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Reilly P, Murga-Zamalloa C, Husain BH, Javois A, Varga P, Imran N, Menchaca M, Schmidt ML. Fibrin-associated diffuse large B-cell lymphoma in a pediatric patient. Pediatr Blood Cancer 2024:e31122. [PMID: 38953145 DOI: 10.1002/pbc.31122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Paige Reilly
- Department of Pediatrics, Hematology/Oncology Division, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Batool H Husain
- Department of Pathology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alex Javois
- Department of Pediatrics, Cardiology Division, University of Illinois Chicago, Chicago, Illinois, USA
| | - Peter Varga
- Department of Pediatrics, Cardiology Division, University of Illinois Chicago, Chicago, Illinois, USA
| | - Naveen Imran
- Department of Pediatrics, Cardiology Division, University of Illinois Chicago, Chicago, Illinois, USA
| | - Martha Menchaca
- Department of Radiology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mary Lou Schmidt
- Department of Pediatrics, Hematology/Oncology Division, University of Illinois Chicago, Chicago, Illinois, USA
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2
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Jia L, Xing C, Kandathil A, Rosado F, Chen W, Ramakrishnan Geethakumari P. Fibrin-Associated Large B-Cell Lymphoma (FA-LBCL) Involving Solid Organs as Necrotic Cystic Lesions-A Rare Entity with Potential Diagnostic Pitfalls: A Two-Case Series and Review of the Literature. Int J Surg Pathol 2024; 32:543-550. [PMID: 37461234 DOI: 10.1177/10668969231185078] [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] [Indexed: 12/22/2023]
Abstract
Fibrin-associated large B-cell lymphoma (FA-LBCL) is a rare subtype of Epstein-Barr virus (EBV)-associated lymphoma, recognized as an independent entity per the 5th edition of the WHO classification of hematolymphoid neoplasms. It is usually associated with longstanding chronic inflammation and arises within fibrinous material in confined anatomic spaces. We report the clinicopathologic manifestations of two patients of FA-LBCL involving the adrenal gland and kidney. Both tumors were diagnosed after presenting as cystic masses on imaging studies. These lymphomas were non-invasive, with microscopic aggregates of large B-lymphoma cells along/within cystic wall and admixed with fibrinous material and without prominent inflammation. By immunohistochemistry and in-situ hybridization, lymphoma cells were positive for CD45, PAX5, CD79a, MUM1, BCL2, PD-L1, and EBV/EBER (Epstein-Barr virus encoded small RNA) with a high proliferation index. Both patients remain in remission after management with complete surgical resection and additional chemo-immunotherapy in one patient. Considering its rarity, scant tumor cells, and varied clinical presentations, FA-LBCL may pose diagnostic challenges, especially when presenting as extensively necrotic cystic lesions, needing multidisciplinary collaboration in formulating management.
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Affiliation(s)
- Liwei Jia
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas TX, USA
| | - Changhong Xing
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas TX, USA
| | - Asha Kandathil
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas TX, USA
| | - Flavia Rosado
- Division of Hematopathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas TX, USA
| | - Praveen Ramakrishnan Geethakumari
- Division of Hematologic Malignancies and Cellular Therapy, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas TX, USA
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3
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Tralongo P, Bakacs A, Larocca LM. EBV-Related Lymphoproliferative Diseases: A Review in Light of New Classifications. Mediterr J Hematol Infect Dis 2024; 16:e2024042. [PMID: 38882456 PMCID: PMC11178045 DOI: 10.4084/mjhid.2024.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
Epstein-Barr virus (EBV) is a prevalent virus that can be detected in the vast majority of the population. Most people are asymptomatic and remain chronically infected throughout their lifetimes. However, in some populations, EBV has been linked to a variety of B-cell lymphoproliferative disorders (LPDs), such as Burkitt lymphoma, classic Hodgkin lymphoma, and other LPDs. T-cell LPDs have been linked to EBV in part of peripheral T-cell lymphomas, angioimmunoblastic T-cell lymphomas, extranodal nasal natural killer/T-cell lymphomas, and other uncommon histotypes. This article summarizes the current evidence for EBV-associated LPDs in light of the upcoming World Health Organization classification and the 2022 ICC classification.
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Affiliation(s)
- Pietro Tralongo
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Arianna Bakacs
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology - Fondazione Policlinico Universitario "Agostino Gemelli"- IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
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4
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Medeiros LJ, Chadburn A, Natkunam Y, Naresh KN. Fifth Edition of the World Health Classification of Tumors of the Hematopoietic and Lymphoid Tissues: B-cell Neoplasms. Mod Pathol 2024; 37:100441. [PMID: 38309432 DOI: 10.1016/j.modpat.2024.100441] [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: 10/03/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
We review B-cell neoplasms in the 5th edition of the World Health Organization classification of hematolymphoid tumors (WHO-HEM5). The revised classification is based on a multidisciplinary approach including input from pathologists, clinicians, and other experts. The WHO-HEM5 follows a hierarchical structure allowing the use of family (class)-level definitions when defining diagnostic criteria are partially met or a complete investigational workup is not possible. Disease types and subtypes have expanded compared with the WHO revised 4th edition (WHO-HEM4R), mainly because of the expansion in genomic knowledge of these diseases. In this review, we focus on highlighting changes and updates in the classification of B-cell lymphomas, providing a comparison with WHO-HEM4R, and offering guidance on how the new classification can be applied to the diagnosis of B-cell lymphomas in routine practice.
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Affiliation(s)
- L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Kikkeri N Naresh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle; Section of Pathology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle
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5
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Dotlic S, Gibson SE, Hartmann S, Hsi ED, Klimkowska M, Rodriguez-Pinilla SM, Sabattini E, Tousseyn TA, de Jong D, Dojcinov S. Lymphomas with plasmablastic features: a report of the lymphoma workshop of the 20th meeting of the European Association for Haematopathology. Virchows Arch 2023; 483:591-609. [PMID: 37561194 DOI: 10.1007/s00428-023-03585-8] [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: 03/20/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 08/11/2023]
Abstract
Lymphomas with plasmablastic features are a heterogeneous group of aggressive and mostly uncommon neoplasms of varied aetiologies, presenting in immunocompetent individuals as well as in immunodeficiency, associated with EBV and Kaposi sarcoma virus infections, and some as progression from indolent B-cell lymphomas. They show overlapping diagnostic features and pose a differential diagnosis with other aggressive B-cell lymphomas that can downregulate the B-cell expression programme. The spectrum of rare reactive proliferations and all lymphomas defined by plasmablastic features, together with an expanding range of poorly characterised, uncommon conditions at the interface between reactive lymphoid proliferations and neoplasia submitted to the session V of the 20th European Association for Haematopathology/Society for Hematopathology lymphoma workshop are summarised and discussed in this paper.
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Affiliation(s)
- Snjezana Dotlic
- Department of Pathology and Cytology, University Hospital Centre Zagreb, University of Zagreb Medical School, Zagreb, Croatia
| | - Sarah E Gibson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Eric D Hsi
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Monika Klimkowska
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Thomas A Tousseyn
- Department of Imaging and Pathology and Translational Cell and Tissue Research Laboratory, Louvain, Belgium
| | - Daphne de Jong
- Department of Pathology, Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | - Stefan Dojcinov
- Department of Pathology, Morriston Hospital, Swansea Bay University Health Board/Swansea University, Swansea, UK.
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6
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Ho TW, Cheuk W, Chan JKC. EBV-negative Fibrin-Associated Large B-Cell Lymphoma Arising in Thyroid Hyperplastic Nodule: Report of a Case and Literature Review. Int J Surg Pathol 2023; 31:1420-1425. [PMID: 36843554 DOI: 10.1177/10668969231152586] [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] [Indexed: 02/28/2023]
Abstract
Fibrin-associated large B-cell lymphoma is a rare microscopic-sized tumor, typically representing an unexpected finding at sites rich in chronic fibrin deposition. It is associated with Epstein-Barr virus, and has been reported to occur in a wide variety of anatomic sites and clinical scenarios. We report a case arising in a thyroid hyperplastic nodule, only the second case reported in this location. Notably, this is only the fourth case of fibrin-associated large B-cell lymphoma that is not associated with Epstein-Barr virus. We provide a literature review on the clinico-pathological characteristics and outcome of this newly characterized indolent lymphoma type, which has only recently been separated out from the pathologically similar but highly aggressive large B-cell lymphoma associated with chronic inflammation.
