A Unique “Composite” PTLD with Diffuse Large B-Cell and T/Anaplastic Large Cell Lymphoma Components Occurring 17 Years after Transplant

Posttransplant lymphoproliferative disorder (PTLD) comprises a spectrum ranging from polyclonal hyperplasia to aggressive monoclonal lymphomas. The majority of PTLDs are of B-cell origin while T-cell PTLDs and Hodgkin lymphoma-like PTLDs are uncommon. Here, we report a unique case of a 56-year-old man in whom a lymphoma with two distinct components developed as a duodenal mass seventeen years following a combined kidney-pancreas transplant. This PTLD, which has features not previously reported in the literature, consisted of one component of CD20 positive and EBV negative monomorphic diffuse large B-cell lymphoma. The other component showed anaplastic morphology, expressed some but not all T-cell markers, failed to express most B-cell markers except for PAX5, and was diffusely EBV positive. Possible etiologies for this peculiar constellation of findings are discussed and the literature reviewed for “composite-like” lymphomas late in the posttransplant setting.

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Expression of X-Linked Inhibitor of Apoptosis Protein in Reactive Lymphoid Tissues, Non-Hodgkin’s Lymphomas, and Hodgkin’s Disease.

Blood ◽

10.1182/blood.v106.11.4655.4655 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4655-4655

Author(s):

James A. Strauchen ◽

David Burstein

Keyword(s):

T Cell ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large Cell ◽

Hodgkin Disease ◽

Large B Cell Lymphoma ◽

Apoptosis Protein ◽

Mantle Cell ◽

Large B Cell

Abstract X-linked inhibitor of apoptosis protein (XIAP) is an important regulator of apoptosis which binds to and inhibits caspases-3, -7 and -9, blocking the caspase 9-mediated apoptosis pathway. This pathway is activated by p53 and DNA damage and may be an important determinant of responsiveness to chemotherapy. Apoptosis also plays a major role in the regulation of follicle center B-cell proliferation and BCL2-mediated inhibition of apoptosis is a key factor in B-cell lymphomagenesis. In this study we examined the expression of XIAP in 65 reactive and neoplastic lymphoid proliferations utilizing a monoclonal antibody to XIAP (#610763 BD Biosciences, San Jose, CA) and immunohistochemistry with avidin-biotin-complex immunoperoxidase technique on formalin-fixed, paraffin-embedded sections. In reactive lymph nodes and tonsils, expression of XIAP was limited to large noncleaved cells in follicle centers (5 of 6 cases). XIAP was absent in plasmacytoma (3 cases) and small lymphocytic lymphoma/chronic lymphocytic leukemia (1 case). XIAP was expressed in follicular lymphoma, predominantly in large noncleaved cells (6 of 9 cases) and in diffuse large B cell lymphoma (11 of 16 cases), including cases of T-cell/histiocyte-rich diffuse large B cell lymphoma (2 cases), primary mediastinal large B cell lymphoma (1 case), and posttransplantation diffuse large B cell lymphoma (1 case). XIAP was consistently expressed in Burkitt and Burkitt-like lymphoma (3 of 3 cases) and anaplastic large cell lymphoma (3 of 3 cases) and in one case of adult T cell leukemia/lymphoma. XIAP was variably expressed in marginal-zone B cell lymphoma, predominantly in large blasts (2 of 4 cases) and in mantle cell lymphoma (2 of 3 cases). XIAP was not detected in peripheral T cell lymphoma, unspecified (1 case), extranodal NK/T cell lymphoma, nasal type (1 case), precursor B cell lymphoblastic leukemia (1 case), or granulocytic sarcoma (1 case). XIAP was consistently expressed in the Reed-Sternberg and mononuclear Reed-Sternberg-variant cells of classical Hodgkin disease (9 of 9 cases) and the L+H Reed-Sternberg-variant cells of nodular lymphocyte predominance Hodgkin disease (3 of 3 cases). XIAP is expressed across a broad range of lymphoproliferative disorders, including classical and nodular lymphocyte predominance Hodgkin disease, diffuse large B cell lymphoma, follicular lymphoma, Burkitt lymphoma, marginal-zone and mantle cell lymphoma, and anaplastic large cell lymphoma. XIAP appears to be selectively expressed in the proliferating elements of these lymphomas. The possible prognostic and therapeutic significance of XIAP expression needs to be determined.

