Section: Malignant Hematology: Lymphomas
Weekly Hematopathology Image Challenge 1/06/2018
Q1. Lymphnode biopsy section from a 60 year old male with generalised lymphadenopathy is given below. On IHC the tumor cells are positive for CD3, CD4 , CD10 and PD1. There is marked proliferation of CD21 positive cells in biopsy sections. The likely diagnosis based upon HPE and IHC as described will be
Image ref: Blood Journal: Published 31 December 1969
Choose correct answer among following options:-
- Peripheral T-cell lymphoma, NOS
- Angioimmunoblastic T-cell lymphoma
- Follicular T-cell lymphoma
- Anaplastic Large cell Lymphoma
Correct answer = 2 = Angioimmunoblastic T-cell lymphoma
What is appreciable in LN HPE section is prominent high endothelial venules and a polymorphous infiltrate.
What IHC is telling us is:-
- Tumor cells are T cells with positive CD4, CD10 and PD1 ie tumor cells are derived from T Helper cells.
- Prominent proliferation of CD21 +ve cells tells that their Follicular dendritic cell hyperplasia.
So in LN pathology = Lymphoma with Polymorphous infiltrate + Tumor cells of T helper phenotype + Follicular dendritic cell proliferation and prominent high endothelial venules = Angioimmunoblastic T cell Lymphoma (AITL)