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Affiliation(s)
- Tin Wai Ho
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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7
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Boyer DF, Perry A, Wey E, Hsueh J, Li A, Jackson R, Soma L, Zhang W, Song JY. Fibrin-associated large B-cell lymphoma shows frequent mutations related to immune surveillance and PTEN. Blood 2023; 142:1022-1025. [PMID: 37433264 PMCID: PMC10517201 DOI: 10.1182/blood.2023020349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Daniel F. Boyer
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Anamarija Perry
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Elizabeth Wey
- Department of Pathology, Beaumont Health System, Royal Oak, MI
| | - Julia Hsueh
- Department of Pathology, City of Hope, Duarte, CA
| | - Aimin Li
- Department of Pathology, City of Hope, Duarte, CA
| | - Ryan Jackson
- Department of Pathology, City of Hope, Duarte, CA
| | - Lorinda Soma
- Department of Pathology, City of Hope, Duarte, CA
| | - Weiwei Zhang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Joo Y. Song
- Department of Pathology, Beaumont Health System, Royal Oak, MI
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8
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Di Napoli A, Soma L, Quintanilla-Martinez L, de Leval L, Leoncini L, Zamò A, Ng SB, Ondrejka SL, Climent F, Wotherspoon A, Dirnhofer S. Cavity-based lymphomas: challenges and novel concepts. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:299-316. [PMID: 37555981 PMCID: PMC10542738 DOI: 10.1007/s00428-023-03599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
The 2022 European Association for Haematopathology/Society for Hematopathology lymphoma workshop session on cavity-based lymphomas included sixty-eight cases in seven sections. The disease entities discussed include primary effusion lymphomas (PEL), extracavitary primary effusion lymphomas and confounding entities (ECPEL), HHV8-negative B-lineage lymphomas-effusion based (EBV-negative, EBV-positive, and plasmablastic types), diffuse large B-cell lymphoma associated with chronic inflammation, fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL), breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), and other lymphomas presenting as an effusion. All entities above are discussed; however, three are delved into greater detail given the challenges with classification: ECPEL, HHV8-negative effusion-based lymphomas, and FA-DLBCL. Cases exemplifying the diagnostic difficulty in differentiating ECPEL from HHV8-positive diffuse large B-cell lymphoma and germinotropic lymphoproliferative disorder were discussed. The more recently recognized effusion-based HHV8-negative large B-cell lymphoma is explored, with several cases submitted raising the question if this subset should be carved out as a specific entity, and if so, what should be the refining diagnostic criteria. Case submissions to the FA-DLBCL section yielded one of the largest case series to date, including classic cases, cases furthering the discussion on disease sites and prognosis, as well as novel concepts to be considered in this entity. The 2022 EA4HP/SH workshop cases allowed for further confirmation of the characteristics of some of the more historically accepted cavity-based lymphomas, as well as further inquiry and debate on relatively new or evolving entities.
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Affiliation(s)
- Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
| | - Lori Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Alberto Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sarah L Ondrejka
- Pathology, and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fina Climent
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet De Llobregat, Barcelona, Spain
| | | | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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9
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Keane GC, Keane AM, Diederich R, Kennard K, Duncavage EJ, Myckatyn TM. The evaluation of the delayed swollen breast in patients with a history of breast implants. Front Oncol 2023; 13:1174173. [PMID: 37476374 PMCID: PMC10354431 DOI: 10.3389/fonc.2023.1174173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Breast implants, whether placed for reconstructive or cosmetic purposes, are rarely lifetime devices. Rupture, resulting from compromised implant shell integrity, and capsular contracture caused by constriction of the specialized scar tissue that normally forms around breast implants, have long been recognized, and remain the leading causes of implant failure. It is apparent, however, that women with breast implants may also experience delayed breast swelling due to a range of etiologic factors. While a majority of delayed seromas associated with breast implants have a benign etiology, this presentation cannot be ignored without an adequate workup as malignancies such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), breast implant associated diffuse large B-cell lymphoma (BIA-DLBCL), and breast implant associated squamous cell carcinoma (BIA-SCC) can have a similar clinical presentation. Since these malignancies occur with sufficient frequency, and with sometimes lethal consequences, their existence must be recognized, and an appropriate diagnostic approach implemented. A multidisciplinary team that involves a plastic surgeon, radiologist, pathologist, and, as required, surgical and medical oncologists can expedite judicious care. Herein we review and further characterize conditions that can lead to delayed swelling around breast implants.
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Affiliation(s)
- Grace C. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Alexandra M. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Ryan Diederich
- MidAmerica Plastic Surgery, Glen Carbon, IL, United States
| | - Kaitlyn Kennard
- Division of Surgical Oncology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Eric J. Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
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10
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El Dirani M, Nagaratnam JM, Amalathasan T, Patel C, Kholoki M, Kholoki S. Findings of Epstein-Barr Virus Large B-Cell Lymphoma in a Patient With a History of Rectal Adenocarcinoma: A Case Report. Cureus 2023; 15:e40680. [PMID: 37485177 PMCID: PMC10357892 DOI: 10.7759/cureus.40680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Colorectal adenocarcinoma is the neoplastic proliferation of glandular tissue in the distal gastrointestinal system and can be managed using surgical resection, novel chemotherapeutic regimens, and radiation therapy. Epstein-Barr virus (EBV) is a common double-stranded DNA virus that has the potential to transform B-cells into lymphoproliferative disorders given the presence of particular conditions such as immunocompromised and chronic inflammatory states. Colorectal cancer is one of the most common malignancies worldwide; however, the additional finding of EBV-positive lymphoma in a patient with a history of colorectal malignancy is uncommon, and this phenomenon has not been thoroughly explored. This report investigates the association between rectal adenocarcinoma and EBV-positive large B-cell lymphoma in an 87-year-old Caucasian male residing in the United States and explores possible causes for this occurrence.
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Affiliation(s)
- Mirna El Dirani
- Internal Medicine, Saint James School of Medicine, Chicago, USA
| | | | | | - Chandni Patel
- General Surgery, Saint George's University School of Medicine, Chicago, USA
| | | | - Samer Kholoki
- Internal Medicine, La Grange Memorial Hospital, Chicago, USA
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11
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Martin de Bustamante JM, Mendoza A, López-Muñoz S, García-Fernández E, Gómez-Prieto P, Jiménez-Yuste V. A New Face of Fibrin-Associated Large B-Cell Lymphoma: Epstein-Barr Virus-Positive Breast Implant-Associated Diffuse Large B-Cell Lymphoma. J Clin Med 2023; 12:jcm12113614. [PMID: 37297811 DOI: 10.3390/jcm12113614] [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: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Recently, there have been reports of what could be a new lymphoproliferative entity: breast implant-associated Epstein-Barr virus positive (EBV+) diffuse large B-cell lymphoma (EBV+ BIA-DLBCL). The new World Health Organization classification has categorized it as fibrin-associated large B-cell lymphomas (FA-LBCLs); therefore, it could be referred to as breast implant-associated fibrin-associated large B-cell lymphomas (BIA-FA-LBCLs). Although the association between breast implants and lymphomas has been known since the mid-1990s, it has been almost exclusively breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Here, we describe the first case of BIA-FA-LBCL at our center, with a literature review of the clinical features, diagnosis and treatment approach of this lymphoma. We also explore the differential diagnosis of BIA-FA-LBCL, highlighting the diagnostic challenges and the reasons that have led these lymphomas to being labeled as a new face of FA-LBCL.
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Affiliation(s)
| | - Ana Mendoza
- Department of Hematology, IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Samuel López-Muñoz
- Department of Pathology, La Paz University Hospital, 28046 Madrid, Spain
| | | | - Pilar Gómez-Prieto
- Department of Hematology, IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Victor Jiménez-Yuste
- Department of Hematology, IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
- Autónoma University, 28046 Madrid, Spain
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12
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Vets J, Marcelis L, Schepers C, Dorreman Y, Verbeek S, Vanwalleghem L, Gieraerts K, Meylaerts L, Lesaffer J, Devos H, Put N, Snauwaert S, De Paepe P, Tousseyn T. Breast implant associated EBV-positive Diffuse Large B-cell lymphoma: an underrecognized entity? Diagn Pathol 2023; 18:52. [PMID: 37098615 PMCID: PMC10127423 DOI: 10.1186/s13000-023-01337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/10/2023] [Indexed: 04/27/2023] Open
Abstract
Breast-implant associated (BIA) lymphoma is an infrequent type of cancer occurring in the fluid and fibrous capsule around a textured breast implant. Recently, both the 2022 WHO 5th edition classification of Haematological tumours (WHO HAEM5) and 2022 International Consensus Classification of Mature Lymphoid Neoplasms (22ICC), recognized breast implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL) as a definitive entity, defined as a mature CD30-positive T-cell lymphoma, confined by a fibrous capsule, in a breast implant setting. Only few B-cell lymphomas have been reported in the literature to be associated with breast implants. Here we report two EBV-positive Diffuse Large B-cell lymphomas (EBV + DLBCL) in relation to a breast implant, both expressing CD30 as well as EBV latency type 3. Both lesions were considered as DLBCL associated with chronic inflammation (CI-DLBCL), but one presented as a 7 cm solid mass, while the other presented as a fibrin-associated DLBCL (FA-DLBCL) in an HIV patient. Clinically, both are in complete remission 6 months or longer after capsulectomy and graft removal, without additional chemotherapy.Such cases, characterized by large CD30-positive cells, can easily be misdiagnosed as BIA-ALCL if the cell of origin is not further established. Therefore, a diagnostic panel including lineage-specific B-and T-cell markers and EBER in situ hybridization is essential to recognize this rare entity, to understand lymphomagenesis, to predict outcome and to define clinical approach.
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Affiliation(s)
- Johanna Vets
- Translational Cell and Tissue Research Laboratory, KU Leuven, Leuven, Belgium
| | - Lukas Marcelis
- Translational Cell and Tissue Research Laboratory, KU Leuven, Leuven, Belgium
- Department of Pathology, UZ Leuven, University Hospitals, Leuven, Belgium
| | - Charlotte Schepers
- Department of Pathology, UZ Leuven, University Hospitals, Leuven, Belgium
| | - Yaliva Dorreman
- Department of Oncological Surgery, UZ Ghent, Brugge, Belgium
| | | | | | | | | | - Jan Lesaffer
- Department of Oncological Surgery, Sint-Jan, Brugge, AZ, Belgium
| | - Helena Devos
- Department of Laboratory Medicine, AZ Sint-Jan, Brugge, Belgium
| | - Natalie Put
- Department of Hematology, ZOL, Genk, Belgium
| | | | | | - Thomas Tousseyn
- Translational Cell and Tissue Research Laboratory, KU Leuven, Leuven, Belgium.
- Department of Pathology, UZ Leuven, University Hospitals, Leuven, Belgium.
