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Diffuse large B cell lymphoma with chronic granulomatous inflammation
W W T Nyunt1, Y P Wong, W F Wan Jamaludin
1Cell Therapy Centre, Level 2, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia. wint@ppukm.ukm.edu.my.
The Malaysian Journal of Pathology
|April 30, 2016
Summary
A rare case highlights diffuse large B cell lymphoma presenting as granulomatous inflammation. Early detection of obscure tumor cells within granulomas is crucial for timely lymphoma diagnosis and treatment.
Area of Science:
- Oncology
- Pathology
- Immunology
Background:
- Non-necrotic epithelioid granulomas are infrequently associated with neoplasms, including lymphomas.
- Prompt diagnosis of lymphoma is essential for effective management and improved patient outcomes.
Observation:
- A 39-year-old woman presented with symptoms mimicking tuberculosis, including dyspnea and weight loss.
- Initial CT-guided biopsy revealed chronic granulomatous inflammation, leading to a presumptive diagnosis of tuberculosis.
- Despite anti-TB treatment, symptoms persisted, prompting a second biopsy.
Findings:
- The second biopsy diagnosed diffuse large B cell lymphoma (DLBCL).
- Histopathological review of the initial sample identified noncaseating granulomas containing CD20-positive tumor cells with a high Ki-67 proliferation index.
- The patient was diagnosed with stage IV B DLBCL and IPSS score 3.
Implications:
- This case underscores the importance of considering lymphoma in the differential diagnosis of granulomatous inflammation, especially when initial treatments fail.
- Awareness of obscure tumor cells within granulomas can prevent diagnostic delays in lymphoma.
- Timely diagnosis and appropriate chemotherapy (R-EPOCH) led to a positive treatment response.
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