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Indolent B lymphoproliferative disorder, chronic lymphocytic leukemia (CLL) represents one of the most common hematologic diseases in the Western world. Although there are many disease development markers known so far, for example, B-cell lymphoma/leukemia (BCL) 2, new ones are needed for better understanding course of the disease. FOXP1 is known to be strongly expressed after B-cell activation. Its essential role in B-cell development suggested that it could also have a role in a various tumor B-cells. We have analyzed 74 bone marrow samples from B-CLL patients for presence of FOXP1 and its gene aberrations in tumor cells. Our results showed presence of FOXP1 protein mostly in the same tumor cells as BCL2 protein, and their specific immunostaining pattern. Diffuse immunostaining pattern of both proteins is present in patients with higher clinical stages of B-CLL and with some other markers that indicate worse outcome of the disease. Thus, FOXP1 and/or BCL2 immunostaining of bone marrow trephine sections could serve as an immunohistochemical marker in B-CLL.

ALK positive anaplastic large cell lymphoma is a T-cell lymphoma usually occurring in children and young adults. It frequently involves lymph nodes and extranodal sites and is associated with favorable prognosis. A 20-year old man was admitted for painful mass in the left axilla with overlying skin redness. Clinical presentation and US findings were highly suspicious for sarcoma. Definitive diagnosis was established cytolologically and using ancillary technologies from cytological samples. Fine needle aspiration cytology of tumor mass (lymph node conglomerate and surrounding tissue) show predominance of large, pleomorphic, atypical cells with large nuclei and vacuolised cytoplasm. Atypical cells immunocytochemically were positive for LCA, CD30, CD3, EMA, and ALK; negative for CD15 and CD56. NPM-ALK transcript was detected by reverse transcriptase-polymerase chain reaction (RT-PCT). Molecular analysis of TCRß and TCRγ genes demonstrated clonal TCR genes rearrangement. Complex karyotype with multiple numerical and structural changes was found on conventional cytogenetics. These findings excluded sarcoma and corroborated the diagnosis of ALK positive ALCL. Cutaneous involvement in ALCL can clinically mimic sarcoma, especially in cases with localized disease without B symptoms. In those cases, immunostaining, PCR, and conventional cytogenetics are helpful to exclude sarcoma. Diagn. Cytopathol. 2017;45:51-54. © 2016 Wiley Periodicals, Inc.

Follicular lymphoma is composed of clonal germinal center B cells. It shows a follicular pattern lacking mantle zones, with a network of interfollicular dendritic cells. Transformation to more aggressive lymphomas is documented, but the only connections to mantle cell lymphoma are described cases of composite lymphoma consisting of these 2 entities. We discuss here a case of a lymph node harboring CD20, CD10, BCL2, BCL6, cyclin D1, CD5, Ki67, and SOX11 with CD21, showing an almost intact network of dendritic cells in one part of a lymph node, and CD20, CD5, SOX11, BCL6, cyclin D1, CD10, Ki67, and CD21 cells restricted to the mantle area in another part of the same lymph node. Both parts of the lymph node had BCL2 rearrangement, a lack of t(11:14)(q13;q32), the presence of SOX11 expression, and the same clonal band. The described case suggests heterogenous development of small cell lymphomas and indicates the possibility of differentiation regression.

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