Mimics of Lymphoma in Routine Biopsies Patrick Treseler, MD, PhD - - PowerPoint PPT Presentation

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Mimics of Lymphoma in Routine Biopsies Patrick Treseler, MD, PhD - - PowerPoint PPT Presentation

Feb 02, 2023 706 likes •904 views

Mimics of Lymphoma in Routine Biopsies Patrick Treseler, MD, PhD Professor of Pathology University of California San Francisco Types of Lymphoid Hyperplasia Mixed follicular Follicular hyperplasia (B-cells) Paracortical hyperplasia

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Mimics of Lymphoma in Routine Biopsies

Patrick Treseler, MD, PhD Professor of Pathology University of California San Francisco

  • Follicular hyperplasia (B-cells)
  • Paracortical hyperplasia (T
  • cells)

(interfollicular immunoblastic hyperplasia)

  • Mixed hyperplasia

Types of Lymphoid Hyperplasia

Mixed follicular and paracortical hyperplasia

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Follicular Hyperplasia Mixed Follicular Hyperplasia and Paracortical Hyperplasia

CD3 CD20

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CD20

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The “Panel o’ Three”

(for assessment of lymphoid infiltrates)

CD20 CD3 CD21

CD20 CD3 CD21

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CD20 CD20

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CD20 CD20

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CD3 CD21

Small B-Cell Lymphomas

Basic Immunophenotypes

CD20 CD5 CD43 CD23 BCL1 BCL6 CD10

CLL/SLL + + + +

  • Mantle cell

+ + +

  • +
  • Follicular

+

  • /+
  • +

+/- Marginal +

  • /+
  • Proportion of cases positive: + >90%, +/- 50-90%, -/+ 10-50%, - <10%

Cyclin D1

The “Panel o’ Nine”

(for diagnosis of small B-cell lymphomas)

CD20 CD3 CD5 CD43 CD10 CD21 CD23 BCL-1 (cyclin D1) BCL-6

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Paracortical hyperplasia

  • Drug reaction
  • Other hypersensitivity reaction
  • Viral infection
  • Post-vaccination
  • No clear etiology

Paracortical hyperplasia

Differential diagnosis

CD3

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CD20

  • Diffuse large B-cell lymphoma, NOS
  • Classical Hodgkin lymphoma
  • T
  • cell/histiocyte-rich large B-cell

lymphoma

  • EBV+ diffuse large B-cell lymphoma
  • f the elderly
  • Peripheral T
  • cell lymphoma

Florid paracortical hyperplasia (e.g., infectious mononucleosis) can mimic:

Infectious Mono Infectious Mono

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Infectious Mono Infectious Mono CD20

“One should think twice and thrice before rendering a diagnosis of DLBCL in a patient younger than 20 years. Infectious mononucleosis in particular has to be suspected when … there are many admixed large T-cells and Waldeyer’s ring is involved.” ACL Chan & JKC Chan, 2011

Diffuse large B-cell lymphoma, in Hematopathology (Saunders/Elsevier)

CD3 Infectious Mono

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Infectious-Mono-EBER-1000X

EBV-ISH

Slide courtesy of Dr. Dan Arber, Stanford Univ.

Infectious Mono Infectious Mono CD30 Infectious Mono CD20

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CD20 (CHL)

Classical Hodgkin lymphoma

HRS Cell Immunophenotype

CD30

+ >90%

CD15

+/- ~80%

CD20

  • /+ ~20% (focal, weak)*

Oct2

  • ~60% (focal, weak)*

Pax-5

+ >90% (often focal, weak)*

CD3

  • <10%

Proportion of cases positive: + >90%, +/- 50-90%, -/+ 10-50%, - <10% *Based on data from García-Cosío et al. Mod Pathol 17: 1531; 2004

(Basic Panel for Dx of CHL)

T-cell/histiocyte-rich large BCL

CD20

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  • Large B-cells (may resemble immunoblasts, LP

cells, or HRS cells) present only as dispersed cells (<10% cells), no aggregates or sheets

  • Background cells are small lymphocytes and

histiocytes, no eos or plasma cells

  • Background small lymphs “nearly all” T
  • cells
  • No nodules typical of NLPHL
  • Most patients present with high-stage disease,

B-symptoms

T

  • cell/histiocyte-rich large BCL

Diagnostic criteria (WHO 2008)

Ratio of small to large B-cells TCHRLBCL 0.7:1 (range 0.3 – 1.5)

T

  • cell/histiocyte-rich large BCL

Boudová et al. (Blood 102: 3753; 2003)

CD30

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CD20 Pax-5 Oct-2 CD20

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“There are aggressive B-cell lymphomas, rich in reactive T-cells, in which the neoplastic cells are sparse, and are EBV-

  • positive. In such cases, the neoplastic cells

may exhibit a Hodgkin-like morphology. Such cases should not be classified as THRLBCL, and should be considered within the spectrum of EBV-positive DLBCL.” WHO Classification (2008), p. 238

EBV-ISH

EBV+ DLBCL of the Elderly Why not infectious mono? EBV uniformly present in large cells, absent or virtually absent in small cells

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CD20 Peripheral T-cell lymphoma, NOS? CD3

Follicular hyperplasia

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17 Follicular hyperplasia Follicular lymphoma

Follicular lymphoma grade 3A

BCL-2

Follicular hyperplasia Follicular lymphoma

Grade Cases Positive Grade 1 97% Grade 2 96% Grade 3A 80% Grade 3B 71% T

  • tal

91%

BCL-2 Expression in Follicular Lymphoma Guo et al. (Leukemia 19:1058; 2005)

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Densely aggregated poorly formed B-cell follicles

  • Follicular lymphoma
  • Follicular pattern mantle cell lymphoma
  • Nodular lymphocyte predominant Hodgkin

lymphoma

  • Nodular lymphocyte-rich classical Hodgkin

lymphoma

Differential Diagnosis

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References

  • Weiss LM. Lymph nodes. New York: Cambridge University Press, 2008.
  • Ioachim HL, Medeiros LJ. Ioachim’s Lymph Node Pathology, 4th ed.

Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkens, 2009.

  • Jaffe ES et al. (eds). Hematopathology. Philadelphia: Saunders/Elsevier,

2011.

  • Swerdlow SH et al (eds). WHO Classification of Tumours of

Haematopoietic and Lymphoid Tissues. Lyon, France: International Agency for Research on Cancer, 2008.

  • Boudová L et al. Nodular lymphocyte-predominant Hodgkin lymphoma

with nodules resembling T

  • cell/histiocyte-rich B-cell lymphoma:

differential diagnosis between nodular lymphocyte-predominant Hodgkin lymphoma and T

  • cell/histiocyte-rich B-cell lymphoma. Blood.

2003 Nov 15;102(10):3753-8.

  • Guo

Y et al. Low-grade follicular lymphoma with t(14;18) presents a homogeneous disease entity otherwise the rest comprises minor groups of heterogeneous disease entities with Bcl2 amplification, Bcl6 translocation or other gene aberrances. Leukemia. 2005 Jun;19(6):1058-63.