The Morphology Illusion Lymphoma Cases Presentation Dr Hebah Ali - - PowerPoint PPT Presentation
AP 17 Oc to b e r 2018 De a d Se a , Jo rda n XXXI I Co ng re ss o f the I The Morphology Illusion Lymphoma Cases Presentation Dr Hebah Ali Consultant Haematopathologist Haematological Malignancy Diagnostic Service Leeds,
XXXI I Co ng re ss o f the I AP 17 Oc to b e r 2018 De a d Se a , Jo rda n
Dr Hebah Ali Consultant Haematopathologist Haematological Malignancy Diagnostic Service Leeds, UK
“T he S un S e ts S ail” Painting by Ro b Go nsalve s
Wa ng e t a l Ho dg kin's lympho ma o f the thyro id: a c linic o pa tho lo g ic study o f five c a se s a nd re vie w o f the lite ra ture . Mo d Pa tho l. 2005
CD30 CD30 IRF 4 IRF 4 CD15 CD15 Pa x5 Pa x5 L MP1 L MP1 CD5 CD5 CD4 CD4 GRANZ GRANZ CD3,2,8,7 - CD3,2,8,7 - CD20,79,138- CD20,79,138- AL K1 - AL K1 -
Cla ssic a l Hodg kin Ana pla stic L a rg e Ce ll HRS CD15 + Ag e T
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Site Pa x5- L MP1- T CA+ Cyto to xic + AL K
CD15 + Mo rpho lo g y
Ve nka ta ra ma n e t a l Ab e rra nt T
Asa no e t a l , Cyto to xic mo le c ule -po sitive c HL : a c linic o pa tho lo g ic a l c o mpa riso n with c yto to xic mo le c ule -po sitive PT CL NOS type . Ha e ma to lo g ic a . 2011
DUSP22/ IRF 4 (re d/ g re e n)
T CR g a mma multiple x PCR a na lysis sug g e sts pa uc ity of T c e ll ta rg e ts
Clona l re a rra ng e me nts we re ide ntifie d
Clona l re a rra ng e me nts we re ide ntifie d
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T issue b io psie s in L e e ds HMDS [2014-2018]
Ma ra fio ti e t a l Ho dg kin a nd re e d-ste rnb e rg c e lls re pre se nt a n e xpa nsio n o f a sing le c lo ne o rig ina ting fro m a g e rmina l c e nte r B-c e ll with func tio na l immuno g lo b ulin g e ne re a rra ng e me nts b ut de fe c tive immuno g lo b ulin tra nsc riptio n. Blo o d. 2000
‘ I n summa ry, c la ssic a l HD is a B-c e ll ne o pla sm in ne arly all insta nc e s.’
CD21 CD21 CD3 CD3 CD68 CD68
Ki- 67 in c yc le Ki- 67 in c yc le CD10- CD10- CD20 CD20 CD79a + CD79a + BCL 6 BCL 6 IRF 4 IRF 4
Bre a k- a pa rt C - MYC F ISH C- MYC/ IGH (re d/ g re e n)
Bre a k- a pa rt F ISH
Se sq ue s P, Jo hnso n NA. Appro a c h to the dia g no sis a nd tre a tme nt o f hig h-g ra de B-c e ll lympho ma s with MYC a nd BCL 2 a nd/ o r BCL 6 re a rra ng e me nts. Blo o d. 2017. Swe rdlo w SH e t a l. WHO c la ssific a tio n o f tumo urs o f ha e ma to po ie tic a nd lympho id tissue s. L yo n, F ra nc e : I ARC Pre ss, 2017
Shi M e t a l. F ive impo rta nt a dva nc e s in he ma to pa tho lo g y. Arc h Pa tho l L a b Me d. 2014. Re vie w.
Auto e-mail notification & MDT listing Auto e-mail notification & MDT listing
Auto request of FISH (3d TAT) Auto request of FISH (3d TAT) Auto request extended-B IHC panel (1d TAT) Includes: CD10 BCL6 BCL2 ● Does NOT include C-MYC Auto request extended-B IHC panel (1d TAT) Includes: CD10 BCL6 BCL2 ● Does NOT include C-MYC HE morphological screening by senior BMS Reporting by pathologist Updating by clinical scientist DLBCL and variants DLBCL and variants High grade B-cell lymphoma, further tests awaiting High grade B-cell lymphoma, further tests awaiting High grade B-cell lymphoma bcl-2 negative, further tests awaiting High grade B-cell lymphoma bcl-2 negative, further tests awaiting C-MYC C-MYC C-MYC, BCL2 & BCL6 C-MYC, BCL2 & BCL6 Immuno-profile, COO, FISH results Immuno-profile, COO, FISH results 11q testing 11q testing BCL2 & BCL6 testing BCL2 & BCL6 testing C-MYC -ve C-MYC -ve All three -ve All three -ve C-MYC +ve C-MYC +ve Any combination +ve Any combination +ve
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Painting by Ro b Go nsalve s