Variable Expression of B-cell Transcription Factors in Reactive Immunoblastic Proliferations

Treetipsatit, Jitsupa; Rimzsa, Lisa; Grogan, Thomas M.; Warnke, Roger A.; Natkunam, Yasodha

doi:10.1097/pas.0000000000000266

Cited by 12 publications

(10 citation statements)

References 36 publications

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“…The major differences between the reactive immunoblasts in infectious mononucleosis and ILVIP are that B cells in infectious mononucleosis are more commonly positive for CD20 (100% vs. 44% in our study) and BCL-2 (53% vs. 0% in our study) 20. However, the immunophenotypic results from our 8 cases are very similar to those of another study based on a more general case database 21…”

Section: Discussionsupporting

confidence: 79%

Reactive Intralymphovascular Immunoblastic Proliferations Mimicking Aggressive Lymphomas

Fang

Wang

Zhang

et al. 2021

American Journal of Surgical Pathology

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Reactive intralymphovascular immunoblastic proliferations (ILVIPs) may mimic aggressive lymphomas and are rarely reported. Herein, we characterize the clinicopathologic features of 8 patients with ILVIPs. No patients had lymphadenopathy, hepatosplenomegaly, or other findings suggestive of lymphoma. The ILVIPs involved the small or large intestine (n=5) and appendix (n=3). Patients were evaluated for abdominal pain, suspected appendicitis, intestinal obstruction, diverticulitis, volvulus, or tumor resection. Histologic sections showed expanded lymphovascular spaces filled by intermediate to large immunoblasts, positive for CD38, CD43, CD45, CD79a, and MUM1/IRF4 in all cases tested. Five of 6 (83%) cases were positive for CD30. CD20 was weakly positive in a subset of cells in 2 (25%) cases, and PAX5 was weakly positive in 4 (50%) cases. The immunoblasts expressed polytypic light chains in all cases tested. In 1 case, a subset of immunoblasts expressed T-cell markers indicating the presence of a T-cell component. The immunoblasts were negative for ALK, BCL-2, BCL-6, CD10, CD56, CD138, and Epstein-Barr virus–encoded small RNA in all cases assessed. The proliferation index shown by Ki-67 was high with a median of 80%. In all 6 cases tested, the immunoblasts were shown within lymphatic channels highlighted by D2-40. In conclusion, ILVIPs can be rarely observed in patients with inflammatory or infectious conditions, especially in gastrointestinal tract surgical specimens. The immunoblasts are predominantly of B-lineage with a postgerminal center immunophenotype and are located within lymphatic channels. It is essential to distinguish reactive ILVIPs from aggressive lymphomas to avoid unnecessary therapy.

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Section: Discussionsupporting

confidence: 79%

Reactive Intralymphovascular Immunoblastic Proliferations Mimicking Aggressive Lymphomas

Fang

Wang

Zhang

et al. 2021

American Journal of Surgical Pathology

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“…Immunoblasts may occur in sheets and show high proliferative activity and necrosis, sometimes resulting in a resemblance to diffuse large B cell lymphoma (DLBCL) 5 9. Another potential diagnostic pitfall is that the CD30-positive immunoblasts can sometimes resemble Hodgkin/Reed-Sternberg (HRS-like) cells (figure 1B), and coupled with a loss of CD45/leucocyte common antigen (LCA) and B cell markers and transcription factor expression that sometimes occurs in these cells,5 8 10 11 this can result in misdiagnosis of CHL 5 6 9…”

Section: Discussion Of Key Entitiesmentioning

confidence: 99%

“…The presence of EBV positivity in both large and small lymphocytes distinguishes it from EBV-positive DLBCL and CHL 5 6. Furthermore, CD15 is usually negative in the B-immunoblasts 5 6 9 11. There is however no substitute for close correlation with the clinical presentation and results of serological investigations 6.…”

Section: Discussion Of Key Entitiesmentioning

confidence: 99%

T cell-rich lymphoid infiltrates with large B cells: a review of key entities and diagnostic approach