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13
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Kurz KS, Ott M, Kalmbach S, Steinlein S, Kalla C, Horn H, Ott G, Staiger AM. Large B-Cell Lymphomas in the 5th Edition of the WHO-Classification of Haematolymphoid Neoplasms-Updated Classification and New Concepts. Cancers (Basel) 2023; 15:cancers15082285. [PMID: 37190213 DOI: 10.3390/cancers15082285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The family/class of the large B-cell lymphomas (LBCL) in the 5th edition of the World Health Organization (WHO) classification of haematolymphoid tumors (WHO-HAEM5) features only a few major changes as compared to the 4th edition. In most entities, there are only subtle changes, many of them only representing some minor modifications in diagnostic terms. Major changes have been made in the diffuse large B-cell lymphomas (DLBCL)/high-grade B-cell lymphomas (HGBL) associated with MYC and BCL2 and/or BCL6 rearrangements. This category now consists of MYC and BCL2 rearranged cases exclusively, while the MYC/BCL6 double hit lymphomas now constitute genetic subtypes of DLBCL, not otherwise specified (NOS) or of HGBL, NOS. Other major changes are the conceptual merger of lymphomas arising in immune-privileged sites and the description of LBCL arising in the setting of immune dysregulation/deficiency. In addition, novel findings concerning underlying biological mechanisms in the pathogenesis of the different entities are provided.
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Affiliation(s)
- Katrin S Kurz
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Michaela Ott
- Department of Pathology, Marienhospital, 70199 Stuttgart, Germany
| | - Sabrina Kalmbach
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Sophia Steinlein
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Claudia Kalla
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Heike Horn
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
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14
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Rössler F, Sachs A, Bieri U, Kuzmanic B, Ballova V, Schneider U, Singer G, Nocito A. Extranodal Diffuse Large B-cell Lymphoma With Primary Clinical Presentation as Acute Cholecystitis: A Case Report. Cureus 2023; 15:e37552. [PMID: 37193435 PMCID: PMC10183092 DOI: 10.7759/cureus.37552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
This case describes a rare presentation of a diffuse large B-cell lymphoma not otherwise specified (DLBC NOS) in the gallbladder. We report the case of an 89-year-old male who initially presented with a two-week history of weakness and abdominal discomfort. We performed laparoscopic cholecystectomy for suspicion of acute cholecystitis. After the initial uneventful course, readmission occurred for persisting weakness a few weeks after surgery. Computed tomography revealed progressive retroperitoneal lymphadenopathy. With new emerging neurological symptoms, taking into account the histopathological findings of the gallbladder specimen, the diagnosis of DLBCL NOS was confirmed. Due to the rapid clinical deterioration and extranodal involvement, the patient opted against further therapy. When the suspicion of cholecystitis is inconclusive, rare differential diagnoses need to be considered. This analysis may improve the understanding of the presentation and course of DLBC NOS in abdominal organs and could form the basis for a systematic review to improve diagnosis and therapy.
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Affiliation(s)
- Fabian Rössler
- Department of Surgery and Transplantation, Universitätsspital Zürich, Zürich, CHE
| | - Alexandra Sachs
- Department of Internal Medicine, Spital Limmattal, Zürich, CHE
| | - Uwe Bieri
- Department of Urology, Kantonsspital Chur, Chur, CHE
| | - Boris Kuzmanic
- Department of Pathology, Kantonsspital Baden, Baden, CHE
| | | | - Ulrich Schneider
- Department of General, Visceral and Vascular Surgery, Kantonsspital Baden, Baden, CHE
| | - Gad Singer
- Department of Pathology, Kantonsspital Baden, Baden, CHE
| | - Antonio Nocito
- Department of General, Visceral and Vascular Surgery, Kantonsspital Baden, Baden, CHE
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15
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Perrin L, Gibault L, Boussaid I, Birsen R. Diffuse large B-cell lymphoma associated with chronic inflammation in a patient with aneurysmal thrombus of the abdominal aorta. BMJ Case Rep 2023; 16:e254061. [PMID: 36963763 PMCID: PMC10040051 DOI: 10.1136/bcr-2022-254061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Affiliation(s)
| | - Laure Gibault
- Pathology, Hopital Europeen Georges Pompidou, Paris, France
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16
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Chapman J. Immunodeficiency-Associated Epstein-Barr Virus-Positive B-cell Lymphoproliferative Disorders. Surg Pathol Clin 2023; 16:213-231. [PMID: 37149357 DOI: 10.1016/j.path.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Sources of immune deficiency and dysregulation (IDD) are being increasingly recognized and defined, as are IDD-related B-cell lymphoproliferative lesions and lymphomas occurring in these patients. In this review, basic biology of Epstein-Barr virus (EBV) as it relates to classification of EBV-positive B-cell lymphoproliferative disorders (LPDs) is reviewed. Also discussed is the new paradigm of classification of IDD-related LPDs adopted by the fifth edition World Health Organization classification. IDD-related EBV-positive B-cell hyperplasias, LPDs, and lymphomas are discussed with particular attention to unifying and unique features that assist with recognition of these IDD-related lesions and their classification scheme.
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Affiliation(s)
- Jennifer Chapman
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami Hospital/Sylvester Comprehensive Cancer Center, 1400 Northwest 12th Avenue, Miami, FL 33136, USA.
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17
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Christe L, Veloza L, Gros L, Bisig B, Blum S, Hewer E, de Leval L. HHV8-negative primary effusion-based large B-cell lymphoma in a patient with chronic myeloid leukemia, BCR::ABL1-positive under dasatinib treatment: Report of a new case and literature review. Diagn Cytopathol 2022; 50:E351-E356. [PMID: 35916333 DOI: 10.1002/dc.25027] [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: 04/23/2022] [Revised: 07/05/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022]
Abstract
Dasatinib, a second-generation tyrosine kinase inhibitor (TKI), used as treatment for chronic myeloid leukemia, BCR::ABL1-positive (CML), is complicated by pleural or pericardial effusions in about one-third of patients. Besides, in exceptional instances, effusion-based neoplastic B-cell lymphoproliferations have been described. Here, we report an HHV8-negative, EBV-positive large B-cell lymphoma presenting as a pericardial effusion in a patient with CML treated with dasatinib for 23 months, without associated tumor mass or lymphadenopathies. Large tumor cells showed a B-cell phenotype (CD20+, CD79+), with evidence of EBV infection (EBER-ISH+), but HHV8 (LANA-1) negative. Monoclonal IG gene rearrangements were identified. BCL2, BCL6, and MYC genes were not rearranged. Despite the aggressive cytomorphology the patient was in complete remission after 4 cycles of R-CHOP after 8 months follow-up. Four other cases of large B-cell effusion-based lymphomas developed in the setting of dasatinib therapy for CML have been reported in the literature. The four cases were HHV8-negative and one case was EBV-positive. Three of the four patients experienced a benign clinical course, which is in contrast to HHV8-positive primary effusion lymphoma (PEL). The mechanisms of development of these effusion-based B-cell lymphoproliferations in patients receiving TKI are not completely elucidated. Acute or relapsing effusions during TKI treatment in the setting of CML should be cytologically examined to exclude clonal B-cell lymphoproliferations.
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Affiliation(s)
- Lucine Christe
- Department of Laboratory Medicine and Pathology, Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luis Veloza
- Department of Laboratory Medicine and Pathology, Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Louis Gros
- Department of Hematology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bettina Bisig
- Department of Laboratory Medicine and Pathology, Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sabine Blum
- Department of Hematology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ekkehard Hewer
- Department of Laboratory Medicine and Pathology, Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
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18
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Habib PM, Serena T, Flynn CM, Hartkop A, Wey E, Lang D, Laveroni E. Incidental Pathogenic Fibrin-Associated Diffuse Large B-cell Lymphoma Found During Aorto-Biiliac Bypass. Cureus 2022; 14:e23681. [PMID: 35510016 PMCID: PMC9061222 DOI: 10.7759/cureus.23681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/31/2022] [Indexed: 11/08/2022] Open
Abstract
Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is in and of itself a rare entity and is a subset of the Epstein-Barr virus (EBV)-associated lymphoma. Due to its indolent course, FA-DLBCL is generally an incidental finding on histopathological examinations. We present the first reported case of FA-DLBCL found within a native aortic thrombus during an aorto-biiliac bypass. This is a 77-year-old male who was taken to the operative theater for open aorto-biiliac bypass secondary to aortooclusive disease resulting in intermittent claudication and gangrene of the right lower extremity digits. Intraoperatively, suspicious inflammatory changes were noted around the aorta. Pathological evaluation of the thrombus within the aorta noted cells of B-cell lineage with BCL2 and MYC positivity in addition to CD30 and EBV positivity. Postoperatively, the patient’s course was complicated by acute tubular necrosis, uremia, dialysis dependence, intubation, and cardiac arrhythmias including cardiac arrest. He was able to recover from these complications, however, he ultimately chose to self-enroll in hospice care. An extensive literature review of over 128 mentions of FA-DLBCL noted a complete paucity of reported cases of FA-DLBCL within a native aorta. The patient’s clinical presentation and histopathology without mass-forming lesions lead to the diagnosis of FA-DLBCL. FA-DLBCL is an extremely rare EBV+ lymphoproliferative disorder associated with chronic inflammation (DLBCL-CI). FA-DLBCL is a rare condition without defined uniform treatment. This article serves to highlight the first reported case of FA-DLBCL found within an abdominal aortic thrombus in a native aorta. Given the paucity of literature on this condition, postoperative treatment and long-term outcomes should be the focus of this condition.
