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Wang X, Wang W, Vega F, Quesada AE. Aggressive Mediastinal Lymphomas. Semin Diagn Pathol 2024; 41:125-139. [PMID: 34175178 DOI: 10.1053/j.semdp.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 11/11/2022]
Abstract
The mediastinum contains essentially all major intrathoracic organs except for the lungs. A variety of both benign and malignant tumors can involve the mediastinum, of which lymphoma is the most common malignancy. Compared to secondary mediastinal involvement by systemic lymphomas, primary mediastinal lymphomas are less common with several specific entities that are mainly confined to mediastinal lymph nodes, and/or thymus. This review will summarize the clinical, histologic, immunophenotypic and molecular genetic features of the most common and most aggressive primary mediastinal lymphomas as well as provide suggested immunohistochemistry panels and differential diagnoses.
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Affiliation(s)
- Xiaoqiong Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andres E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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2
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El Hussein S, Evans AG, Fang H, Wang W, Medeiros LJ. Unicentric Castleman Disease: Illustration of Its Morphologic Spectrum and Review of the Differential Diagnosis. Arch Pathol Lab Med 2024; 148:99-106. [PMID: 36920021 DOI: 10.5858/arpa.2022-0404-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 03/16/2023]
Abstract
CONTEXT.— Unicentric Castleman disease (UCD) is a dynamic entity with a wide spectrum of morphologic findings. UCD can be further subdivided into hyaline-vascular and mixed/plasmacytic variants. Hyaline-vascular UCD has both follicular and interfollicular (stromal) changes, and occasionally these lesions show a skewed representation of either the follicular or stromal compartments. Plasmacytosis is usually minimal in the hyaline-vascular variant. The mixed/plasmacytic variant of UCD is composed of sheets of plasma cells often associated with a variable number of follicles with regressive changes. OBJECTIVE.— To illustrate the differential diagnosis of UCD, as it is quite broad and includes lymphomas, plasma cell neoplasms, stromal neoplasms such as follicular dendritic cell sarcoma and vascular neoplasms, immunoglobulin G4-related disease, infections, and other rare lesions. An additional objective is to enhance awareness of the morphologic features of UCD in excisional and in small core-needle biopsy specimens, the latter of which may inadvertently target follicle- or stroma-rich areas, causing diagnostic challenges. DATA SOURCES.— In this review, we provide readers a concise illustration of the morphologic spectrum of UCD that we have encountered in our practice and a brief discussion of entities in the differential diagnosis. CONCLUSIONS.— UCD exhibits a broad spectrum of morphologic changes, and awareness of these morphologic variations is key to avoid misdiagnosis.
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Affiliation(s)
- Siba El Hussein
- From the Department of Pathology, University of Rochester Medical Center, Rochester, New York (El Hussein, Evans)
| | - Andrew G Evans
- From the Department of Pathology, University of Rochester Medical Center, Rochester, New York (El Hussein, Evans)
| | - Hong Fang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
| | - Wei Wang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
| | - L Jeffrey Medeiros
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
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3
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Ghezavati A, Liang CA, Mais D, Nazarullah A. Indolent T-lymphoblastic proliferation involving hepatocellular carcinoma-presentation in novel settings and comprehensive review of literature. J Hematop 2023; 16:167-175. [PMID: 38175402 DOI: 10.1007/s12308-023-00554-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/06/2023] [Indexed: 01/05/2024] Open
Abstract
Indolent T-lymphoblastic proliferation (iT-LBP) is a rare, non-clonal, extrathymic lymphoid proliferation with an immature T cell phenotype, indolent clinical course, and excellent prognosis. Although their pathogenesis is unclear, they are reported to be associated with Castleman disease, follicular dendritic cell tumors/sarcomas, angioimmunoblastic T cell lymphoma, hepatocellular carcinoma (HCC), myasthenia gravis, and acinic cell carcinoma. There are around 51 reported cases of iT-LBP in the literature. Recognition and accurate diagnosis of this entity is critical as it shares morphologic and immunophenotypic features with an aggressive malignancy-acute T cell leukemia/lymphoma (T-ALL). IT-LBP in HCC post-liver transplant and in metastatic sites has not been reported in the literature. Two case reports of patients presenting with recurrent and metastatic HCC in post-liver transplant settings are described. A 50-year-old man with an end-stage liver disease with HCC underwent liver transplant. A year later, he developed pulmonary metastasis with associated iT-LBP. A 69-year-old man underwent liver transplant for end-stage liver disease and HCC. Eighteen months later, he developed recurrent HCC in the transplanted liver and omental metastasis; both sites showed HCC with iT-LBP. iT-LBP in both patients expressed TdT, CD3, and CD4 and lacked CD34 and clonal T cell receptor gene rearrangements. On retrospective review, the pre-transplant HCC specimens lacked iT-LBP. We present two cases of iT-LBP associated with HCC in novel settings-in post-liver transplant patients and in recurrent/metastatic sites of HCC. In addition, a comprehensive literature review of clinical, histological, and immunophenotypic characteristics of reported cases of iT-LBP is presented.