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CD7 Positive Diffuse Large B-Cell Lymphoma Arising in a Background of Follicular Lymphoma: A Case Report and Review of the Literature

Case Reports in Hematology ◽

10.1155/2016/5415974 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Elham Vali Betts ◽

Hooman H. Rashidi

Keyword(s):

T Cell ◽

Follicular Lymphoma ◽

B Cell ◽

Cell Lymphoma ◽

Prognostic Significance ◽

B Cell Lymphoma ◽

Cell Markers ◽

Large B Cell Lymphoma ◽

T Cell Antigens ◽

Large B Cell

Diffuse large B-cell lymphoma (DLBCL) is a neoplasm of large B-lymphocytes with a diffuse growth pattern. The neoplastic cells express B-cell markers such as CD20 and PAX-5 and there may be coexpression of BCL-2, BCL-6, CD10, and MUM-1. With the exception of CD5, other T-cell markers are not commonly expressed in this neoplasm. Here, we describe the first reported case of a DLBCL with abnormal expression CD7 arising in a background of follicular lymphoma in an 81-year-old male who presented with a nontender left axillary mass. Additionally, no other T-cell antigens were expressed in this B-cell lymphoma. Expression of CD7 in DLBCL is exceptionally rare and its prognostic significance is unknown. Here, we describe this rare case with review of literature of known DLBCLs with expression of T-cell antigens.

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CD30 Expression in Monomorphic Posttransplant Lymphoproliferative Disorder, Diffuse Large B-Cell Lymphoma Correlates With Greater Regulatory T-Cell Infiltration

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqx097 ◽

2017 ◽

Vol 148 (6) ◽

pp. 485-493 ◽

Cited By ~ 5

Author(s):

Christopher Hartley ◽

James W Vaughan ◽

Jason Jarzembowski ◽

Steven H Kroft ◽

Paul Hosking ◽

...

Keyword(s):

T Cell ◽

B Cell ◽

Regulatory T Cell ◽

Lymphoproliferative Disorder ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Posttransplant Lymphoproliferative Disorder ◽

T Cell Infiltration ◽

Large B Cell Lymphoma ◽

Large B Cell

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PRDM1/BLIMP1 is commonly inactivated in anaplastic large T-cell lymphoma

Blood ◽

10.1182/blood-2013-04-497933 ◽

2013 ◽

Vol 122 (15) ◽

pp. 2683-2693 ◽

Cited By ~ 60

Author(s):

Michela Boi ◽

Andrea Rinaldi ◽

Ivo Kwee ◽

Paola Bonetti ◽

Maria Todaro ◽

...

Keyword(s):

T Cell ◽

Tumor Suppressor ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large Cell ◽

Suppressor Gene ◽

Large B Cell Lymphoma ◽

Key Points ◽

Large B Cell

Key Points The commonest lesions in anaplastic large cell lymphomas are losses at 17p13 and at 6q21, concomitant in up to one-quarter of the cases. PRDM1 (BLIMP1) gene (6q21) is inactivated by multiple mechanisms and acts as a tumor suppressor gene in anaplastic large B-cell lymphoma.

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Collision Anaplastic Large Cell Lymphoma (T-Cell/Histiocyte-Rich) and Diffuse Large B Cell Lymphoma: A Pathologic and Clinical Evaluation

Journal of Cancer Therapy ◽

10.4236/jct.2012.36138 ◽

2012 ◽

Vol 03 (06) ◽

pp. 1060-1065

Author(s):

Lakshmi Rajappannair ◽

Elaine Lam ◽

Don Benson ◽

Frederick Racke ◽

Steven Devine ◽

...