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19
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Dargent JL, Toffoli S, De Rop C, Hérin M. Fibrin-Associated EBV-Positive Large B-Cell Lymphoma Incidentally Found Within a Multinodular Goiter. Int J Surg Pathol 2022; 30:658-661. [PMID: 35040342 DOI: 10.1177/10668969221074604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibrin-associated diffuse large B-cell lymphoma (fibrin-associated DLBCL) is a very rare subtype of Epstein-Barr virus (EBV)-associated DLBCL that usually develops within fibrin-rich lesions such as cardiac myxoma, chronic hematoma, thrombus, pseudocysts or cysts, prosthetic devices or breast implants. The pathogenesis as well as the clinicopathologic features of this usually indolent lymphoproliferative disorder, which are based on the analysis of a relatively limited number of cases, are still poorly known. Herein, we report a case of fibrin-associated DLBCL that was incidentally found within a multinodular goiter, a location not yet reported to our knowledge. Our findings not only illustrate further the specific nature of this peculiar lymphoproliferative disorder but also allow some interesting comments on its pathogenesis.
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Affiliation(s)
| | - Sébastien Toffoli
- 37468Institut de Pathologie et de Génétique (IPG), Gosselies, Belgium
| | - Céline De Rop
- 37468Institut de Pathologie et de Génétique (IPG), Gosselies, Belgium
| | - Michel Hérin
- 37468Institut de Pathologie et de Génétique (IPG), Gosselies, Belgium
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20
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Medeiros LJ, Marques-Piubelli ML, Sangiorgio VFI, Ruiz-Cordero R, Vega F, Feldman AL, Chapman JR, Clemens MW, Hunt KK, Evans MG, Khoo C, Lade S, Silberman M, Morkowski J, Pina EM, Mills DC, Bates CM, Magno WB, Sohani AR, Sieling BA, O'Donoghue JM, Bacon CM, Patani N, Televantou D, Turner SD, Johnson L, MacNeill F, Wotherspoon AC, Iyer SP, Malpica LE, Patel KP, Xu J, Miranda RN. Epstein-Barr-virus-positive large B-cell lymphoma associated with breast implants: an analysis of eight patients suggesting a possible pathogenetic relationship. Mod Pathol 2021; 34:2154-2167. [PMID: 34226673 DOI: 10.1038/s41379-021-00863-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/08/2022]
Abstract
Breast implant anaplastic large cell lymphoma (ALCL) is a T-cell neoplasm arising around textured breast implants that was recognized recently as a distinct entity by the World Health Organization. Rarely, other types of lymphoma have been reported in patients with breast implants, raising the possibility of a pathogenetic relationship between breast implants and other types of lymphoma. We report eight cases of Epstein-Barr virus (EBV)-positive large B-cell lymphoma associated with breast implants. One of these cases was invasive, and the other seven neoplasms were noninvasive and showed morphologic overlap with breast implant ALCL. All eight cases expressed B-cell markers, had a non-germinal center B-cell immunophenotype, and were EBV+ with a latency type III pattern of infection. We compared the noninvasive EBV+ large B-cell lymphoma cases with a cohort of breast implant ALCL cases matched for clinical and pathologic stage. The EBV+ large B-cell lymphoma cases more frequently showed a thicker capsule, and more often were associated with calcification and prominent lymphoid aggregates outside of the capsule. The EBV+ B-cell lymphoma cells were more often arranged within necrotic fibrinoid material in a layered pattern. We believe that this case series highlights many morphologic similarities between EBV+ large B-cell lymphoma and breast implant ALCL. The data presented suggest a pathogenetic role for breast implants (as well as EBV) in the pathogenesis of EBV+ large B-cell lymphoma. We also provide some histologic findings useful for distinguishing EBV+ large B-cell lymphoma from breast implant ALCL in this clinical setting.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/analysis
- Breast Implantation/adverse effects
- Breast Implantation/instrumentation
- Breast Implants/adverse effects
- Diagnosis, Differential
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/virology
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, Large-Cell, Anaplastic/etiology
- Lymphoma, Large-Cell, Anaplastic/immunology
- Lymphoma, Large-Cell, Anaplastic/pathology
- Middle Aged
- Neoplasm Staging
- Predictive Value of Tests
- Prosthesis Design
- Risk Factors
- Surface Properties
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Affiliation(s)
- L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mario L Marques-Piubelli
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina F I Sangiorgio
- Division of Hematopathology, Department of Cellular Pathology, The Royal London Hospital. Barts Health NSH Trust, London, UK
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew L Feldman
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jennifer R Chapman
- Department of Pathology and Laboratory Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark G Evans
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine Khoo
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephen Lade
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | - Edward M Pina
- Pina Cosmetic Surgery, Dpt Surgery HCA Houston Healthcare Southeast, Houston, TX, USA
| | - Daniel C Mills
- Aesthetic Plastic Surgical Institute, Laguna Beach, CA, USA
| | | | | | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Beth A Sieling
- Department of Surgery, St. Mary's Hospital, Trinity Health of New England, Waterbury, CT, USA
| | - Joseph M O'Donoghue
- Department of Plastic Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Chris M Bacon
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Despina Televantou
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Laura Johnson
- Department of Surgery, Barts Health NHS Trust, London, UK
| | - Fiona MacNeill
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew C Wotherspoon
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Swaminathan P Iyer
- Department of Myeloma and Lymphoma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Malpica
- Department of Myeloma and Lymphoma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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21
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Hall J, Kampfer C, Williams N, Osswald M, Bishop B, Hall M, Alderete J. Fibrin-Associated Diffuse Large B Cell Lymphoma Found on Revision Arthroplasty of the Knee. South Med J 2021; 114:708-713. [PMID: 34729615 DOI: 10.14423/smj.0000000000001321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fibrin-associated diffuse large B cell lymphoma (FA-DLBCL) is a rare Epstein-Barr viruspositive B cell lymphoma that is nonmass-forming, does not directly produce symptoms, and is incidentally discovered on histological examination of tissues excised for other reasons. Despite overlap in morphologic and immunophenotypic features with aggressive B cell neoplasms, FA-DLBCL shows an excellent clinical outcome, even with surgical excision alone. We report an extremely rare occurrence of FA-DLBCL found in association with a metallic implant on revision arthroplasty of the knee. This report also illustrates the need for an integrated multidisciplinary approach for accurate diagnosis and avoidance of overtreatment.
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Affiliation(s)
- Jordan Hall
- From the Departments of Pathology, Orthopedic Surgery, Radiation Oncology, and Hematology Oncology, Brooke Army Medical Center, Joint Base San Antonio, Texas
| | - Craig Kampfer
- From the Departments of Pathology, Orthopedic Surgery, Radiation Oncology, and Hematology Oncology, Brooke Army Medical Center, Joint Base San Antonio, Texas
| | - Ned Williams
- From the Departments of Pathology, Orthopedic Surgery, Radiation Oncology, and Hematology Oncology, Brooke Army Medical Center, Joint Base San Antonio, Texas
| | - Michael Osswald
- From the Departments of Pathology, Orthopedic Surgery, Radiation Oncology, and Hematology Oncology, Brooke Army Medical Center, Joint Base San Antonio, Texas
| | - Bradie Bishop
- From the Departments of Pathology, Orthopedic Surgery, Radiation Oncology, and Hematology Oncology, Brooke Army Medical Center, Joint Base San Antonio, Texas
| | - Misty Hall
- From the Departments of Pathology, Orthopedic Surgery, Radiation Oncology, and Hematology Oncology, Brooke Army Medical Center, Joint Base San Antonio, Texas
| | - Joseph Alderete
- From the Departments of Pathology, Orthopedic Surgery, Radiation Oncology, and Hematology Oncology, Brooke Army Medical Center, Joint Base San Antonio, Texas
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22
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Chatta P, Qureashi M, Plato S, Kirk S, Yau D, Kheiwa A, Parwani P, Razzouk A. A case report of right ventricular outflow tract obstruction caused by B-cell lymphoma: a rare presentation in an adult patient with pulmonary atresia. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab402. [PMID: 34729454 PMCID: PMC8557348 DOI: 10.1093/ehjcr/ytab402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/12/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022]
Abstract
Background Right ventricle outflow tract (RVOT) dysfunction is a common long-term complication in adult patients with pulmonary atresia/ventricular septal defect (PA/VSD). Common causes include valve thrombosis, stent fractures, and graft calcification. We present, to the best of our knowledge, the first case of malignant invasion of a Gore-Tex conduit, causing severe right ventricle (RV) failure. Case summary A 30-year-old woman with a history of PA/VSD with major aortopulmonary collateral arteries (MAPCAs) presented with worsening dyspnoea and exercise intolerance. In infancy, she underwent unifocalization of the right- and left-sided AP collaterals utilizing an 18 and 16 mm Gore-Tex graft, respectively. At age 7, she had surgical repair with VSD patch closure and placement of a 20 mm right ventricle-pulmonary artery (RVPA) homograft connected to a 20 mm Gore-Tex graft with linkage to the previously placed right and left unifocalization grafts. A transthoracic echocardiogram revealed a severely dilated RV and a heavily calcified RVOT conduit with severe stenosis. Cardiac computed tomography showed a stenotic RVPA conduit with calcified mural mass. She underwent surgical revision of the RVPA conduit with thromboendarterectomy of bilateral pulmonary arteries. Pathology of the removed conduit revealed fibrin-associated Epstein–Barr virus-positive diffuse large B-cell lymphoma (FA DLBCL). Discussion One prior case report has demonstrated invasion of DLBCL involving an aortic synthetic tube graft. However, malignant invasion of the RVOT Gore-Tex conduit has yet to be reported. Pathological review can be essential in guiding management. Malignant invasion of Gore-Tex conduits is a rare phenomenon, but one that should be closely monitored following repair of the RVOT.
