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Cutaneous T-cell lymphomas with panniculitis-like histologic features have different clinical courses depending on whether they are composed of alphabeta T cells or gammadelta T cells, necessitating their distinction for proper prognostication. However, unlike alphabeta T cells, gammadelta T cells cannot be reliably detected in formalin-fixed, paraffin-embedded sections. We demonstrated that a commercially available antibody can detect gammadelta T cells and examined 2 cases of flow cytometry-proven gammadelta T-cell lymphomas and 15 control cases of nonneoplastic panniculitis. In both lymphomas, the atypical lymphocytes were gammadelta T cells, whereas the reactive lymphocytes were alphabeta T cells. In contrast, nonneoplastic panniculitis had predominantly alphabeta T cells with many fewer and individually scattered gammadelta T cells. The detection of gammadelta T cells in paraffin sections provides a powerful new tool to characterize T cells in lymphomas and inflammation.

A 60-year-old female presented with progressive and rapid onset of malaise, fatigue, and weakness. On admission to the hospital, she was found to have Coombs-positive anemia (hemoglobin 4.7 g/dL), thrombocytopenia (platelets 1 K/L), lymphadenopathy, and rapidly growing bilateral breast masses. She did not respond to transfusions, intravenous immunoglobulin (IVIG), or steroids. Since the breast masses exhibited rapid growth, an aggressive lymphoma was a strong clinical concern. However, these masses were not biopsied due to the patient's thrombocytopenia. A bone marrow biopsy revealed panmyelosis (90% cellularity) with 5% to 10% polyclonal plasma cells, and frequent plasmacytoid lymphocytes were seen on the peripheral smear. Serum protein electrophoresis (SPEP) was negative for an M-spike, and free light chain assays were normal. Serum immunoglobulins G (IgG), IgM, and IgA were all elevated. Other laboratory studies included lactate dehydrogenase (LDH) of 462 U/L, positive anti-nuclear antibody, negative HIV testing and normal serum IL-6 D I A G N O S I S I N O N C O L O G Y

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Primary cardiac lymphoma (PCL) is an extremely rare disease defined as a lymphoma strictly confined to the heart or pericardium without dissemination. We present the case of an 82 yr old male with newly diagnosed PCL and two years of subsequent follow up. This report highlights the utility of a multimodality imaging approach in the diagnosis and management of PCL.An 82-year-old man with chronic atrial fibrillation presented in September 2005 with weight loss, night sweats, dyspnea, and chest pain. Transthoracic echocardiography was diagnostic of cardiac tamponade. A pericardial window was emergently placed and hemorrhagic pericardial fluid evacuated. A postoperative transthoracic echocardiogram revealed a 3.5 x 3 x 2.5 cm mass in the right atrium appearing to originate from the coronary sinus. Twelve days later, the patient underwent surgical resection of this mass (Fig. 1). Routine histopathology revealed a dense infiltrate of large malignant lymphoid cells with a brisk mitotic rate ( Fig. 2A). Immunohistochemistry showed co-expression by tumor cells of CD20 (Fig. 2B), CD79a, and BCL2 ( Fig. 2C) with weak BCL6 expression; CD5 and CD10 were not expressed. Ki-67 staining demonstrated a proliferative rate of 50% (Fig. 2D). Flow cytometric analysis of a cell suspension prepared from fresh tissue revealed a clonal population of kappa light chain restricted, large B-cells that expressed CD20 without co-expression of CD19, CD5, CD10, CD11c or CD23. These morphologic and immunophenotypic features were consistent with diffuse large B-cell lymphoma, probably of non-germinal center histogenic origin. 1,2 CT scans with IV contrast of the chest, abdomen and pelvis performed 3 days after surgery showed no pathologically enlarged lymph nodes or other evidence of lymphoma; an intracardiac mass was not identified. A combined CT / FDG-PET scan performed 10 days post-op revealed a large markedly hypermetabolic intra-atrial mass in the mid lower chest just above the level of the diaphragm without evidence of extra-cardiac involvement by lymphoma (Fig. 3). MRI examination of the heart performed 29 days post-op revealed a soft tissue mass located in the interatrial and basal interventricular septum measuring 5.6 x 3.6 x 3.6 cm with infiltration into the right atrial wall, right ventricular myocardium and basal left ventricle (Fig. 4). Laboratory data at presentation were remarkable for anemia and a mildly increased serum LDH (638 U/L; normal ≤618 U/L). The patient was diagnosed with stage IE primary cardiac lymphoma (PCL), diffuse large B-cell type (DLBCL).The patient received his first cycle of R-CHOP chemotherapy (Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) 29 days post-op. 3 Due to the patient's age and performance status, a decision was made to administer R-CHOP using a modified schedule as follows: Day 1-Rituximab 375mg/m 2 mg, doxorubicin 25 mg/m 2 , cyclophosphamide 375mg/m 2 mg, vincristine 1 mg and prednisone 50 mg daily for five days; Day 14-doxorubicin 25 mg/m 2 , cyclophosphamide 375 mg/m ...