ANSWER TO KCIAPM CYTOLOGY SLIDE SEMINAR JULY 2014

1. Case 3
15y/boy presented with on and off
abdominal pain of 6months and a mass
felt to the left of umbilicus. USG FNA of
the mass done.

11. 1. GCT
2. GCT with Embryonal Carcinoma
3. GCT/ALCL
4. Testicular GCT
5. Pleomorphic Adenocarcinoma-Pancreas
6. HCC
7. High Grade Malignant Tumour
8. ALCL, GCT

14. Review smears - Poorly differentiated
tumour
Adv. Repeat test at KMIO
Poorly differentiated tumour - ?GCT,
?ALCL
Case will be reviewed after workup

15. H’gram – Nml
Biochemistry – Nml LDH – 1674 ( 450-N)
Tumour markers – AFP, β-HCG – within Nml
HBsAg & HIV – Non-reactive
USG Abdomen – Enlarged multiple abdominal
mesenteric lymphnodes, largest 3x4x2.5cm
(FNA node) with mild splenomegaly.
Scrotal scan – NAD
No peripheral Lymphadenopathy
Advised IHC on cell block
Lymphnode Biopsy done

18. LCA

19. CD3 CD20
CD30

20. ALK+

21. PAX5 CD34
CD138

22. MUM1

23. Kappa Lamda
Ki67

24. EMA

25. CD4

26. A young boy,
Abdnominal lymphnodes++,
Non- immunocompramised,
H&E- high grade lesion.

27. IHC
LCA+ CD20-
CD3- CD30-
EMA+ CD34-
CK- CD4 +
ALK+(Granular) LMP1-
CD68- LMP1 ?
CD138- MUM1+
Kappa+ Lamda-
Ki67-65% Pax5 focal+

28. DIAGNOSIS

29. FINAL DIAGNOSIS
ALK Positive Diffuse Large B- Cell Lymphoma

30. ALK Positive Diffuse Large
• B- Cell Lymphoma
•1997 – Delsol workers – Delsol’s Tumour
•Median Age – 36yrs. Paed. – 30%
•High Stage Nodal Disease.
•No Assoc. with immunosuppression
•Poor prognosis – 11months

31. MORPH: Immunoblastic/plasmablastic,
Sinusoidal infiltration,
Appear deceptively cohesive – D/D Ca
IHC: LCA + 75%, CD+ 3% (weak & focal)
CD79a+ 16%, EMA+ 100%,
CD30+ 6% (weak & focal)

32. IHC contd
ƛ/ƙ+ 90% (IgA), CD138+/-, CD4+ 64%,
CD57+ 40%, CK+ rare,
ALK+ usually granular cytoplasm
Cytg: t(2:17)(q23;q23) – Fusion of CLTC
(clathrin) gene with ALK gene
t(2:5)(q23;q35)(NPM:ALK) – Rare
EBV – Neg.

33. NEOPLASIA
ALK-positive diffuse large B-cell lymphoma is
associated with Clathrin-ALK rearrangements:
report of 6 cases
Randy D. Gascoyne, Laurence Lamant, Jose I. Martin-Subero,
Valia S. Lestou, Nancy Lee Harris, Hans-Konrad Mu¨ ller-Hermelink,
John F. Seymour, Lynda J. Campbell, Douglas E. Horsman,
Isabelle Auvigne, Estelle Espinos, Reiner Siebert, and Georges Delsol
Blood. 2003;102:2568-2573

34. American Journal Clinical Pathology
(2011) Clinical Pathology, 136, 183-194.
Plasmablastic Lymphoma and
Related Disorders
Eric D. Hsi, MD1, Robert B. Lorsbach, MD, PhD2,
Falko Fend, MD3 and Ahmet Dogan, MD, PhD4
+Author Affiliations
1From the Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH;
Department of Pathology, University of Arkansas for Medical Sciences, Little
Rock; 3Institute of Pathology, University Hospital Tuebingen, Eberhard-Karls
University, Tuebingen, Germany and 4Department of Laboratory Medicine a
and Pathology, Mayo Clinic, Rochester, MN