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Affiliation(s)
- Alireza Ghezavati
- Department of Pathology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Christine A Liang
- Department of Pathology, South Texas Pathology Associates, San Antonio, TX, USA
| | - Daniel Mais
- Department of Pathology, University of Louisville Health, Kentucky, USA
| | - Alia Nazarullah
- Department of Pathology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
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4
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Saglam A, Singh K, Gollapudi S, Kumar J, Brar N, Butzmann A, Warnke R, Ohgami RS. Indolent T-lymphoblastic proliferation: A systematic review of the literature analyzing the epidemiologic, clinical, and pathologic features of 45 cases. Int J Lab Hematol 2022; 44:700-711. [PMID: 35577551 DOI: 10.1111/ijlh.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
An indolent T-lymphoblastic proliferation (iT-LBP) is a rare benign disorder characterized by an abnormal expansion of immature T-cells, which morphologically can mimic malignancy. Since the first case was described in 1999, dozens more have been reported in the literature. However, the epidemiologic, clinical, pathologic, and biologic features of this disease have not been well described. Here, we retrospectively reviewed all known cases reported in the literature to better understand this entity. A PubMed search up to January 2022 highlighted 25 papers describing cases/case series of iT-LBP, one of which was a case presentation in a slide workshop. Except for 9 of the cases in one of the papers, where it was evident that the number of CD3+/TdT+ cells were too few to conform with a diagnosis of iT-LBP, all papers and all the cases reported were included in the study amounting to a total of 45 cases. Clinicopathologic characteristics were analyzed using descriptive statistics and frequencies. Our analysis highlighted the previously known association with Castleman disease and Castleman-like features and underlined its association with dendritic cell proliferations in general, as well as uncovering high frequency of concurrence with hepatocellular carcinoma and autoimmune diseases, most notably myasthenia gravis, paraneoplastic pemphigus and paraneoplastic autoimmune multiorgan syndrome. Furthermore, the co-expression of CD4 and CD8 and high prevalence of extranodal disease and recurrences were other less well described features that were revealed.
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Affiliation(s)
- Arzu Saglam
- Department of Pathology, Hacettepe University, Ankara, Turkey
| | - Kunwar Singh
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Sumanth Gollapudi
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Jyoti Kumar
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Nivaz Brar
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexandra Butzmann
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Roger Warnke
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Robert S Ohgami
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
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5
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Karki NR, Arfa AS, Savage N, Kutlar A. Indolent T-Lymphoblastic Proliferation in Idiopathic Multicentric Castleman Disease. Acta Haematol 2021; 145:214-220. [PMID: 34818661 DOI: 10.1159/000520240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
Benign and polyclonal proliferation of immature T cells in a lymph node with preserved morphological architecture is called indolent T-lymphoblastic proliferation (iT-LBP). Although overall rare, they have been described in association with both benign and malignant disorders including Castleman disease. We report the first case of idiopathic multicentric Castleman disease associated with iT-LBP, all previous reports of iT-LBP in Castleman disease were unicentric. A 37-year-old-male presented with 3 months of fevers and B-symptoms and was found to have enlargement of multiple bilateral lymph node sites on both sides of diaphragm along with splenomegaly. Anemia, elevated C-reactive protein, hypoalbuminemia, and elevated interleukin-6 levels were present. Biopsy of a lymph node showed features suggestive of idiopathic multicentric Castleman disease and iT-LBP. Bone marrow biopsy was unremarkable. Siltuximab and steroids were used to treat the condition.
