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.
By flow cytometry immunophenotyping, the lymphoma cells are positive for CD4, CD5, CD11c, CD19dim, CD22, CD30 (moderate, uniform), CD38 moderate, CD43, CD44. They are negative for CD10, CD20, CD23, CD200, and surface light chain.
These features are supportive of the diagnosis of relapsed DLBCL with CD5 and CD30 expression, and aberrant CD4 expression.
Digital slides: https://bit.ly/3sW4XwW| Slides labeled case 5