From: Brent Dorsett (brentd@nyct.net)
Date: Mon Apr 27 1998 - 15:41:30 EST
We had a biopsy of an isolated groin mass, blocking lymphatic drainage, in a 43 year old male. Histologically, this mass was composed of many small lymphoid nodules in subcutaneous fat. The nodules, at low magnification, look almost like granulomas, but are composed only of small lymphocytes around larger lymphoid cells. The smaller cells stain intensely for CD79a and CD20. The larger cells stain lightly for CD20 and little, if any for CD79a. There are numerous scatted CD3+ cells throughout the nodules. The area between the nodules is largely composed of CD3+CD5+ small lymphocytes. In flow cytometry, we saw a single population of small to medium sized cells of low granularity and bright CD45 expression. These cells had the following immunophenotype: CD3 44%, CD4 40%, CD8 4%, CD5 44%, CD19 55%, CD10 neg, CD22 56%, CD23 30%, CD20 53%, kappa 22%, Lambda 10%. There was no coexpression of CD5 and CD19. There was a bimodal expression of CD19 amd CD20. The cells with moderately bright CD19 and CD20 expressed CD23 and light chains, without any sign of restriction. The bright CD19/20 population ( 28%) is CD23 negative and had no detectable surface light chains. We performed PCR for detection of clonal rearrangements of the immunoglobulin heavy chain ( semi-nested FR3A by LJH and VLJH ). The results showed no evidence of clonality. So whats the problem? Well If you looked at this lesion you would definitely think lymphoma, but there are no signs of further involvement and the flow is consistent with reactive, except for the lack of surface Ig on the CD19/20 bright cells. If those cells are transformed, I don't see how we could have missed them in PCR. What do you think is the significance of the CD19/20 bright cells without surface Ig. There seems to be a distinct conflict between histologic appearance and the usual probes for clonality. Any suggestions would be appreciated. Brent Dorsett Cancer Research Group Lenox Hill Hospital - NYC
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