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Affiliation(s)
- Nabin Raj Karki
- Division of Hematology/Oncology, Augusta University, Augusta, Georgia, USA
| | | | - Natasha Savage
- Department of Pathology, Augusta University, Augusta, Georgia, USA
| | - Abdullah Kutlar
- Division of Hematology/Oncology, Augusta University, Augusta, Georgia, USA
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6
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Yuanyuan Z, Jianlan X, Yanlin Z, Xiaoge Z. Indolent T-lymphoblastic proliferation: a report of three cases. Virchows Arch 2021; 480:1121-1126. [PMID: 34482472 DOI: 10.1007/s00428-021-03184-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 01/28/2023]
Abstract
Indolent T-lymphoblastic proliferation (iT-LBP) is the extrathymic proliferation of nonclonal TdT + T cells and is typically associated with lymphoid disorders. Although one study revealed that iT-LBP occurred in angioimmunoblastic T-cell lymphoma, no other lymphoma-related cases have been reported. Here, we report three cases of concurrent iT-LBP and benign or malignant lymphoid disorders. The first patient had bilateral cervical lymph node enlargement, and the resected lymph node showed polyclonal precursor T-cells distributed between benign hyperplastic lymphoid follicles. In the second case, iT-LBP occurred in peripheral T-cell lymphoma with a follicular growth pattern, showing that precursor T-cells were distributed between neoplastic follicles composed of CD4 + and CXCL13 + T-cells. In the third case, polyclonal precursor T-cells were distributed between the neoplastic follicles of follicular lymphoma. In summary, our results indicate an association between iT-LBP and reactive lymphoid hyperplasia (case 1) and lymphoma (cases 2 and 3).
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Affiliation(s)
- Zheng Yuanyuan
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Xie Jianlan
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhang Yanlin
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhou Xiaoge
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
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7
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Abstract
Lymphoproliferative disorders comprise 50% to 60% of all mediastinal malignancies in both children and adults. Primary mediastinal involvement is rare (∼5%), whereas secondary mediastinal involvement by systemic disease is more common (10% to 25%). Primary mediastinal disease is defined as involvement by a lymphoproliferative disorder of mediastinal lymph nodes, the thymus, and/or extranodal mediastinal organs without evidence of systemic disease at presentation. In this review, the clinical, radiologic, histopathologic, immunohistochemical, and genetic features of some of the most characteristic mediastinal lymphoproliferative disorders are presented. The entities discussed here include: classic Hodgkin lymphoma with emphasis on nodular sclerosis and mixed cellularity types, and non-Hodgkin lymphomas, including primary mediastinal (thymic) large B-cell lymphoma, mediastinal gray zone lymphoma, mediastinal diffuse large B-cell lymphoma, thymic marginal zone lymphoma, mediastinal plasmacytoma, T-lymphoblastic lymphoma, and anaplastic large cell lymphoma. Although not a malignant process, hyaline vascular Castleman disease is also discussed here as this disorder commonly involves the mediastinum. Despite multiple advances in hematopathology in recent decades, the day-to-day diagnosis of these lesions still requires a morphologic approach and a proper selection of immunohistochemical markers. For this reason, it is crucial for general pathologists to be familiar with these entities and their particular clinicoradiologic presentation.
