Snell Department of Molecular Pathology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia Immunoglobulin and T cell receptor gene rearrangements can be helpful in identifying monoclonal populations of lymphoid cells in tissue samples. This information can then be used in association with clinical and other laboratory findings to aid in the differential diagnosis of lymphoid malignancies. The gene rearrangements can be detected using polymerase chain reaction (PCR) with analysis by gel electrophoresis. The limited resolution of gel electrophoresis can make interpretation highly subjective and monoclonality in duplicate reactions should be verified by a more accurate method, for example by sizing the PCR products using capillary electrophoresis and fragment analysis software (þ/– 1 base pair). This method can provide assurance that monoclonal populations are consistent in replicate samples. However, this approach can provide information about other lesser clonal populations which can complicate interpretation. Our experience indicates that it is important not to over-interpret this extra information. Specific examples will be presented.
Pathology (2011), 43(S1)
correlation with the past history of a myeloma followed by a subsequent supraclavicular mass biopsy revealing better preserved plasma cells with similar CD3 expression. Awareness of the ability of neoplastic plasma cells in expressing both B and T cell antigens in addition to careful light microscopic examination, performance of a panel of immunohistochemistry stains and correlation with clinical history is pivotal in establishing the correct diagnosis. CHILDHOOD INTRAMUSCULAR LIPOMA WITH A NOVEL THREE WAY TRANSLOCATION. A CASE REPORT Hui Sien Tay, Alan E. Mills Department of Anatomical Pathology, Bendigo Health Pathology Services, Bendigo, Vic, Australia Lipomas are common benign adipocyte tumours of adults, and frequently exhibit clonality, with karyotypic anomalies occurring in approximately two-thirds of adult cases. In contrast, lipomas are exceptionally rare in childhood. We describe an intramuscular lipoma in the back of a healthy 5-year-old boy, with the initial MRI examination showing features suspicious of rhabdomyosarcoma. An incisional biopsy and a subsequent excisional biopsy were performed and both confirmed the lesion to be a lipoma. Cytogenetic analysis demonstrated a three way translocation involving chromosomes 8q12, 17q25 and 13q14. The 8q11–13 breakpoints are common in lipoblastomas, but are rare in lipomas. It has been postulated that rearrangements involving this chromosomal breakpoint is associated with up-regulation of the PLAG1 gene. The 13q14 breakpoint is associated with a subset of lipomas, usually involving deletion of material from 13q with a minimal region of deletion identified in band 13q14. Our patient’s karyotype does not show a visible deletion, therefore a molecular technique would be required to investigate the possibility of submicroscopic deletion or rearrangement at this site. Lipomas in childhood are known to occur as part of the Bannayan-Riley-Ruvalcaba syndrome and Aicardi syndrome. Our patient is a normal, healthy 5-year-old child. MATERNAL DEATHS IN THE GREATER AUCKLAND REGION OVER A 10 YEAR PERIOD
UNUSUAL IMMUNOPHENOTYPIC EXPRESSIONS OF PLASMA CELL NEOPLASM: A POTENTIAL DIAGNOSTIC PITFALL
Daniela Vogel, Simon Stables Department of Forensic Pathology, Labplus, Auckland City Hospital, Auckland, New Zealand
Y. L. Tang, C. Y. P. Chau, C. N. L. Rao, W. M. Yap, K. L. Chuah Department of Pathology, Tan Tock Seng Hospital, Singapore
Introduction: A maternal death is one occurring between conception and 42 days of termination of pregnancy, and excludes coincidental deaths. Maternal deaths can be divided into direct and indirect deaths. Aims: To determine the number of maternal deaths and review the causes of death in coronial autopsy cases in the greater Auckland region from 2000 to 2010. Methods: A computerised search for maternal deaths and deaths in pregnancy was performed using the departmental database. Information recorded included demographic data, body mass index, gestational age and cause of death. The cases were divided into direct, indirect and co-incidental deaths based on autopsy findings and clinical circumstances. Late maternal deaths were not included. Results: A total of 30 maternal deaths, 18 direct and 12 indirect; and 7 co-incidental deaths were identified. The most common
A histological diagnosis of a plasma cell neoplasm is usually straightforward. We highlight two instances where the diagnosis of a plasma cell neoplasm was challenging due to unusual immunophenotypic expressions of the tumour, potentially mimicking a lymphoma. In the first case, a 68-year-old man presented with a neoplasm affecting T3-T5 of the spinal cord. On histology, the excised tumour disclosed a proliferation of malignant plasma cells with diffuse CD20 and cyclin D1 expressions, simulating a mantle cell lymphoma. In the second case, a 67-year-old Chinese man presented with gastric and duodenal tumour nodules. Superficial biopsy of the nodules disclosed poorly preserved large neoplastic cells in the lamina propria which resembled lymphoid cells and stained for CD3. A diagnosis of myeloma was only apparent after
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.