Related Experiment Video
Updated: May 14, 2026
Isolating Human Peripheral Blood Mononuclear Cells and CD4+ T cells from Sézary Syndrome Patients for Transcriptomic Profiling
Published on: October 14, 2021
Extreme signet ring cell change in a large B-cell lymphoma of follicular origin
Agata Monika Bogusz1, Bethany Tierno, Daniel Brown
1Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
Insights
This study describes a rare follicular lymphoma with extensive signet ring cell features. These unique cellular changes initially obscured the lymphoma
Area of Science:
- Hematopathology
- Oncology
- Cell Biology
Background:
- Follicular lymphoma is a common type of non-Hodgkin lymphoma.
- Signet ring cell morphology is typically associated with adenocarcinomas, not lymphomas.
Observation:
- A case of follicular lymphoma presented with unusual, extensive signet ring cell differentiation.
- Initial biopsy suggested follicular lymphoma, but cohesive sheets of signet ring cells prompted further investigation.
- The excised lymph node showed follicular lymphoma alongside a neoplasm of large atypical cells with clear intracytoplasmic vacuoles.
Findings:
- Tumor cells were CD20, BCL-2, BCL-6, and CD10 positive, confirming B-cell origin.
- Tumor cells lacked mucin and pancytokeratin, ruling out epithelial origin.
- Electron microscopy confirmed electron-lucent vacuoles without specific internal structures.
Implications:
- This case highlights the importance of considering unusual presentations in lymphoma diagnosis.
- Extreme signet ring cell differentiation can mimic other malignancies, necessitating comprehensive diagnostic workup.
- Understanding this rare morphology expands the differential diagnosis for signet ring cell tumors.
Abstract:
We report a large B-cell lymphoma of follicular origin with extreme signet ring cell differentiation. Initially classified as follicular lymphoma on a fine needle core biopsy, the presence of cohesive sheets of extrafollicular signet ring cells triggered an excisional biopsy for further characterization. The excised lymph node revealed focal follicular hyperplasia, follicular lymphoma, and a neoplasm composed of vague nodules and sheets of large atypical cells, all of which virtually exhibited large clear intracytoplasmic vacuoles with peripheral displacement of nuclei. The tumor cells were negative for mucin and lacked immunoreactivity with pancytokeratin, but were strongly immunoreactive with CD20, BCL-2, BCL-6, and CD10 antibodies. Electron microscopy studies revealed electron-lucent vacuoles with no particular internal structure. This case is unique in that extreme signet ring cell differentiation somewhat obscured the true cytological identity of the interfollicular lymphoma and suggested alternative diagnoses.
More Related Videos
15:07VDJ-Seq: Deep Sequencing Analysis of Rearranged Immunoglobulin Heavy Chain Gene to Reveal Clonal Evolution Patterns of B Cell Lymphoma
Published on: December 28, 2015
07:13Comparison of Predictive Performance of Three Lymph Node Staging Systems in Colorectal Signet Ring Cell Carcinoma Based on Machine Learning Model
Published on: April 18, 2025