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Affiliation(s)
- Payush Chatta
- Division of Internal Medicine, Department of Medicine, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Mohammad Qureashi
- Division of Internal Medicine, Department of Medicine, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Steven Plato
- Division of Cardiothoracic Surgery, Department of Cardiology, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Shannon Kirk
- Division of Radiology, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - David Yau
- Division of Pathology, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Ahmed Kheiwa
- Division of Cardiology, Department of International Heart Institute, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Anees Razzouk
- Division of Cardiothoracic Surgery, Department of Cardiology, Loma Linda University, 11234 Anderson St, Loma Linda, CA 92354, USA
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23
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Recurrent fibrin associated diffuse large B-cell lymphoma: A case report. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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24
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Morgan S, Tremblay-LeMay R, Lipa JE, Sur M, Delabie J, Imrie K, Crump M, Snell LJ, Ghorab Z. Breast implant-associated EBV-positive diffuse large B-cell lymphoma: Two case reports and literature review. Pathol Res Pract 2021; 226:153589. [PMID: 34455365 DOI: 10.1016/j.prp.2021.153589] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Lymphomas associated with breast implants are mostly of the T-cell type. They are predominantly anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALK-negative ALCL) characterized by CD30 positivity universally. Whilst the majority of primary breast lymphomas occurring in the absence of breast implants are of B-cell origin, there are few cases of implant-associated B-cell lymphomas reported to date in the literature, a subset of which are diffuse large B-cell lymphoma (DLBCL). Given the rarity of this entity, we describe two cases of breast implant-associated DLBCL. Both patients developed Epstein-Barr Virus (EBV)-positive large cell lymphoma of B-cell origin confined to the implant capsule with no evidence of systemic lymphoma. Considering the association with EBV, the activated B-cell phenotype and the presumed chronic inflammatory environment associated with the implant capsule, these might represent forms of DLBCL associated with chronic inflammation (DLBCL-CI) or fibrin-associated DLBCL (FA-DLBCL). Treatment included implant removal with total capsulectomy, and for one of the cases adjuvant systemic chemotherapy. Recognizing this rare type of breast implant-associated B-cell lymphoma could improve our understanding of this entity and hence develop appropriate management strategies.
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Affiliation(s)
- Sarah Morgan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Rosemarie Tremblay-LeMay
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Ontario, Canada
| | - Joan E Lipa
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monalisa Sur
- Department of Pathology and Molecular Medicine and Hamilton Regional Laboratory Medicine Program, Juravinski Cancer Centre and Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Jan Delabie
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kevin Imrie
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Crump
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Laura J Snell
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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25
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Hatano Y, Ideta T, Hirata A, Hatano K, Tomita H, Okada H, Shimizu M, Tanaka T, Hara A. Virus-Driven Carcinogenesis. Cancers (Basel) 2021; 13:2625. [PMID: 34071792 PMCID: PMC8198641 DOI: 10.3390/cancers13112625] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Cancer arises from the accumulation of genetic and epigenetic alterations. Even in the era of precision oncology, carcinogens contributing to neoplastic process are still an important focus of research. Comprehensive genomic analyses have revealed various combinations of base substitutions, referred to as the mutational signatures, in cancer. Each mutational signature is believed to arise from specific DNA damage and repair processes, including carcinogens. However, as a type of carcinogen, tumor viruses increase the cancer risk by alternative mechanisms, including insertional mutagenesis, viral oncogenes, and immunosuppression. In this review, we summarize virus-driven carcinogenesis to provide a framework for the control of malignant cell proliferation. We first provide a brief overview of oncogenic viruses and describe their implication in virus-related tumors. Next, we describe tumor viruses (HPV, Human papilloma virus; HBV, Hepatitis B virus; HCV, Hepatitis C virus; EBV, Epstein-Barr virus; Kaposi sarcoma herpesvirus; MCV, Merkel cell polyoma virus; HTLV-1, Human T-cell lymphotropic virus, type-1) and tumor virus-related cancers. Lastly, we introduce emerging tumor virus candidates, human cytomegalovirus (CMV), human herpesvirus-6 (HHV-6) and adeno-associated virus-2 (AAV-2). We expect this review to be a hub in a complex network of data for virus-associated carcinogenesis.
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Affiliation(s)
- Yuichiro Hatano
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (H.T.); (A.H.)
| | - Takayasu Ideta
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (T.I.); (M.S.)
- Department of Laboratory Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Akihiro Hirata
- Laboratory of Veterinary Pathology, Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu 501-1194, Japan;
| | - Kayoko Hatano
- Department of Obstetrics and Gynecology, Gifu University Hospital, Gifu 501-1194, Japan;
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (H.T.); (A.H.)
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan;
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (T.I.); (M.S.)
| | - Takuji Tanaka
- Department of Diagnostic Pathology (DDP) and Research Center of Diagnostic Pathology (RC-DiP), Gifu Municipal Hospital, Gifu 500-8513, Japan;
| | - Akira Hara
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (H.T.); (A.H.)
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26
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Mansy M, Wotherspoon AC, El-Sharkawi D, Cunningham D, Wren D, Sharma B, MacNeill F, Attygalle AD. Fibrin-associated diffuse large B-cell lymphoma misdiagnosed as breast implant-associated anaplastic large-cell lymphoma. Histopathology 2021; 79:269-271. [PMID: 33772830 DOI: 10.1111/his.14372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/10/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Mina Mansy
- Department of Histopathology, The Royal Marsden Hospital, London, UK
| | | | - Dima El-Sharkawi
- Department of Haematology, The Royal Marsden Hospital, London, UK
| | - David Cunningham
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital, London, UK
| | - Dorte Wren
- Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
| | | | | | - Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden Hospital, London, UK
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27
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Affiliation(s)
- Young Hyeh Ko
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
- Department of Pathology, Hanyang University Hospital, Seoul, Korea
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28
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Baugh L, Brown N, Song JY, Pandya S, Montoya V, Perry AM. Fibrin-Associated, EBV-Negative Diffuse Large B-Cell Lymphoma Arising in Atrial Myxoma: Expanding the Spectrum of the Entity. Int J Surg Pathol 2021; 30:39-45. [PMID: 33913371 DOI: 10.1177/10668969211014959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is a provisional entity in the 2017 Revision of the World Health Organization Classification. This indolent entity, which is frequently discovered incidentally, is currently classified under the category of diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), an aggressive lymphoma with poor survival. Several authors have proposed that it be classified separately since, in contrast to DLBCL-CI, transformation to aggressive lymphoma has rarely been reported and this entity has distinct clinical and histological features. We describe a rare case of a 62-year-old male with FA-DLBCL associated with atrial myxoma, which was incidentally discovered. In contrast to typically described immunophenotypic features of this entity, that is, activated B-cell phenotype (ABC) and Epstein-Barr virus (EBV) positivity, our case showed germinal center B-cell (GCB) phenotype and was EBV negative. Clinical staging revealed no evidence of lymphoma elsewhere in the body, and the patient did not receive adjuvant chemotherapy after surgical excision and remains in remission. This case illustrates that occasionally FA-DLBCL can show GCB phenotype, as opposed to the typical ABC phenotype. Moreover, we propose that the definition of the entity be expanded to include EBV-negative cases.
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Affiliation(s)
| | - Noah Brown
- University of Michigan, Ann Arbor, MI, USA
| | - Joo Y Song
- 20220City of Hope National Medical Center, Duarte, CA, USA
| | - Shreyash Pandya
- Northside Hospital, Hospital Corporation of America, St. Petersburg, FL, USA
| | - Vernon Montoya
- Cancer Care and Urology of North Florida, Lake City, FL, USA
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29
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Fath AR, Eldaly AS, Aglan A, Varkoly KS, Beladi RN, Solsi A, Hahn MF, Karis JP, Nafisi S, Brady K, Bellamkonda P, Wakefield DN, Clapp WL, Lucas AR. Incidental Finding of a Large Right Atrial Thrombus in a Patient With Cerebral Lymphoma. J Investig Med High Impact Case Rep 2021; 9:23247096211001636. [PMID: 33749363 PMCID: PMC7985942 DOI: 10.1177/23247096211001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Right atrial (RA) masses are rare, challenging to diagnose, and potentially life-threatening with high mortality if untreated. We present a patient presenting with diffuse large B-cell lymphoma in the brain that was incidentally found to have a large RA mass. For a better definition of the RA mass, extensive workup using multimodality imaging including chest computed tomography, transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance imaging, and left heart catheterization was warranted. The imaging demonstrated a large RA mass extending through the tricuspid valve into the right ventricle and superior and inferior vena cava without a mobile component. The mass was then successfully resected, and further histology examination was performed to rule out lymphoma and rare subtypes of diffuse large B-cell lymphoma. The comprehensive workup proved the RA mass to be a calcified thrombus rather than a direct metastatic spread of lymphoma.