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Affiliation(s)
- Sergio Pina-Oviedo
- Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock, AR
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8
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T-lymphoblastic leukemia/lymphoma with interfollicular growth pattern and Castleman-like morphologic features. J Hematop 2021. [DOI: 10.1007/s12308-021-00446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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9
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Chauveau B, Le Loarer F, Bacci J, Baylac F, Dubus P, Ling C, Parrens M. [Indolent T-lymphoblastic proliferation in association with localized Castleman disease: A case report]. Ann Pathol 2018; 39:29-35. [PMID: 30554835 DOI: 10.1016/j.annpat.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/18/2018] [Accepted: 09/03/2018] [Indexed: 01/09/2023]
Abstract
Herein we report the case of a 41-year-old woman who presented with pelvic pain. Magnetic Resonance Imaging exhibited a single pelvic mass, measuring 50mm long axis, alongside the right iliac vessels. Histological examination of the excision specimen showed a lymphoid tumor with features of localized Castleman disease, hyaline vascular type. Moreover we identified multiple interfollicular dark clusters, composed of cells morphologically resembling cortical thymocytes. Their immunophenotype was consistent with an intermediate stage of T-cell differentiation, with the expression of CD3, CD4, CD8, TdT, CD1a, CD99, CD2, CD5, CD7 and CD10, with 40% Ki67. After integration of clinical and molecular data, the retained diagnosis was an indolent T-cell lymphoblastic proliferation associated with hyaline vascular localized Castleman disease. The clinical course confirmed the indolent nature of the proliferation, despite a late local recurrence at 7 years of the initial diagnosis, without histological modification, due to an incomplete initial resection surgery.
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Affiliation(s)
- Bertrand Chauveau
- Service de pathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France.
| | - François Le Loarer
- Service de biopathologie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France
| | - Julia Bacci
- Service de biopathologie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - François Baylac
- SCP Lhomme-Baylac-cabinet d'anatomie et cytologie pathologiques, 182, rue de Périgueux, 16000 Angoulême, France
| | - Pierre Dubus
- Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France; Service de biologie des tumeurs et tumorothèque, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France
| | - Catherine Ling
- Service de pathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France
| | - Marie Parrens
- Service de pathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France
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10
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Li W, Dim D, Paulson L, Rivard D. Diagnosis of intrathyroidal ectopic thymus in thyroid fine needle aspiration samples. J Clin Pathol 2018; 72:145-151. [DOI: 10.1136/jclinpath-2018-205424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/27/2018] [Accepted: 10/09/2018] [Indexed: 11/04/2022]
Abstract
AimsIntrathyroidal ectopic thymus (ITET) is a rare cause of paediatric thyroid nodules. Although ultrasonography of ITET demonstrates a characteristic appearance similar to that of normal thymus, accurate differentiation from other thyroid nodule etiologies by ultrasonography is difficult, and so that fine needle aspiration (FNA) is usually performed for further analysis. The aim of this study was to evaluate the utility of flow cytometry (FCM) in confirming the diagnosis of ITET in thyroid FNA samples.MethodsFive cases of ITET were retrieved from our thyroid FNA database within a 3-year period. Their clinical information, ultrasonographic features, cytology and FCM findings were retrospectively reviewed. The FCM results were compared with those of 22 T-cell acute lymphoblastic leukaemia/lymphoblastic lymphoma (T-ALL/LBL) cases.ResultsThe FNA smears of all five ITET cases demonstrated abundant lymphocytes of variable sizes, which included some immature lymphoid cells. No Hassall’s bodies or atypical epithelioid cells were recognised. By multicolour FCM analysis including antibodies against CD1a, CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD34, TDT and TCR, all ITET cases showed antigen expression patterns consistent with normal thymocyte maturation. All T-ALL/LBL cases exhibited significant immunophenotypic aberrancy.ConclusionsThe diagnosis of ITET based on FNA cytology is often inconclusive. The presence of immature lymphocytes often raises the concern for LBL. FCM with adequate antigen coverage can reliably distinguish ITET from T-ALL/LBL and make the diagnosis of ITET in FNA samples. Avoiding unnecessary further invasive procedures, providing reassurance to clinician and patient, the accurate diagnosis of ITET by FCM in FNA samples is clinically important.
