Case histories for Monterey Conference on Lymphoma

This 81 year old man underwent a lymph node biopsy in 1998. A diagnosis of follicular small cleaved cell lymphoma was made. The patient recently presented with enlarged right neck lymph nodes, one of which was removed. Flow cytometry showed that 90% of the lymphocytes labeled for CD19, 60% for CD20, 60% for CD5 and 85% for CD23.

Fig 1a. H&E stain (original magnification 50X)	Fig 1b. H&E stain (original magnification 1000X)
Fig 1c. CD20 stain (original magnification 1000X)	Fig 1d. CD5 stain (original magnification 1000X)
Fig 1e. Bcl-1 (cyclin D1) stain (original magnification 1000X)

This 47 year old man presented with mediastinal and peripheral lymphadenopathy, a right pleural effusion and weight loss. An excisional biopsy of a right axillary lymph node was performed. Immunohistochemistry was performed; the atypical cells labeled for CD79a, CD5 and Cyclin D1/BCL-1 but not for CD99 or TdT.

Submitted by Drs. Jyothsna Narla and S. Robert Freedman- Regional Medical Center of San Jose

This 73 year old woman presented with abdominal pain and underwent segmental resection of a constricting lesion in the proximal small bowel. Immunohistochemistry was performed; subsets of cells stained for CD20, CD43 and CD138. Most of the plasmacytoid cells stained for kappa light chains.

Fig 3a. H&E stain (original magnification 50X)	Fig 3b. H&E stain (original magnification 1000X)
Fig 3c. CD20 stain (original magnification 100X)	Fig 3d. Kappa Ig light chain stain (original magnification 1000X)
Fig 3e. Lambda Ig light chain stain (original magnification 1000X)

This 62 year old man underwent resection of a colon carcinoma in 1999. Recently he developed recurrent bouts of abdominal pain, nausea and vomiting. A small bowel mass was resected. The atypical cells were reported to stain for CD20 but not for cytokeratin, CD30 or CD3.

This 51 year old woman presented with a left neck mass. The large cells stain for CD20 and CD30 but not for CD15 or CD45. Kappa and lambda light chain stains are noncontributory. The cells also stain for the latent membrane protein of the Epstein Barr virus (EBV LMP).

Fig 5a. H&E stain (original magnification 1000X)	Fig 5b. CD30 stain (original magnification 1000X)
Fig 5c. CD15 stain (original magnification 1000X)	Fig 5d. LCA (CD45) stain (original mag. 1000X)
Fig 5e. CD20 stain (original magnification 1000X)

This 30 year old man has a longstanding history of ulcerative colitis. Several years ago the patient underwent a proctocolectomy. An ileal pouch was created with an ileal-anal anastomosis. He recently presented with abdominal pain and bleeding as well as inguinal adenopathy. A mass was removed from the ileal-anal junction and mesenteric lymph nodes were also sampled. The large cells labeled for CD30 , CD15, and EBV- LMP but not for CD20 or CD3.

This 49-year-old woman underwent excision of a chronically draining infection of the right shoulder. A biopsy was performed. The atypical cells stain for CD30, CD45 and partially for CD3 but not for keratin or S100. Additional staining shows reactivity for CD43 but not for the anaplastic lymphoma kinase (ALK).

This 16 year old male underwent biopsy of a nasal lesion in March 2000. After a diagnosis was rendered, he received radiation therapy followed by CHOP chemotherapy. He then developed bilateral cervical and axillary adenopathy as well as a large ulcerated lesion on the left arm. Numerous small fragments from an enlarged cervical lymph node were received. The atypical cells labeled for CD3 and CD56 and also contained EBV RNA (EBER).

Fig 8a. H&E stain (original magnification 1000X)	Fig 8b. CD3 stain (original magnification 1000X)
Fig 8c. CD20 stain (original magnification 1000X)	Fig 8d. CD56 stain (original magnification 1000X)

H&E	H&E 60x
bcl 1	CD 20

H&E	H&E 60x
CD 20 10x	CD 20 20x

H&E 2x	H&E 60x
CD 15	CD 30

H&E 4x	H&E 40x
CD 30	CD 43