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Affiliation(s)
| | | | - Amro Aglan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Mary F Hahn
- St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | | | | | | | - Alexandra R Lucas
- Creighton University, Phoenix, AZ, USA.,Dignity Health, Phoenix, AZ, USA.,Arizona State University, Tempe, AZ, USA
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30
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HHV8-Negative Effusion-Based Large B Cell Lymphoma Arising in Chronic Myeloid Leukemia Patients under Dasatinib Treatment: A Report of Two Cases. BIOLOGY 2021; 10:biology10020152. [PMID: 33672947 PMCID: PMC7918666 DOI: 10.3390/biology10020152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
Simple Summary Tyrosine kinase inhibitors (TKIs) are the treatment of choice for BCR-ABL1-positive chronic myeloid leukemia (CML). Dasatinib is a second generation TKI frequently associated with pleural effusion in up to 33% of patients. Here, we describe two cases of HHV8-negative large B cell effusion-based lymphoma (EBL) confined to the pleura, incidentally, diagnosed in patients presenting with dasatinib-related pleural effusion. One patient is alive and is in remission at 17 months from diagnosis, while unfortunately the other patient died of progressive disease and novel coronavirus disease 2019 (COVID-19)-related pneumonia 16 months from diagnosis. These cases of large B cell EBL in patients receiving dasatinib raise concern about a possible association and we strongly recommend cytological investigation in patients with persistent/relapsing pleural effusion under dasatinib to improve the knowledge about this entity. Abstract Tyrosine kinase inhibitors (TKIs) are the treatment of choice for BCR-ABL1-positive chronic myeloid leukemia (CML). Although TKIs have substantially improved prognosis of CML patients, their use is not free of adverse effects. Dasatinib is a second generation TKI frequently associated with pleural effusion in up to 33% of patients. This results in symptoms as dyspnea, cough and chest pain that may require therapy discontinuation. In the present report, we describe two exceptional cases of HHV8-negative large B-cell effusion-based lymphoma (EBL) confined to the pleura, incidentally, diagnosed in patients presenting with dasatinib-related pleural effusion. One patient (case 1) is alive and is in remission at 17 months from large B-cell EBL diagnosis while unfortunately the other patient (case 2) died of progressive disease and COVID-19 pneumonia 16 months from large B-cell EBL diagnosis. These cases raise concern about a possible association between large B-cell EBL and dasatinib, and the different clinical outcome of the two cases poses a challenge in treatment decision. For this reason, we strongly recommend cytological investigation in patients with persistent/relapsing pleural effusion under dasatinib, primarily to validate its possible association with lymphoma development and to improve the knowledge about this entity.
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31
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Khoo C, McTigue C, Hunter-Smith DJ, Walker P. EBV positive fibrin/chronic inflammation associated diffuse large B-cell lymphoma: an incidental finding associated with a breast implant. Pathology 2020; 53:673-675. [PMID: 33358173 DOI: 10.1016/j.pathol.2020.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Christine Khoo
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.
| | | | - David J Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne, Vic, Australia
| | - Patricia Walker
- Department of Haematology, Peninsula Health, Peninsula Private Hospital, and Alfred Health, Melbourne, Vic, Australia
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32
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Bhavsar T, Crane GM. Immunodeficiency-Related Lymphoid Proliferations: New Insights With Relevance to Practice. Curr Hematol Malig Rep 2020; 15:360-371. [PMID: 32535851 DOI: 10.1007/s11899-020-00594-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Our understanding of risk factors and mechanisms underlying immunosuppression-related lymphoproliferative disorders continues to evolve. An increasing number of patients are living with altered immune status due to HIV, solid organ or hematopoietic stem cell transplant, treatment of autoimmune disease, or advanced age. This review covers advances in understanding, emerging trends, and revisions to diagnostic guidelines. RECENT FINDINGS The tumor microenvironment, including interactions between the host immune system and tumor cells, is of increasing interest in the setting of immunosuppression. While some forms of lymphoproliferative disease are associated with unique risk factors, common mechanisms are also emerging. Indolent forms, such as Epstein-Barr virus positive mucocutaneous ulcer, are important to recognize. As methods to modulate the immune system evolve, more data are needed to understand and minimize lymphoproliferative disease risk. A better understanding of individual risk factors and common mechanisms underlying immunosuppression-related lymphoproliferations will ultimately enable improved prevention and treatment of these disorders.
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Affiliation(s)
- Tapan Bhavsar
- Department of Pathology and Laboratory Medicine, George Washington School of Medicine, Washington, DC, USA
| | - Genevieve M Crane
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
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33
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Jantuan E, Chiu B, Chiu B, Shen F, Oudit GY, Sergi C. The tumor microenvironment may trigger lymphoproliferation in cardiac myxoma. Transl Oncol 2020; 14:100911. [PMID: 33129111 PMCID: PMC7586245 DOI: 10.1016/j.tranon.2020.100911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Lymphoproliferative disorders (LPD) in cardiac myxomas (CM) has been occasionally reported, and chronic inflammation in response to viral infection may be the key. CM can upregulate autophagy, creating a favorable environment for Epstein Barr Virus (EBV)-driven oncogenesis. P62 accumulates when autophagy is inhibited, and aberrant excessive p62 may result from autophagy defect, causing oxidative stress and tumorigenesis. NanoString technology is a relatively new method for capturing tumor-immune signaling in tissues exploring how the signaling axis is associated with inflammation.
Cardiac myxomas (CM) and primary cardiac lymphoproliferative disorders (LPD) are rare primary cardiac neoplasms. The composite occurrence of LPD in CM has been occasionally reported, and chronic inflammation in response to viral infection has been suggested to be at the basis of oncogenesis. Cancers can upregulate autophagy to endure microenvironmental stress and to increase local growth and aggressiveness. CM exhibit a dichotomous separation in low and high inflammatory grades (LIG vs. HIG). We studied 23 CMs using autophagy-related proteins and NanoString technology for gene expression. Autophagy-related proteins (Beclin-1, LAMP-1, LC3, and p62) were demonstrated in both tumor and stromal cells. ATG genes showed a progression of involvement in CM using an 8-gene signature. They were associated with Epstein-Barr virus (EBV) encoded latent membrane protein 1 (EBV LMP1) activation. We suggest that CM can upregulate autophagy, creating a favorable environment for EBV-driven oncogenesis. To the best of our knowledge, the present study is the first to report on the TME using the expression of autophagy-related genes and proteins in CM. The microenvironment of CM is dynamic, with a variety of cell types and different molecular pathways at play, and this study may clearly warrant further investigation.
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Affiliation(s)
- Eugeniu Jantuan
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta, Canada
| | - Brian Chiu
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta, Canada
| | - Bonnie Chiu
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta, Canada
| | - Fan Shen
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta, Canada
| | - Gavin Y Oudit
- Department of Medicine, Division of Cardiology, Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
| | - Consolato Sergi
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta, Canada; Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; National "111″ Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering, Hubei University of Technology, Wuhan, Hubei, China; Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, China.
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34
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Moreno EM, Ferrer-Gómez A, Arias HP, García IG, García-Cosío M. Fibrin-associated diffuse large B-cell lymphoma with plasmacytic differentiation: case report and literature review. Diagn Pathol 2020; 15:117. [PMID: 32972426 PMCID: PMC7513544 DOI: 10.1186/s13000-020-01034-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
Background Primary cardiac lymphomas are extremely rare entities (< 2% of cardiac tumours) and the most frequent histologic type is diffuse large B-cell lymphoma (DLBCL). Fibrin-associated DLBCL (FA-DLBCL) is a very unusual form of DLBCL associated with chronic inflammation, and only case reports and small series have been described. In the heart, it usually occurs in the context of a cardiac myxoma or cardiac prostheses and it is not bulk forming. These lymphomas frequently present with non-germinal center phenotype and are associated with Epstein-Barr virus (EBV) type III latency. Case presentation We describe a case of FA-DLBCL arising in a cardiac myxoma, with plasmacytic differentiation and type I EBV latency. Conclusions Although they are very rare, FA-DLBCLs should be known for their diagnostic difficulty, due to its unspecified clinical manifestations, and for their more favourable prognosis, sometimes even without additional treatment after surgical resection.
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Affiliation(s)
- Esther Moreno Moreno
- Department of Pathology, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km 9,100, Madrid, 28034, Spain
| | - Ana Ferrer-Gómez
- Department of Pathology, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km 9,100, Madrid, 28034, Spain
| | - Héctor Pian Arias
- Department of Pathology, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km 9,100, Madrid, 28034, Spain
| | - Irene García García
- Department of Haematology, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain
| | - Mónica García-Cosío
- Department of Pathology, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km 9,100, Madrid, 28034, Spain.
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35
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Goodlad JR, Ott G. Lymphoproliferations at extranodal sites: a morphologically, genetically, and clinically diverse group of neoplasms with overlapping features. Virchows Arch 2020; 476:629-631. [PMID: 31897817 DOI: 10.1007/s00428-019-02733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John R Goodlad
- Department of Pathology, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, Scotland.
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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36
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Takahara T, Satou A, Ishikawa E, Kohno K, Kato S, Suzuki Y, Takahashi E, Ohashi A, Asano N, Tsuzuki T, Nakamura S. Clinicopathological analysis of neoplastic PD-L1-positive EBV + diffuse large B cell lymphoma, not otherwise specified, in a Japanese cohort. Virchows Arch 2020; 478:541-552. [PMID: 32803453 DOI: 10.1007/s00428-020-02901-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/09/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
The programmed death 1 (PD1)/PD1 ligand (PD-L1) axis plays an important role in the pathogenesis of Epstein-Barr virus-positive diffuse large B cell lymphoma, not otherwise specified (EBV+ DLBCL, NOS). Here, we describe PD-L1 expression by EBV+ DLBCL, NOS in order to evaluate its possible contribution to the pathogenesis of this tumor. The study included 57 cases of EBV+ DLBCL, NOS. The median patient age was 69 years and 95% (n = 54) were aged > 45. Extranodal lesions were present in 39 (69%) at initial diagnosis. PD-L1 expression (mAb SP142-positive staining) was present in more than 5% of tumor cells in only six cases (11%), in clear contrast to the 77% reported in cases aged under 45 years. Among the PD-L1+ cases, three were nodal lesions. All six PD-L1+ cases progressed in the 3 years after diagnosis and four of the six patients died of the disease within 2 years. PD-L1+ cases had significantly shorter PFS (P = 0.002) and relatively short OS (P = 0.26), compared with PD-L1- cases. EBV+ DLBCL, NOS in the elderly infrequently expressed PD-L1 and had poor prognosis. PD-L1 expression in EBV+ DLBCL, NOS of the elderly sheds light on the pathogenetic role of immune senescence.
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Affiliation(s)
- Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan.
