[Application of digital pathology tools. An unusual case of non-Hodgkin lymphoma]
A-S K Meyer1, F E Dallenbach, G Lienert
1Institut für Pathologie, Universität Ulm, Ulm.
Insights
Digital pathology enhances lymphoma diagnosis by integrating morphology, immunophenotyping, and molecular data. This case highlights its utility in diagnosing rare T-cell and plasma cell lymphomas.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Lymphoma diagnosis relies on morphology, immunophenotyping, and molecular testing.
- Digital pathology offers advanced visualization for integrating diagnostic data.
Observation:
- A 45-year-old woman presented with skin rash and lymphadenopathy.
- Histology revealed diffuse infiltration and increased mitotic activity.
- Immunohistochemistry showed atypical T-cell infiltration and MUM1-positive plasma cells.
Findings:
- Digital image analysis quantified proliferation in T-cells (>60%), plasma cells (>50%), and B-cells (20%).
- PCR confirmed monoclonal rearrangement in T-cell receptor gamma and immunoglobulin heavy chains.
- The case presented an unusual combination of angioimmunoblastic T-cell lymphoma (AITL) and plasma cell lymphoma.
Implications:
- Digital pathology aids in visually integrating complex morphological and molecular findings.
- This technology can improve the diagnostic accuracy of rare and challenging lymphoma cases.
- Enhanced visualization facilitates a comprehensive understanding of lymphoma subtypes and their interactions.
Abstract:
Currently, lymphoma diagnosis is based on a combination of morphology, immunophenotyping, and molecular testing. Using the example of an unusual case of malignant non-Hodgkin lymphoma, we show that improved visualization using digital pathology contributes to the convergence of these complementary diagnostic modalities. A 45-year-old woman presented with skin rash and cervical lymphadenopathy. Histological workup of an excised lymph node showed loss of normal architecture with diffuse infiltration and increased mitotic activity. Immunohistochemistry for CD3/CD5 showed atypical arrangement and infiltration of a T-cell population that dominated over regionally dense, MUM1-positive plasmacellular infiltrates. Expanded CD21/CD23-positive meshworks of follicular dendritic cells were present within and between regressed follicles and the T-cell infiltrate; staining for CD56 and cyclin-D1 was negative. Quantification of Ki-67 staining within the T-, B- and plasmacellular compartments was achieved by digital image conversion, overlay and subsequent quantification algorithms that revealed proliferation within more than 60% of T-cells, over 50% of plasma cells and only 20% of B-cells. Clonality analysis by PCR revealed monoclonal rearrangement for both T-cell receptor gamma chains and immunoglobulin heavy chains. Taken together, we present an unusual combination of an angioimmunoblastic T-cell lymphoma (AITL) and simultaneous plasmacellular lymphoma. This report demonstrates how application of modern tools of digital pathology can visually integrate unusual morphological and molecular findings.
