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Updated: Aug 8, 2026
Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma
Published on: January 9, 2019
Anaplastic large-cell lymphoma (Ki-1 lymphoma) and diffuse large-cell immunoblastic lymphoma: two diagnostic problem
J A King1, R L Martino, J A Tucker
1Department of Pathology, University of South Alabama, Mobile 36617-2293, USA.
Insights
Electron microscopy aids in diagnosing difficult neoplasia cases, particularly anaplastic tumors initially unrecognized as lymphoma. This technique proved valuable in two cases, enabling accurate lymphoma diagnosis when histology was inconclusive.
Area of Science:
- Oncology
- Pathology
- Diagnostic Imaging
Background:
- Electron microscopy (EM) is not typically a primary tool for lymphoma diagnosis.
- However, EM can be crucial for diagnosing anaplastic tumors that are not initially identified as lymphomas.
Observation:
- Two challenging cases are presented where initial histological examination did not suggest lymphoma.
- Case 1: A retroperitoneal mass in a 60-year-old woman showed nuclear pockets on EM, leading to a diagnosis of anaplastic large-cell lymphoma (Ki-1 lymphoma).
- Case 2: A 43-year-old male with retroperitoneal lymphadenopathy and systemic symptoms exhibited signet-ring cells without junctions on EM, confirmed as diffuse large-cell immunoblastic lymphoma via immunoperoxidase stains.
Findings:
- EM identified specific ultrastructural features (nuclear pockets, signet-ring cells without junctions) indicative of lymphoma.
- These findings were critical in cases where conventional histology was ambiguous.
- The diagnoses were ultimately confirmed with additional methods like immunoperoxidase staining.
Implications:
- Electron microscopy offers unique diagnostic value in challenging neoplasia cases, especially when lymphoma is not initially suspected.
- This highlights the importance of considering EM in the differential diagnosis of poorly differentiated or anaplastic tumors.
- EM can refine diagnoses and guide appropriate treatment strategies for lymphomas presenting with unusual histological features.
Abstract:
Electron microscopy can be used to establish diagnoses in some otherwise difficult cases of neoplasia, but it is not generally regarded as important in the diagnosis of lymphoma. However, in some cases of anaplastic tumors not initially recognized as lymphomas, electron microscopy can prove quite valuable. Two cases are reported in which lymphoma was not suspected on the basis of the histologic findings, but was diagnosed by electron microscopy. Case 1 involved a 60-year-old woman who presented with a retroperitoneal mass that was located primarily in the body of the psoas muscle. Nuclear pockets were seen with electron microscopy. Ultimately she was diagnosed with anaplastic large-cell lymphoma (Ki-1 lymphoma). Case 2 involved a 43-year-old male with retroperitoneal lymphadenopathy, renal failure, polyclonal gammopathy, and a febrile illness. Signet-ring cells without junctions were identified with electron microscopy. Immunoperoxidase stains confirmed diffuse large-cell immunoblastic lymphoma.