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Emiko Takahashi
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan
| | - Akiko Ohashi
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan
| | - Naoko Asano
- Department of Clinical Laboratory, Nagano Prefectural Suzaka Hospital, Nagano, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
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Wang Z, Gong Q, Zhao Y, Xu H, Hu S, Zhang Z. Indolent EBV-positive T-cell lymphoproliferative disorder arising in a chronic pericardial hematoma: the T-cell counterpart of fibrin-associated diffuse large B-cell lymphoma? Haematologica 2020; 105:e437-e439. [PMID: 32414846 PMCID: PMC7395287 DOI: 10.3324/haematol.2020.252007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Zhen Wang
- Department of Pathology, Jiangsu Province Hospital and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qixing Gong
- Department of Pathology, Jiangsu Province Hospital and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Youcai Zhao
- Department of Pathology, Nanjing First Hospital, Nanjing, China
| | - Hai Xu
- Department of Radiology, Jiangsu Province Hospital and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shimin Hu
- Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhihong Zhang
- Department of Pathology, Jiangsu Province Hospital and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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38
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Chu W, Zhang B, Zhang Y, Tian D, Tang Y, Zhang W, Shao Q, Sun L, Wang J, Ji H. Fibrin-associate diffuse large B-Cell lymphoma arising in a left atrial myxoma: A case report and literature review ✰,✰✰. Cardiovasc Pathol 2020; 49:107264. [PMID: 32805552 DOI: 10.1016/j.carpath.2020.107264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/15/2022] Open
Abstract
We report a 60-year-old male with fibrin-associated diffuse large B-cell lymphoma (fa-DLBCL) in left atrial myxoma. Echocardiography showed a mass (63 mm × 33 mm) in the left atrium. Histological inspection indicated fa-DLBCL on the surface of atrial myxoma incidentally, together with extensive fibrinous like exudation on myxoma surface. Malignant cells were localized in solid sheets and nests at the peripheral area of the fibrinous exudation which were positive for B-lineage markers (CD20+, CD79a+, PAX-5+) and in situ hybridization of EBV-encoded RNA (EBER). PCR amplification showed clonal rearrangement of immunoglobulin heavy chain (IgH) genes. The patient was still alive with no recurrence in the 35-month follow-up after surgery. We also did a detailed clinicopathological analysis and literature review, which indicated that fa-DLBCL was a heterogeneous entity.
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Affiliation(s)
- Wei Chu
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Bing Zhang
- Department of Surgery, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Yangyang Zhang
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Dong Tian
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Yuan Tang
- Department of Pathology, Huaxi Medical Hospital, Chengdu 610041, China
| | - Wenxiao Zhang
- Department of Ultrasonic, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Qiwen Shao
- Department of Ultrasonic, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Lixia Sun
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Jingjing Wang
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, China
| | - Hong Ji
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, China.
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39
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Primary central nervous system lymphomas associated with chronic inflammation: diagnostic pitfalls of central nervous system lymphomas. Brain Tumor Pathol 2020; 37:127-135. [PMID: 32627089 DOI: 10.1007/s10014-020-00373-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
In recent years, the features of lymphomas associated with chronic inflammation, referred to as diffuse large B-cell lymphoma (DLBCL) associated with chronic inflammation (DLBCL-CI), have been elucidated. DLBCL-CI is an aggressive lymphoma occurring in the context of long-standing chronic inflammation and showing an association with Epstein-Barr virus. Fibrin-associated diffuse large B-cell lymphoma (F-DLBCL) was suggested as a new and unusual form of DLBCL-CI in the most recent version of the World Health Organization classification. From the perspective of genetics, DLBCL-CI was associated with frequent TP53 mutation, MYC amplification and complex karyotypes, but cases of F-DLBCL behaved indolently and showed a relatively lower genetic complexity. In the central nervous system (CNS), several examples of DLBCL-CI and F-DLBCL have been reported. As with DLBCL-CI outside the CNS, DLBCL-CI in the CNS is an aggressive lymphoma. However, the clinical outcome of F-DLBCL in the CNS is good. Immunohistochemistry for p53 and c-Myc in DLBCL-CI and F-DLBCL in the CNS showed similar findings of those outside the CNS. However, one aggressive case showed transitional genetics and morphology between F-DLBCL and DLBCL-CI. These findings suggest that some cases of F-DLBCL in the CNS might have the potential to progress to DLBCL-CI.
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Jaffe ES, Feldman AL, Gaulard P, Miranda RN, Sohani AR. Reply to M. Romero et al. J Clin Oncol 2020; 38:2819-2820. [PMID: 32552469 DOI: 10.1200/jco.20.00931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elaine S Jaffe
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrew L Feldman
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Philippe Gaulard
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Roberto N Miranda
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Aliyah R Sohani
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Kelemen K, Rimsza LM, Craig FE. Primary Pulmonary B-cell Lymphoma. Semin Diagn Pathol 2020; 37:259-267. [PMID: 32444246 DOI: 10.1053/j.semdp.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/22/2020] [Accepted: 04/09/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Katalin Kelemen
- Mayo Clinic Arizona, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Phoenix, Arizona.
| | - Lisa M Rimsza
- Mayo Clinic Arizona, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Phoenix, Arizona
| | - Fiona E Craig
- Mayo Clinic Arizona, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Phoenix, Arizona
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Jaffe ES, Ashar BS, Clemens MW, Feldman AL, Gaulard P, Miranda RN, Sohani AR, Stenzel T, Yoon SW. Best Practices Guideline for the Pathologic Diagnosis of Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol 2020; 38:1102-1111. [PMID: 32045544 PMCID: PMC7106983 DOI: 10.1200/jco.19.02778] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To provide guidelines for the accurate pathologic diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), the preoperative evaluation of the patient with suspected BIA-ALCL, and the pathologic evaluation of the capsulectomy specimen. METHODS To better inform patients and healthcare providers about BIA-ALCL, we convened to review diagnostic procedures used in the evaluation of patients with suspected BIA-ALCL. We focused on the processing of the seroma fluid/effusion surrounding the implant, the handling of capsulectomy specimens following removal of implant(s), and the preoperative evaluation of the patient with suspected BIA-ALCL. Recommendations were based on the published literature and our experience to optimize procedures to obtain an accurate diagnosis and assess for tumor invasion and the extent of the disease. RECOMMENDATIONS Early diagnosis of BIA-ALCL is important as the disease can progress and deaths have been reported. Because the most common presentation of BIA-ALCL is swelling of the breast with fluid collection, an accurate diagnosis requires cytologic evaluation of the effusion fluid surrounding the affected implant. The first priority is cytocentrifugation and filtration of fresh, unfixed effusion fluid to produce air-dried smears that are stained with Wright-Giemsa or other Romanowsky-type stains. Preparation of a cell block is desirable to allow for hematoxylin and eosin staining and immunohistochemical analysis of formalin-fixed, paraffin-embedded histologic sections. Cell block sections can be used for polymerase chain reaction-based investigation of T-cell receptor gene rearrangement to detect clonality. Fixation and mapping of the capsulectomy specimen to select multiple representative sections are advised to assess for microscopic tumor involvement and capsular invasion. It is appropriate to assess lymph node involvement by excisional biopsy material rather than fine needle aspiration, due to propensity for focal involvement.
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Affiliation(s)
- Elaine S. Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Binita S. Ashar
- Office of Surgical and Infection Control Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
| | - Mark W. Clemens
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew L. Feldman
- Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Philippe Gaulard
- Department of Pathology, Hôpital Henri Mondor, Institut National de la Santé et de la Recherche Médicale U955, Université Paris-Est, Créteil, France
| | - Roberto N. Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aliyah R. Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Timothy Stenzel
- Office of In Vitro Diagnostics and Radiological Health, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | - Sung W. Yoon
- Office of Surgical and Infection Control Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
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Maas JA, Menes M, Siomin V. Cardiac Myxoma with Cerebral Metastases and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Case Report and Review. J Neurol Surg Rep 2020; 81:e1-e6. [PMID: 32051810 PMCID: PMC7012640 DOI: 10.1055/s-0039-3399570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background
Cardiac myxomas, the most common primary cardiac tumors, are generally benign neoplasms. Primary cardiac lymphoma is a rare cardiac malignancy with a very poor prognosis. Here we present a case of a cardiac myxoma with cerebral metastases and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) arising within the cerebral metastases.
Case description
A 62-year-old man, who presented with symptoms of multiple transient ischemic attacks, was found to have a left atrial myxoma. Twelve months after excision of the myxoma, the patient experienced a recurrence of neurologic symptoms. Brain magnetic resonance imaging revealed multiple hemorrhagic masses. Craniotomy was performed to resect the lesions. Histopathologic examination confirmed cardiac myxoma metastases and a small lymphocytic infiltrate within the tumor consistent with CLL/SLL.
Conclusion
Including the present case, there are 27 cases of cardiac myxoma cerebral metastases and 22 cases of lymphomas arising within myxomas. The present case is the first known instance of both entities in the same patient. There is no standard management for either cardiac myxoma metastases or lymphoma within a myxoma. For both diseases, surgical excision is the primary treatment modality, but postoperative chemotherapy and/or radiation have been attempted. Myxomas may create a chronic inflammatory state that could lead to the development of CLL/SLL.
