1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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
|
5
|
Affiliation(s)
- Young Hyeh Ko
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
- Department of Pathology, Hanyang University Hospital, Seoul, Korea
| |
Collapse
|
6
|
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.
Collapse
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
| | | |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
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.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Ossified Chronic Subdural Hematoma and Subsequent Epstein-Barr Virus-Positive Large B-Cell Lymphoma: Case Report and Literature Review. World Neurosurg 2019; 130:165-169. [PMID: 31299306 DOI: 10.1016/j.wneu.2019.07.011] [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: 05/16/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ossified chronic subdural hematoma (CSH) associated with neoplasm has rarely been reported in the literature. We describe a patient with ossified CSH and underlying large B-cell lymphoma and discuss the relationship between lymphoma and CSH, emphasizing clinical characteristics, tumorigenic mechanism, and histopathologic analysis. CASE DESCRIPTION A 46-year-old man with a history of alcohol abuse and a right frontotemporoparietal and left frontal ossified CSH that was diagnosed 2 years previously presented with headache and memory loss over 6 days. The patient was being followed with serial imaging, which showed the static state of the mass and no other lesions 7 months before admission. He underwent right frontotemporoparietal craniectomy to remove the ossified CSH and tumor. When the bone was lifted and the thin dura was opened, a hard, thick, ossified capsule was observed. No apparent tumor invasion was noted in the skull or epidural space. Despite refusing further chemotherapy and radiation therapy, the patient has been disease-free and working for 5 years. CONCLUSIONS Based on reported cases and relevant literature, large B-cell lymphoma may be associated with ossified CSH.
Collapse
|
13
|
Kirschenbaum D, Prömmel P, Vasella F, Haralambieva E, Marques Maggio E, Reisch R, Beer M, Camenisch U, Rushing EJ. Fibrin-associated diffuse large B-cell lymphoma in a hemorrhagic cranial arachnoid cyst. Acta Neuropathol Commun 2017; 5:60. [PMID: 28784166 PMCID: PMC5545859 DOI: 10.1186/s40478-017-0463-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
|
14
|
Fibrin-associated EBV-positive Large B-Cell Lymphoma: An Indolent Neoplasm With Features Distinct From Diffuse Large B-Cell Lymphoma Associated With Chronic Inflammation. Am J Surg Pathol 2017; 41:299-312. [PMID: 28195879 DOI: 10.1097/pas.0000000000000775] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Incidental cases of localized fibrin-associated Epstein-Barr virus (EBV)+ large B-cell proliferations have been described at unusual anatomic sites and have been included in the category of diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI) in the WHO Classification. We describe 12 cases and review the literature to define their clinicopathologic spectrum and compare features with typical cases of DLBCL-CI. Median age was 55.5 years with a M:F ratio of 3. In all 12 cases, the lymphoma was an incidental microscopic finding involving atrial myxomas (n=3), thrombi associated with endovascular grafts (n=3), chronic hematomas (n=2), and pseudocysts (n=4). All cases tested were nongerminal center B-cell origin, type III EBV latency, and were negative for MYC rearrangements and alternative lengthening of telomeres by FISH. Most showed high CD30, Ki67, and PD-L1, and low to moderate MYC and p53 expression. Among 11 patients with detailed follow-up, 6 were treated surgically, 3 with cardiac or vascular lesions had persistent/recurrent disease at intravascular sites, and 4 died of causes not directly attributable to lymphoma. Reports of previously published fibrin-associated cases showed similar features, whereas traditional DLBCL-CI cases with a mass lesion had significantly higher lymphoma-associated mortality. Fibrin-associated EBV+ large B-cell lymphoma is clinicopathologically distinct from DLBCL-CI, warranting separate classification. Most cases, particularly those associated with pseudocysts, behave indolently with the potential for cure by surgery alone and may represent a form of EBV+ lymphoproliferative disease rather than lymphoma. However, primary cardiac or vascular disease may have a higher risk of recurrence despite systemic chemotherapy.
Collapse
|
15
|
Natkunam Y, Goodlad JR, Chadburn A, de Jong D, Gratzinger D, Chan JKC, Said J, Jaffe ES. EBV-Positive B-Cell Proliferations of Varied Malignant Potential: 2015 SH/EAHP Workshop Report-Part 1. Am J Clin Pathol 2017; 147:129-152. [PMID: 28395107 DOI: 10.1093/ajcp/aqw214] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The 2015 Workshop of the Society for Hematopathology/European Association for Haematopathology aimed to review B-cell proliferations of varied malignant potential associated with immunodeficiency. METHODS The Workshop Panel reviewed all cases of B-cell hyperplasias, polymorphic B-lymphoproliferative disorders, Epstein-Barr virus (EBV)-positive mucocutaneous ulcer, and large B-cell proliferations associated with chronic inflammation and rendered consensus diagnoses. Disease definitions, boundaries with more aggressive B-cell proliferations, and association with EBV were explored. RESULTS B-cell proliferations of varied malignant potential occurred in all immunodeficiency backgrounds. Presentation early in the course of immunodeficiency and in younger age groups and regression with reduction of immunosuppression were characteristic features. EBV positivity was essential for diagnosis in some hyperplasias where other specific defining features were absent. CONCLUSIONS This spectrum of B-cell proliferations show similarities across immunodeficiency backgrounds. Localized forms of immunodeficiency disorders arise in immunocompetent patients most likely due to chronic immune stimulation and, despite aggressive histologic features, often show indolent clinical behavior.
Collapse
|