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History: 57 yo woman who presented with a high grade non-Hodgkin's
lymphoma involving an axillary lymph node that was eventually read as small
non-cleaved non-Burkitts. The spleen, liver and bone marrow were involved.
The malignant cells in the bone marrow were classic for small non-cleaved
(even classic for Burkitts). The cells in the lymph node were obviously
high grade but the pathologist signing out the node was leaning towards
Large cell lymphoma untill I showed him the bone marrow. We never got to
immunophenotype the cells before she was blasted with heavy duty
chemotherapy. The bone marrow became hypocellular with few B-cells and
remained so. There was a good response but then the patient relapsed in the
CNS.
Now she has 8 % tumor cells in the peripheral blood. They are + for
lambda light chains, CD19, CD20, CD22, CD38, HLADR, and CD10(very dim). Now
the unusual part- they are also CD5+, dim CD45 (like an ALL or AML), CD36+
(Fairly bright), very dim CD15+ and have heterogeneous expression of CD16
(approximately 50% +CD16).
I'm not sure this is a small non-cleaved lymphoma anymore. One of
my smartest friends suggested this might have been a CLL that transformed
before diagnosis. What do you think?
Maryalice
Maryalice Stetler-Stevenson
Director Flow Cytometry Unit
Laboratory of Pathology, NCI, NIH
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