Bone Marrow Biopsy Focal involvement by small B-cell neoplasm without significant plasmacytic...
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Transcript of Bone Marrow Biopsy Focal involvement by small B-cell neoplasm without significant plasmacytic...
Bone Marrow Biopsy
Focal involvement by small B-cell neoplasm without significant plasmacytic differentiation (CD3-, CD20+, PAX5+, kappa IHC-, lambda IHC-, CD5-, CD10-, BCL6-, BCL2+, cyclin D1-, IgD-, Ki67 low)
Courtesy of T Pongpruttipan, MD.
Review of Colonic Polyp Biospy Tissue
HE
CD20
HE HE
Courtesy of T Pongpruttipan, MD.
Final Pathological Diagnosis
Involvement by small B-cell lymphoid neoplasm with CD10+, BCL2+, BCL6- phenotype. No evidence of large cell involvement.
Some small and large cells showed large aggregates with infiltrative growth pattern.
IMP: follicular lymphoma with focus of large cell transformation
DDx DLBCL with accompanying follicular lymphoma Follicular lymphoma, grade 3/3 (focal) in the
background of follicular lymphoma, low grade
Colorectal Lymphoma
A type of extranodal lymphoma involving GI tract
Primary GI lymphoma Stomach 40-50% Small bowel 20-30% Colon and rectum
10-20%
Primary GI lymphoma No palpable, superficial LN No enlarged mediastinal LN
on CXR Normal WBC (No and
differential count) Only regional LN involved No involvement of liver and
spleen
Dawson IM, et al. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg 1961;49:80-9.
Staging of Lymphoma
Musshoff Modifications to Ann Arbor Staging System for Extranodal Lymphoma
Stage
I or IE Single lymphatic organ or extranodal site
II Two or more lymphatic regions on the same site of the diaphragm or a single extranodal organ and lymph node involvement at the same site of diaphragm
II1 Regional lymph node involved
II2 Distant lymph node involved
III Lymph node involved on both sides of diaphragm
IV Disseminated disease with involvement of bone marrow, liver, etc
Musshoff K. Strahlentherapie 1977;153:218-21.
Boot H. Best Pract Res Clin Gastroenterol 2010;24(1):3-12.
Common Types in Colorectal NHL
DLBCL 60% de novo Transformation from
CLL, follicular lymphoma, MALT
MALT 15%% Burkitt 15
Recent report from Terada T, Japan 37 cases of GI
lymphoma M:F 20:17 Median age 69 yr (46-
89) Types
Gastric 25 (68%) Small bowel 6 (16%) Colon 6 (16%)
Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012;2(3):194-200.
Gastrointestinal Lymphoma
Types B-cell 35 (95%) T-cell 2 (5%)
Gastric NHL 25 DLBCL 11 MALT 14
Small intestine DLBCL 4 PTCL 2
Colon 6 DLBCL 5 FL 1
Clinical diagnosis of colon NHL at first GIST 1 Colon carcinoma
4 Colon polyp 1
No cases of Hodgkin lymphoma Burkitt lymphoma Mantle cell lymphom
Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012;2(3):194-200.
Primary FL of GI tract:Massachusetts General Hospital, 1995-2010
Excluded cases History of FL outside
GI tract Widespread
lymphoma Distant nodal disease
within 6 months Multifocal diseases Splenic involvement FL in transformation
Misdraji J, et al. Primary follicular lymphoma of the
gastrointestinal tract. Am J Surg Pathol 2011;35:1255-63.
Presenting Symptoms/ Finding
Symptoms Abdominal pain and
nausea, vomiting (12), bowel obstruction
Intussuspection (1) Incidental finding (13)
on investigation of Reflux symptoms or
Barrett esophagus Screening for
colorectal cancer Resection of sigmoid
carcinoma
Macroscopic findings White patches or
plaques Mucosal nodularity or
granularity Nodules Polyp (1, 2, 3) Submucosal mass Thickening of wall or
folds
Misdraji J, et al. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol 2011;35:1255-63.