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Clear cell variant of diffuse large B-cell lymphoma: a case report
Suzana Manxhuka-Kerliu1, Gordana Petrusevska, Irma Kerliu
1Faculty of Medicine, Institute of Pathology, University of Prishtina, Mother Theresa Street NN, 10 000, Prishtina, Kosovo. skerliu@hotmail.com.
Insights
A rare clear cell variant of diffuse large B-cell lymphoma was identified in a neck lymph node. Immunohistochemical analysis confirmed this diagnosis, distinguishing it from metastatic carcinoma.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Diffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin lymphoma characterized by large neoplastic B cells.
- A clear cell variant of DLBCL is rare and can be mistaken for other malignancies, such as metastatic carcinoma.
- Accurate diagnosis is crucial for appropriate treatment and patient management.
Purpose of the Study:
- To report a case of a clear cell variant of DLBCL presenting as a neck lymph node mass.
- To highlight the diagnostic challenges and the importance of immunohistochemistry in differentiating this variant from metastatic carcinoma.
- To describe the clinical presentation, pathological findings, and treatment of this rare lymphoma subtype.
Main Methods:
- A 39-year-old male presented with a rapidly enlarging neck lymph node and B symptoms.
- Fine-needle aspiration and subsequent lymph node biopsy were performed.
- Histopathological examination and immunohistochemical staining (CD20, Bcl-2, Bcl-6, CD5, CD3, CD21, PSA, HMB45, Melan-A, CK7, MUM1, Ki-67) were conducted.
Main Results:
- The lymph node biopsy revealed a clear cell variant of DLBCL with a partial alveolar growth pattern.
- Immunohistochemistry showed CD20+, Bcl-2+, MUM1+ (30%), Ki-67 (80%), and negative staining for cytokeratins, PSA, HMB45, Melan-A, and CK7.
- These findings excluded metastatic carcinoma and confirmed the diagnosis of DLBCL, activated B-cell type, post-germinal center origin.
Conclusions:
- The patient was diagnosed with a clear cell variant of diffuse large B-cell lymphoma.
- Immunohistochemical profile was key in differentiating this lymphoma from metastatic carcinoma.
- The patient is currently undergoing R-CHOP chemotherapy.
Introduction:
Diffuse large B-cell lymphoma is a diffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to or exceeding the normal macrophage nuclei. We report a case of a clear cell variant of diffuse large B-cell lymphoma involving a lymph node in the neck, which was clinically suspected of being metastatic carcinoma.
Case Presentation:
A 39-year-old Caucasian ethnic Albanian man from Kosovo presented with a rapidly enlarging lymph node in his neck, but he also disclosed B symptoms and fatigue. A cytological aspirate of the lymph node revealed pleomorphic features. Our patient underwent a cervical lymph node biopsy (large excision). The mass was homogeneously fish-flesh, pale white tissue replacing almost the whole structure of the lymph node. The lymph node biopsy showed a partial alveolar growth pattern, which raised clinical suspicion that it was an epithelial neoplasm. With regard to morphological and phenotypic features, we discovered large nodules in diffuse areas, comprising large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. In these areas, there was high mitotic activity, and in some areas there were macrophages with tangible bodies. Staining for cytokeratins was negative. These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).
Conclusion:
According to the immunohistochemical findings, we concluded that this patient has a clear cell variant of diffuse large B-cell lymphoma of activated cell type, post-germinal center cell origin. Our patient is undergoing R-CHOP chemotherapy treatment.