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Affiliation(s)
- Jared A Maas
- Department of Radiation Oncology, University of Alabama at Birmingham, Hazelrig Salter Radiation Oncology Center, Birmingham, Alabama, United States
| | - Manuel Menes
- Department of Pathology, Baptist Health South Florida, Miami, Florida, United States
| | - Vitaly Siomin
- Department of Neurosurgery, Baptist Health South Florida, Miami, Florida, United States
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Zamora G, Altes P, Pons L, Llagostera S. Fibrin Associated Epstein–Barr Virus Positive Large B Cell Lymphoma as a Complication of a Repaired Thoraco-abdominal Aortic Aneurysm. EJVES Vasc Forum 2020. [PMCID: PMC7320198 DOI: 10.1016/j.ejvssr.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Malignancies involving the aorta are extremely rare. Case report A 62 year old man with a history of open repair of a thoracic aortic aneurysm developed new visceral aneurysms and an anastomotic pseudoaneurysm. Fludeoxyglucose positron emission tomography/computed tomography, performed for suspicion of graft infection, found abnormal uptake around the bypass, the visceral aneurysms, and the femoral arteries. The patient was treated by embolisation of the visceral aneurysms and a thoracic endovascular aortic repair. Several bleeding complications occurred, and the patient died. Post-mortem revealed a fibrin associated Epstein–Barr virus positive diffuse large B cell lymphoma. Conclusion Patients with aortic aneurysms can develop malignancies including fibrin associated lymphoma. Clinical manifestations may be similar to those of an infectious process; timely diagnosis is uncommon. Malignancies as fibrin associated lymphoma can be found involving aortic aneurysms. Clinical manifestations of a fibrin associated lymphoma can mimic an infection. Timely diagnosis of aortic malignancies is uncommon.
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Lymphomas arising in immune-privileged sites: insights into biology, diagnosis, and pathogenesis. Virchows Arch 2019; 476:647-665. [PMID: 31863183 DOI: 10.1007/s00428-019-02698-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/24/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023]
Abstract
Session 2 of the 2018 European Association of Hematopathology/Society for Hematopathology Workshop focused on lymphomas arising in immune-privileged sites: both lymphomas arising in the traditionally described "immune sanctuary" sites of the central nervous system (CNS) and testes, as well as those arising at sites of local immune privilege. Primary CNS large B cell lymphoma and primary testicular large B cell lymphoma were discussed, and the biology of these unique tumors was highlighted by several cases showing the classic mutation profile including MYD88 L265P and CD79B. The tendency of these tumors to involve both the CNS and testis was also reinforced by several cases. Four cases of low-grade B cell lymphomas (LGBCL) of the CNS were discussed. Two were classic Bing-Neel syndrome associated with LPL, and two were LGBCL with plasmacytic differentiation and amyloid deposition without systemic disease. Rare examples of systemic T and NK cell lymphomas involving the CNS were also discussed. Several cases of breast implant-associated anaplastic large cell lymphoma (BI-ALCL) were submitted showing the typical clinicopathologic features. These cases were discussed along with a case with analogous features arising in a patient with a gastric band implant, as well as large B cell lymphomas arising alongside foreign materials. Finally, large B cell lymphomas arising in effusions or localized sites of chronic inflammation (fibrin-associated diffuse large B cell lymphoma [DLBCL] and DLBCL associated with chronic inflammation) were described. The pathogenesis of all of these lymphomas is believed to be related to decreased immune surveillance, either innate to the physiology of the organ or acquired at a local site.
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Medeiros LJ, Spagnolo DV. Lymphoma 2020: an update on recent advances in pathobiology and application to clinical practice. Pathology 2019; 52:1-5. [PMID: 31812272 DOI: 10.1016/j.pathol.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023]
Affiliation(s)
- L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Dominic V Spagnolo
- Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Center and the University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, WA, Australia.
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Rodríguez-Pinilla SM, García FJS, Balagué O, Rodríguez-Justo M, Piris MÁ. Breast implant-associated Epstein-Barr virus-positive large B-cell lymphomas: a report of three cases. Haematologica 2019; 105:e412-e414. [PMID: 31753922 DOI: 10.3324/haematol.2019.232355] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
| | | | - Olga Balagué
- Hospital Clinic of Barcelona, Pathology Department, Barcelona, Spain
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Sukswai N, Lyapichev K, Khoury JD, Medeiros LJ. Diffuse large B-cell lymphoma variants: an update. Pathology 2019; 52:53-67. [PMID: 31735345 DOI: 10.1016/j.pathol.2019.08.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma, representing approximately one-third of all cases worldwide. In the World Health Organization (WHO) classification of lymphomas, most cases of DLBCL are designated as not otherwise specified (NOS). About 20% of cases, however, are designated as specific variants of DLBCL. These variants, 13 in total, are specified on the basis of distinctive morphological or immunophenotypic findings or distinctive biological or clinical issues associated with their diagnoses. In this review we discuss the following variants: T-cell/histiocyte-rich large B-cell lymphoma; ALK-positive large B-cell lymphoma; plasmablastic lymphoma; intravascular large B-cell lymphoma; large B-cell lymphoma with IRF4 rearrangement; primary mediastinal large B-cell lymphoma; primary cutaneous diffuse large B-cell lymphoma, leg type; primary diffuse large B-cell lymphoma of the central nervous system; diffuse large B-cell lymphoma associated with chronic inflammation; lymphomatoid granulomatosis; primary effusion lymphoma; and HHV8-positive diffuse large B-cell lymphoma, NOS. Two additional variants recognised in the WHO classification, EBV-positive diffuse large B-cell lymphoma and EBV-positive mucocutaneous ulcer are discussed elsewhere in another review within this issue of Pathology. Although not recognised as a specific variant in the current WHO classification, primary testicular diffuse large B-cell lymphoma also has unique biological features and requires some modification of the standard treatment approach for patients with DLBCL. Therefore, we suggest that primary testicular diffuse large B-cell lymphoma also should be recognised as a specific variant of DLBCL in a future version of the WHO classification.
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Affiliation(s)
- Narittee Sukswai
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kirill Lyapichev
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Primary Mediastinal Nodal and Extranodal Non-Hodgkin Lymphomas: Current Concepts, Historical Evolution, and Useful Diagnostic Approach: Part 1. Adv Anat Pathol 2019; 26:346-370. [PMID: 31567132 DOI: 10.1097/pap.0000000000000249] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary mediastinal non-Hodgkin lymphomas (PM-NHLs) represent ~5% of all NHLs and comprise lymphomas of B-cell and T-cell origin. PM-NHLs are defined as involvement of mediastinal lymph nodes, thymus, and/or mediastinal organs (heart, lung, pleura, pericardium) by NHL without evidence of systemic disease at presentation. The clinical scenario is variable and depends on the lymphoma subtype. The radiologic presentation is also variable ranging from a mediastinal mass with or without superior vena cava syndrome, a pleural or a cardiac mass associated with an effusion, or as an effusion only. The diagnosis of PM-NHLs can only be established by microscopic evaluation, and therefore, general pathologists should be aware of these tumors and familiar with their diagnostic approach. The most common anterior mediastinal NHLs (90% to 95%) are primary mediastinal large B-cell lymphoma and T lymphoblastic lymphoma. Thymic marginal zone lymphoma and mediastinal gray zone lymphoma are very rare. The remainder PM-NHLs involving middle or posterior mediastinum include diffuse large B-cell lymphoma (DLBCL) and rare cases of T-cell lymphoma, including anaplastic large cell lymphoma and breast implant-associated anaplastic large cell lymphoma extending to the anterior mediastinum. Primary pleural and cardiac NHLs are mostly DLBCLs. Other rare subtypes of PM-NHLs include DLBCL associated with chronic inflammation/pyothorax-associated lymphoma, fibrin-associated DLBCL (both EBV), and pleural and/or pericardial primary effusion lymphoma (HHV-8/EBV). We review the historical aspects, epidemiology, clinico-radiologic features, histopathology, immunohistochemistry, differential diagnosis, and relevant cytogenetic and molecular features of PM (thymic) LBCL, PM "nonthymic" DLBCL, BCL, unclassifiable, with features intermediate between DLBCL and classic Hodgkin lymphoma (mediastinal gray zone lymphoma), DLBCL associated with chronic inflammation (pyothorax-associated lymphoma), fibrin-associated DLBCL, and primary effusion lymphoma. This review represents the first part of 2 manuscripts covering PM-NHLs.
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Zanelli M, Zizzo M, Montanaro M, Gomes V, Martino G, De Marco L, Fraternali Orcioni G, Martelli MP, Ascani S. Fibrin-associated large B-cell lymphoma: first case report within a cerebral artery aneurysm and literature review. BMC Cancer 2019; 19:916. [PMID: 31519155 PMCID: PMC6743119 DOI: 10.1186/s12885-019-6123-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023] Open
Abstract
Background Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is a rare Epstein-Barr virus (EBV) positive lymphoproliferative disorder included in the current World Health Organization (WHO) classification. It arises within fibrinous material in the context of hematomas, pseudocysts, cardiac myxoma or in relation with prosthetic devices. In these clinical settings the diagnosis requires an high index of suspicion, because it does not form a mass itself, being composed of small foci of neoplastic cells. Despite overlapping features with diffuse large B-cell lymphoma associated with chronic inflammation, it deserves a separate classification, being not mass-forming and often following an indolent course. Case presentation A 64-year-old immunocompetent woman required medical care for cerebral hemorrhage. Computed Tomography (CT) angiography identified an aneurysm in the left middle cerebral artery. A FA-DLBCL was incidentally identified within thrombotic material in the context of the arterial aneurysm. After surgical removal, it followed a benign course with no further treatment. Conclusions The current case represents the first report of FA-DLBCL identified in a cerebral artery aneurysm, expanding the clinicopathologic spectrum of this rare entity. A complete literature review is additionally made.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | | | - Vito Gomes
- Pathology Unit, Ospedale di Belcolle, Viterbo, Italy
| | - Giovanni Martino
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Perugia, Italy
| | - Loredana De Marco
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Paola Martelli
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Perugia, Italy
| | - Stefano Ascani
- Pathology Unit, Ospedale di Terni, University of Perugia, Perugia, Italy
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