Keyword(s):

T Cell ◽

B Cell ◽

Clinical Evaluation ◽

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large Cell ◽

Large B Cell Lymphoma ◽

Large Cell Lymphoma ◽

Large B Cell

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Aberrant expression of multiple T cell markers on diffuse large B cell lymphoma: a case report

Journal of the Egyptian National Cancer Institute ◽

10.1186/s43046-021-00071-7 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Anurag Mehta ◽

Prerna Chadha ◽

Poojan Agarwal ◽

Sunil Pasricha

Keyword(s):

T Cell ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Antigen Expression ◽

Aberrant Expression ◽

Cell Markers ◽

Cell Antigen ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Background Aberrant T cell antigen expression has been well documented in diffuse large B cell lymphomas. However, co-expression of multiple T cell antigens including CD3, which has been considered a specific marker for T cells is extremely rare. Awareness about such aberrant expression is important so as not to misdiagnose or wrongly classify a lymphoma. The aim of this article is to report such a case. Case presentation A 68-year-old postmenopausal lady, diabetic and hypertensive, presented with an axillary lump of one week’s duration. There was no other relevant medical history. Ultrasonography revealed multiple hypoechoic cystic lesions varying in size from 3.9 to 4.2 cm3. Aspiration was suggestive of an infective pathology. Excision biopsy of the mass was diagnosed as diffuse large B cell lymphoma with aberrant T cell antigen expression. She received 4 cycles of chemotherapy after which she was lost to follow-up. Conclusion The case presented as a diagnostic dilemma for the pathologist. The predicament lies in classifying it as a B cell lymphoma with an aberrant expression of T cell markers versus a T cell lymphoma with an aberrant B cell marker expression which has a significant implication on the treatment offered. This can be solved by looking at the expression of the B cell specific transcription factors. The key to diagnosis lies in the knowledge of their existence and the application of a panel of markers.

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Fibrin‐associated diffuse large B‐cell lymphoma misdiagnosed as breast implant‐associated anaplastic large cell lymphoma

Histopathology ◽

10.1111/his.14372 ◽

2021 ◽

Author(s):

Mina Mansy ◽

Andrew C Wotherspoon ◽

Dima El‐Sharkawi ◽

David Cunningham ◽

Dorte Wren ◽

...

Keyword(s):

B Cell ◽

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implant ◽

B Cell Lymphoma ◽

Large Cell ◽

Large B Cell Lymphoma ◽

Large Cell Lymphoma ◽

Large B Cell

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Use of immune repertoire sequencing to resolve discordant microscopic and immunochemical findings in a case of T cell-rich large B cell lymphoma in a young dog

BMC Veterinary Research ◽

10.1186/s12917-021-02783-3 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Gary Kwok Cheong Lee ◽

Dorothee Bienzle ◽

Stefan Matthias Keller ◽

Mei-Hua Hwang ◽

Nikos Darzentas ◽

...

Keyword(s):

T Cells ◽

T Cell ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Immune Repertoire ◽

Large B Cell Lymphoma ◽

Repertoire Sequencing ◽

Reactive Lymphocytes ◽

Large B Cell

Abstract Background Lymphocytic neoplasms with frequent reactive lymphocytes are uncommonly reported in dogs, and can pose a diagnostic challenge. Different diagnostic modalities such as cytology, flow cytometry, histopathology, immunohistochemistry, and clonality testing, are sometimes required for a diagnosis. This report illustrates the value of using a multi-modal diagnostic approach to decipher a complex lymphocytic tumor, and introduces immune repertoire sequencing as a diagnostic adjunct. Case presentation A 10-month-old Great Dane was referred for marked ascites. Cytologic analysis of abdominal fluid and hepatic aspirates revealed a mixed lymphocyte population including numerous large lymphocytes, yielding a diagnosis of lymphoma. Flow cytometrically, abdominal fluid lymphocytes were highly positive for CD4, CD5, CD18, CD45, and MHC II, consistent with T cell lymphoma. Due to a rapidly deteriorating clinical condition, the dog was euthanized. Post mortem histologic evaluation showed effacement of the liver by aggregates of B cells surrounded by T cells, suggestive of hepatic T cell-rich large B cell lymphoma. Immune repertoire sequencing confirmed the presence of clonal B cells in the liver but not the abdominal fluid, whereas reactive T cells with shared, polyclonal immune repertoires were found in both locations. Conclusions T cell-rich large B cell lymphoma is a rare neoplasm in dogs that may be challenging to diagnose and classify due to mixed lymphocyte populations. In this case, the results of histopathology, immunohistochemistry and immune repertoire sequencing were most consistent with a hepatic B cell neoplasm and reactive T cells exfoliating into the abdominal fluid. Immune repertoire sequencing was helpful in delineating neoplastic from reactive lymphocytes and characterizing repertoire overlap in both compartments. The potential pitfalls of equating atypical cytomorphology and monotypic marker expression in neoplasia are highlighted.

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