Cheng

O’Connor

2016

J Clin Pathol

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Accurate diagnostic interpretation of a lymphoid population composed predominantly of small T cells, together with smaller numbers of large B cells, with or without a nodular architecture, is a common problem faced by the histopathologist. The differential diagnosis of this histological pattern is wide, ranging from reactive conditions such as drug reactions and viral infections, through borderline entities such as immunodeficiency-related lymphoproliferative disorders to lymphomas. The latter includes entities where the large B cells are primarily neoplastic (classical and nodular lymphocyte-predominant Hodgkin lymphomas and T cell/histiocyte-rich large B cell lymphoma) as well as T cell lymphomas such as angioimmunoblastic T cell lymphoma where the large B cells represent an epiphenomenon and may or may not be neoplastic. Several rare variants of these conditions, and the fact that treatment can significantly modify appearances, add to the diagnostic difficulty of these pathological entities. Unlike monomorphic lymphoid infiltrates, the histological pattern of T cell-rich proliferation with large B cells requires close evaluation of the inter-relationship between B cells and T cells, follicular dendritic cells and sometimes other inflammatory cells. Epstein-Barr virus plays a key role in several of these scenarios, and interpreting not only its presence but also its distribution within cellular subgroups is essential to accurate diagnosis and the avoidance of some important diagnostic pitfalls. An understanding of normal immunoarchitecture and lymphoid maturational pathways is also fundamental to resolving these cases, as is a knowledge of their common patterns of spread, which facilitates correlation with clinical and radiological findings.

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“…The clinicopathologic features of each case were reviewed retrospectively and included the patient's age and sex, history of lymphoma, the biopsy site, the FNA/core biopsy needle size (gauge) and the number of passes, image guidance (computed tomography-guided, ultrasound-guided), the professional who performed the procedure, the availability of a cell block and/or core biopsy, results from immunohistochemistry and flow cytometry ancillary studies, and the diagnosis of the biopsy and of any subsequent, related surgical excisional or incisional biopsy. Immunohistochemistry and in situ hybridization for EBV-encoded nucleic acid were performed as previously described 14 (for case-bycase immunohistochemistry panels, see Supporting Table 1. Flow cytometry was performed using a 10-channel, 8-color FACS Canto flow cytometer (Becton Dickinson) with commercially available antibodies in 11 of 13 cases, as previously described.…”

Section: Methodsmentioning

confidence: 99%

Role of FNA with core biopsy or cell block in patients with nodular lymphocyte‐predominant Hodgkin lymphoma

Gupta

Long

Natkunam

et al. 2020

Cancer Cytopathology

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BACKGROUND: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) represents a diagnostic challenge on surgical excisional or incisional biopsy. Classification is further challenging on fine needle aspiration (FNA) material accompanied by needle core and/or cell block biopsy (FNA+core/CB). METHODS: The authors studied all FNA+core/CB and surgical excisional or incisional biopsies to evaluate for lymphoma in patients who had a prior history of NLPHL or subsequent diagnosis of NLPHL over a 5-year period from 2012 through 2016. RESULTS: Patients who ultimately were diagnosed with NLPHL represented <0.5% of those who underwent FNA+core/CB for an initial suspicion of lymphoma. FNA+core/CB resulted in a definitive diagnosis in 7 of 13 cases, and surgical excisional or incisional biopsy specimens resulted in a definitive diagnosis in 13 of 13 cases (chi-square statistic, 9.6; P = .002). At initial diagnosis, FNA+core/CB was negative in 2 cases and atypical or suspicious in 3 cases; all 5 of those patients required surgical excisional or incisional biopsy for a definitive lymphoma diagnosis. By contrast, patients who underwent FNA+core/CB for recurrent lymphoma required surgical excisional or incisional biopsy in only 1 of 8 cases (chi-square statistic, 9.5; P = .002). Flow cytometry was positive for a light-chain-restricted B-cell population in only 1 of 11 biopsies that were involved by lymphoma. CONCLUSIONS: Surgical excisional or incisional biopsy remains the gold standard for NLPHL diagnosis and for distinguishing progression to a T-cell/histiocyte-rich large B-cell lymphoma pattern. At a tertiary cancer center with routine collaborative diagnosis of lymphoma on FNA+core/CB by cytopathologists and hematopathologists, FNA+core/CB performs well to assess for recurrent or transformed NLPHL, rarely requiring subsequent surgical excisional or incisional biopsy. FNA+core/CB has limited sensitivity in the initial diagnosis set-

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Variable Expression of B-cell Transcription Factors in Reactive Immunoblastic Proliferations

Cited by 12 publications

References 36 publications

Reactive Intralymphovascular Immunoblastic Proliferations Mimicking Aggressive Lymphomas

Reactive Intralymphovascular Immunoblastic Proliferations Mimicking Aggressive Lymphomas

T cell-rich lymphoid infiltrates with large B cells: a review of key entities and diagnostic approach

Role of FNA with core biopsy or cell block in patients with nodular lymphocyte‐predominant Hodgkin lymphoma

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