Comparative morphological analysis of paediatric double hit lymphoma to those seen in adults
The index patient had an incisional rectal biopsy initially which displayed features in keeping with a diffuse large B-cell lymphoma. The neoplastic tumour cells displaying a diffuse arrangement. The individual cells having an increased nuclear-to-cytoplasmic ratio, round nuclei with vesicular chromatin pattern and prominent nucleoli. The tumour showed CD20, BCL6, and CD10 immunopositivity was demonstrated. EBER was positive and there was patchy BCL2 staining. The case was reported as a diffuse large B-cell lymphoma. Meanwhile, fluorescence in situ hybridization (FISH) was subsequently undertaken and it confirmed a translocation in CMYC/BCLs, in keeping …show more content…
The tumour cells are large with increased nuclear-to-cytoplasm ratio. These cells showed more variability in areas, but overall much similar morphology to the incision biopsy. A diffuse arrangement of pleomorphic, large and intermediate lymphoid cells is present. A starry sky appearance of the tumour cells was not seen. The nuclei appearing large, round, having vesicular chromatic pattern, and prominent nucleoli. Mitotic figures, numerous centroblasts and immunoblasts are present within the tumour. The immunohistochemical stains demonstrated diffuse CD20 positivity, BCL6, CD10, EBER, and variable MUM-1 nuclear positivity. The Ki67 proliferative marker showed 95% positivity. Focal and patchy BCL2 staining of the tumour cells is seen. The CD3 is negative. Treatment-related change was not seen. The tumour was present at the inked circumferential resection …show more content…
Most large B-cell lymphomas have a germinal centre immunophenotype with expression of CD10 and BCL6 10 Xu et al. This was an observation seen in Aukemia et al. who found the CD10 positivity in 88% of the 122 cases, whilst BCL6 was 75% in 60 cases. Johnson et al. found that the cases were considered positive for CD10 and BCL2 if more than 30% of the neoplastic cells stained positively23 Pederson et al. This was the case observed in the index patient. Our index patient show MUM1 positivity, and this had patchy, weak, variable nuclear staining. MUM1 can be appreciated in DHL, and Aukemia et al. 31 Aukema et al found it to be positive in 17% of 69 cases. BCL2 is commonly expressed in DHL. This finding is not infrequent and corroborates the observation that BCL2 translocations are mainly found in GC type of DLBCL, and that also MYC translocations are associated with a GC molecular profile in DLBCL32 Lenz G et al, Klapper et
The index patient had an incisional rectal biopsy initially which displayed features in keeping with a diffuse large B-cell lymphoma. The neoplastic tumour cells displaying a diffuse arrangement. The individual cells having an increased nuclear-to-cytoplasmic ratio, round nuclei with vesicular chromatin pattern and prominent nucleoli. The tumour showed CD20, BCL6, and CD10 immunopositivity was demonstrated. EBER was positive and there was patchy BCL2 staining. The case was reported as a diffuse large B-cell lymphoma. Meanwhile, fluorescence in situ hybridization (FISH) was subsequently undertaken and it confirmed a translocation in CMYC/BCLs, in keeping …show more content…
The tumour cells are large with increased nuclear-to-cytoplasm ratio. These cells showed more variability in areas, but overall much similar morphology to the incision biopsy. A diffuse arrangement of pleomorphic, large and intermediate lymphoid cells is present. A starry sky appearance of the tumour cells was not seen. The nuclei appearing large, round, having vesicular chromatic pattern, and prominent nucleoli. Mitotic figures, numerous centroblasts and immunoblasts are present within the tumour. The immunohistochemical stains demonstrated diffuse CD20 positivity, BCL6, CD10, EBER, and variable MUM-1 nuclear positivity. The Ki67 proliferative marker showed 95% positivity. Focal and patchy BCL2 staining of the tumour cells is seen. The CD3 is negative. Treatment-related change was not seen. The tumour was present at the inked circumferential resection …show more content…
Most large B-cell lymphomas have a germinal centre immunophenotype with expression of CD10 and BCL6 10 Xu et al. This was an observation seen in Aukemia et al. who found the CD10 positivity in 88% of the 122 cases, whilst BCL6 was 75% in 60 cases. Johnson et al. found that the cases were considered positive for CD10 and BCL2 if more than 30% of the neoplastic cells stained positively23 Pederson et al. This was the case observed in the index patient. Our index patient show MUM1 positivity, and this had patchy, weak, variable nuclear staining. MUM1 can be appreciated in DHL, and Aukemia et al. 31 Aukema et al found it to be positive in 17% of 69 cases. BCL2 is commonly expressed in DHL. This finding is not infrequent and corroborates the observation that BCL2 translocations are mainly found in GC type of DLBCL, and that also MYC translocations are associated with a GC molecular profile in DLBCL32 Lenz G et al, Klapper et