Relapsed CD4, CD5 & CD30-Positive DLBCL with Immunoblastic Features

Lessons From the Friday Unknowns

The patient has a history of DLBCL.

Histologic sections show multiple cylindrical cores of lymphoid tissue, with focal area of hemorrhage, necrosis and sclerosis involved by lymphoma.

The neoplastic cells are composed of large atypical lymphocytes with vesicular nuclei and irregular nuclear contours, these neoplastic cells appear to be predominantly centroblast and immunoblasts.

Also seen are other atypical cells with curved irregular nuclei resembling hallmark-like cells. Mitoses and apoptotic debris are equally seen.

The neoplastic cells are positive for CD4, BCL-2, BCL6, cyclin D1 (weakly positive in a subset of cells), and negative for EBER, MUM1 (only a small subset positive, ~30%), SOX 11, PD-1, ALK1 and CD138. MYC is positive in about 30% of cells overall, patchy.