Interesting clinical case
Maryalice Stetler-Stevenson (stetler@box-s.nih.gov)
Fri, 18 Oct 1996 09:58:46 -0400
I received a bone marrow and peripheral blood on a patient with working
diagnosis of Burkitt's lymphoma. There were many medium sized malignant
lymphoid looking cells in the specimens with very basophillic cytoplasm
containing nice lipid droplets. The nuclei had nucleoli that were a bit
prominanat and there was some variation in nuclear size so that it looked
like a small non-cleaved non-Burkitt's or "Burkitt-like in REAL
classification. There was nothing of interest in the lymphoid CD45/SSC gate
and many CD45 negative cells (the erythroid area) smearing up a bit on SSC,
as if heading into the granulocytes. These were of course the tumor cells.
The tumor cells were negative for everything ( CD19,CD10, CD20, CD22,
CD23,FMC-7, Ig, CD2, CD3, CD4, CD5, CD7, CD8, TCR alpha beta and gamma
delta, cd16, CD56, CD13, CD14, CD33, CD11b, CD15, CD36, CD64,CD71, CD61,
CD41, CD34, Glycophorin A, lysozyme, MPO,) but CD38 (bright +) and dim
HLADR. The proliferation marker M1B1 was +. TDT was very dim. They were
negative for cytoplasmic Ig, CD20 and CD3. CD79a was unsatisfactory.
We did in situ for EBV with EBER probe and all malignant cells were
positive. There were very few non-malignant cells on the slide as a
negative control but there were a few.
We had no immuno diagnosis and had to go with morphology and called
this c/w Burkitt-like lymphoma. Finally cytogenetics showed an t(8;14),
among many other cytogenetic abnormalities. The patient has responded well
to therapy.
I would like to hear if any one else has seen this in a small
non-cleaved non-Burkitt or Burkitt-like lymphoma (our final diagnosis).
Maryalice
Maryalice Stetler-Stevenson
Director Flow Cytometry Unit
Laboratory of Pathology, NCI, NIH
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