CPC 28102019 - Follicular Lymphoma

1. CPC Session
28/10/2019

2. Patient details
• Male 59 years
• Hospital No: 1627484
• Biopsy no: 2811/19
• Clinical Diagnosis : ?Lymphoma
• Nature of Specimen : Left inguinal lymph node
.

3. Gross Features
• Received a single nodular grey white soft
tissue mass measuring 2 x 1.5 x 1cm.
• External surface showed mild congestion.
• Cut surface showed pale white nodular areas.

4. Microscopic Features
Lymph node architecture effaced by
a neoplasm arranged as vague
nodules
Normal lymph node architecture

5. Microscopic Features
Neoplasm infiltrating the perinodal adipose tissue.

6. Is it
Hodgkin’s or Non-Hodgkin(NH)’s
Lymphoma?
The lymph node architecture is effaced by variable
numbers of Reed-Sternberg (HRS) cells admixed with
a rich inflammatory background.
This classic Reed-Sternberg cell is
binucleated, with prominent
eosinophilic nucleoli, producing the
so-called owl's eye appearance.

7. Microscopic Features
Neoplasm with follicular and diffuse architecture
Follicular
architecture
Diffuse
architecture

8. Microscopic Features
Follicular areas Diffuse areas

9. Is it B-cell or T-cell NH lymphoma?
Immunohistochemistry Type of lymphoma
CD3+, CD20- T-cell NH lymphoma
CD3-, CD20+ B-cell NH lymphoma

10. B-cell NH Lymphoma
Differential Diagnosis
– Follicular lymphoma
– Mantle cell lymphoma
– Marginal zone lymphoma

11. Cell morphology in NH Lymphoma

12. Microscopic Features
Intermediate sized neoplastic cells with moderate clear to eosinophilic cytoplasm
and angular vescular nuclei devoid of nucleoli

13. Microscopic Features
Proliferation of capillary sized vessels

14. Impression
Biopsy of left inguinal lymph node
showing
histopathological features of
Non-Hodgkin’s Lymphoma.
Possibilities considered are : -
1. Mantle cell Lymphoma
2. Diffuse Large B-cell Lymphoma
Immunohistochemistry is required for confirmation.

15. Differential Diagnosis
Nodal marginal zone lymphoma
Lymphoma with follicular growth
pattern with pale cells that focally
surround portions of reactive
germinal centres.
Lymphoma composed of a proliferation
of small cells growing between a reactive
germinal centre and an attenuated mantle
zone.

16. Differential Diagnosis
Diffuse Large B-cell Lymphoma
Diffuse large B-cell lymphoma
(centroblastic monomorphic)
Neoplastic cells have a polymorphic and
multilobated appearance

17. Immunohistochemistry
IHC Marker Result
CD3 Non-immunoreactive, score 0 in neoplastic cells
CD20 Immunoreactive, score 4+ in neoplastic cells
CD21 Non-immunoreactive, score 0 in neoplastic cells.
Highlights follicular dendritic meshwork.
BCL-6 Immunoreactive, score 4+ in neoplastic cells
BCL-2 Immunoreactive, score 4+ in neoplastic cells
Score 4+ => Immunoreactive in 76-100% of cells
Impression : Follicular Lymphoma

18. Follicular lymphoma grading

20. Final Impression
Follicular Lymphoma Grade 2 with follicular
and diffuse architecture