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Pizzi M, Brignola S, Righi S, Agostinelli C, Bertuzzi C, Pillon M, Semenzato G, Rugge M, Sabattini E. Benign TdT-positive cells in pediatric and adult lymph nodes: a potential diagnostic pitfall. Hum Pathol 2018; 81:131-137. [PMID: 29969607 DOI: 10.1016/j.humpath.2018.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
Abstract
Benign terminal deoxynucleotidyl transferase (TdT)-positive cells have been documented in a variety of nonhematopoietic tissues. Scant data are, however, available on their presence in nonneoplastic lymph nodes. This study is aimed to (1) characterize the presence/distribution of benign TdT-positive cells in pediatric and adult reactive lymph nodes and (2) define the phenotype and nature of such elements. This retrospective study considered 141 reactive lymph nodes from pediatric and adult patients without history of neoplastic disease. TdT-positive cells were characterized by immunohistochemical and morphometric analyses, and their presence was correlated with the clinical-pathological features. The nature of TdT-positive cells was investigated by (1) double immunostaining for early lymphoid cell markers and (2) assessment of TdT expression in fetal lymph nodes. Sparse TdT-positive cells were documented in all pediatric cases and in most (76%) adult lymph nodes. TdT-positive cell density was higher in children than adults (15.9/mm2 versus 8.6/mm2; P < .05). TdT positivity did not correlate with any clinical or histological parameter, and double immunostaining disclosed a phenotype compatible with early lymphoid precursors (positivity for CD34 and CD10, and variable expression of CD7). A very high TdT-positive cell density (802.4/mm2) was reported in all fetal lymph nodes. In conclusion, TdT-positive cells are a common finding in pediatric and adult lymph nodes. The interstitial distribution and low number of such cells allow for the differential diagnosis with precursor lymphoid neoplasms. The high density in fetal lymph nodes and the phenotype of such cells suggest their belonging to an immature lymphoid subset gradually decreasing with age.
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Affiliation(s)
- Marco Pizzi
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35121 Padova, Italy.
| | - Stefano Brignola
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35121 Padova, Italy
| | - Simona Righi
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Claudio Agostinelli
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Clara Bertuzzi
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Marta Pillon
- Clinic of Paediatric Haemato-Oncology, Department of Women's and Children's Health, University of Padova, 35128 Padova, Italy
| | - Gianpietro Semenzato
- Hematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Massimo Rugge
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35121 Padova, Italy
| | - Elena Sabattini
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
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Quesada AE, Young KH, Medeiros LJ, Thakral B. Indolent T-lymphoblastic proliferation associated with low grade follicular dendritic cell sarcoma and Castleman disease. Pathology 2018; 50:351-352. [DOI: 10.1016/j.pathol.2017.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/27/2017] [Accepted: 09/03/2017] [Indexed: 10/17/2022]
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13
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Yasuda H, Tsutsui M, Ota Y, Tanaka M, Komatsu N. Indolent T-lymphoblastic proliferation concomitant with acinic cell carcinoma mimicking T-lymphoblastic lymphoma: case report and literature review. Histopathology 2017; 72:862-866. [PMID: 29143359 DOI: 10.1111/his.13433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/08/2017] [Indexed: 11/28/2022]
Abstract
AIMS Indolent T-lymphoblastic proliferation (iT-LBP) is a non-clonal benign condition showing extrathymic proliferation of T-lymphoblasts positive for CD3, CD4, CD8, and TdT. Isolated iT-LBP has been observed, but the majority of iT-LBPs have been seen in conjunction with other disorders, including Castleman disease, hepatocellular carcinoma, follicular dendritic cell tumours, angioimmunoblastic T-cell lymphoma, myasthenia gravis, and acinic cell carcinoma (ACC). The clinical course of iT-LBP is indolent, and no therapy is usually required. A major concern is misdiagnosis as T-lymphoblastic lymphoma, and a correct diagnosis of iT-LBP often requires not only pathological analysis but also careful monitoring of the clinical course. The aim of this study was to broaden the knowledge of pathologists and physicians concerning this as yet not well-recognised entity. METHODS AND RESULTS We report a case of iT-LBP concomitant with ACC, along with a literature review of all 14 cases of iT-LBP reported to date. CONCLUSIONS iT-LBP should always be considered as a differential diagnosis of T-lymphoblastic lymphoma, as the two disorders show extremely similar traits.
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Affiliation(s)
- Hajime Yasuda
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Miyuki Tsutsui
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasunori Ota
- Department of Pathology, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Masaru Tanaka
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
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14
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Yuan J, Gali VL, Perry DA, Fu K, Qureishi H, Amador-Ortiz C, Greiner T, Pirruccello SJ. Flow Cytometric Characteristics of Extrathymic Thymocytes in Adenoid Tissue: A Case Report and Comparison to Normal Thymus and Thymoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:357-362. [DOI: 10.1002/cyto.b.21514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ji Yuan
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Vasantha L. Gali
- Department of Pathology; Sanford School of Medicine; Sioux Falls Sanford
| | - Deborah A. Perry
- Department of Pathology; Children's Hospital and Medical Center; Omaha Nebraska
| | - Kai Fu
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Hina Qureishi
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Catalina Amador-Ortiz
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Timothy Greiner
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Samuel J. Pirruccello
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
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15
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Yuan J, Gali VL, Perry DA, Fu K, Qureishi H, Amador-Ortiz C, Greiner T, Pirruccello SJ. Flow cytometric characteristics of extrathymic thymocytes in adenoid tissue: A case report and comparison to normal thymus and thymoma. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2017. [PMID: 28165662 DOI: 10.1002/cyto.b.21516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/21/2016] [Accepted: 12/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Normal thymocyte precursors in secondary lymphoid organs have previously been described. It is important to recognize normal thymocyte precursors by flow cytometry to differentiate them from T-cell lymphoblastic leukemia. METHODS A 3-year-old boy status 2 years post-allogenic cardiac transplant underwent adenoidectomy to exclude post-transplant lymphoproliferative disorder. Microscopic, immunohistochemical, and flow cytometry analyses of the adenoid were performed. RESULTS By flow cytometry, a population of CD45+(dim)/CD7+(bright)/CD3- cells were observed at 1.0% of lymphocytes. These cells expressed CD10, partial CD34, and exhibited acquisition of CD4 followed by CD8. Within the brighter CD45+ lymphocytes, a population of CD3-/CD4+/CD8+ thymocytes and a similarly sized population of CD4+/CD8+ cells exhibiting acquisition of low-density CD3 were identified. By immunostaining, clusters of TdT+/CD1a+/CD4+/CD8+ T-cells were identified in the interfollicular areas. Compared to normal thymus, thymocytes in the adenoid tissue lacked the classic CD4xCD8 winged differentiation profile but showed a normal early precursor pattern. CONCLUSIONS Thymocytes in adenoid show a similar differentiation pattern to thymus and thymoma. However, the classic winged pattern of common thymocyte differentiation may not be readily apparent in thymocytes differentiating outside of the thymus. Recognition of the early thymocyte precursor antigen acquisition profile can be crucial to correct interpretation. © 2017 International Clinical Cytometry Society.
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Affiliation(s)
- Ji Yuan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Vasantha L Gali
- Department of Pathology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Deborah A Perry
- Department of Pathology, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Hina Qureishi
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Catalina Amador-Ortiz
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Timothy Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Samuel J Pirruccello
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
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Ohgami RS, Natkunam Y, Warnke RA. Indolent T-lymphoblastic proliferation: a name with specific meaning. Hum Pathol 2015; 46:1785-6. [DOI: 10.1016/j.humpath.2015.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/27/2015] [Indexed: 11/15/2022]
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Nathwani BN, Kansal R, Yiakoumis X, Pangalis GA. Indolent T-lymphoblastic proliferation: a name with specific meaning—reply. Hum Pathol 2015; 46:1786-7. [DOI: 10.1016/j.humpath.2015.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022]
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