Bcl-2 and BLIMP-1 expression predict worse prognosis in gastric diffuse large B cell lymphoma (DLCBL) while other markers for nodal DLBCL are not useful.

AIMS: Previous studies have identified clinicopathological and immunohistochemical differences among diffuse large B cell lymphomas (DLBCL) as a function of disease location. Nevertheless, there is a continuing tendency to generalize the prognostic value of various identified markers without taking into account tumour site. Accordingly, we analysed the prognostic value of several of the immunohistochemical markers that have been proposed for nodal DLBCL in a group of patients with gastric DLBCL. METHODS AND RESULTS: Using histochemical methods, CD10, Bcl-6, Gcet1, MUM-1, Bcl-2 and BLIMP-1 expression was investigated in 43 cases of gastric DBLCL. As in nodal DLBCLs, expression of BLIMP-1, and of Bcl-2 in non-germinal centre B cell-like (non-GCB) patients, was associated with a worse prognosis. However, unlike nodal DBLCL, there was no significant association of prognosis with expression of CD10, Bcl-6, Gcet1 or MUM-1, or with categorization according to Hans or Muris algorithms. CONCLUSIONS: Although most markers of prognosis in nodal DLBCL are not useful indicators for gastric DLBCL, Bcl-2 or BLIMP-1 expression does correlate with worse prognosis. These data support the notion that clinicopathological features in DLBCL vary according to the disease location.

Paragastric paraganglioma: a case report with unusual alveolar pattern and myxoid component.

Paragangliomas are neural crest-derived neuroendocrine tumors. Nearly 5 to 10% occur in extraadrenal sites, from the upper cervical region to the pelvis, related to the autonomic nervous system. Very few cases of gastric or paragastric paragangliomas have been reported. We report a paraganglioma attached to the stomach of an 85-year-old man. The tumor was 15 cm in diameter and was surgically resected via a subtotal gastrectomy. Fine-needle aspiration smears showed round epithelioid cells forming acini and spindle cells attached to capillaries. Occasional cells showed excentric nuclei and pale vesicular cytoplasm. Microscopically, the tumor was characterized by an alveolar and solid pattern of growth with some unusual features, such as myxoid stroma and pseudoalveoli that contained myxoid material. Spindle cells stained with vimentin and S-100 protein, whereas epithelioid cells showed diffuse cytoplasmic staining with chromogranin A. Electron microscopy of the tumor tissue revealed the presence of neurosecretory granules. To the best of our knowledge, this pattern of growth has yet to be described in the literature and may result in a misdiagnosis if sufficient immunohistochemical markers are not employed. We briefly discuss the cytomorphological features and differential diagnosis of this tumor, which was discovered in a rare location.

Potential misdiagnosis of angioimmunoblastic T-cell lymphoma with Hodgkin's lymphoma: a case report.

BACKGROUND: Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive neoplasm. We investigated the potential utility of touch imprints evaluated in conjunction with the histology of lymph nodes in the diagnosis of AITL. CASE A 58-year-old man presented with generalized lymphadenopathy, splenomegaly, and autoimmune phenomena, which complicated the diagnosis. Touch imprints were obtained from the lymph node biopsy, which were valuable in making the correct diagnosis. The cytologic and microscopic features of these imprints and lymph node samples showed a heterogeneous population of hematolymphoid cells, including small to intermediate lymphoid cells, immunoblasts, plasma cells, dendritic cells, and eosinophils, as well as small vessels that were surrounded by some of the abnormal cells. Neoplastic cells stained positive for CD3, CD4, and CD5. Isolated immunoblasts stained with CD20 and CD30. CONCLUSION: We draw attention to this neoplastic diagnosis and correlate the cytomorphologic and immunohistochemical findings with the adequate clinical setting in order to avoid misdiagnosis, primarily with Hodgkin's lymphoma and reactive hyperplasia. Touch imprints are useful in the diagnosis of AITL if the broad population of proliferating cells is distinguished. However, some cases display binucleated or mononucleated cells with prominent nucleoli and many eosinophils, which may induce a potential misdiagnosis with Hodgkin's lymphoma.

Littoral-cell angioma of the spleen: a case report.

Littoral-cell angioma (LCA) is a primary splenic vascular tumor that arises from the normal littoral cells lining the sinus channels of the splenic red pulp. We report a case of LCA of the spleen, which has been infrequently communicated in the literature. A 76-year-old man with a 2-wk history of weight loss, abdominal pain and changes in bowel habits was admitted to our hospital. Imaging studies (CT and MRI) showed multiple lesions in the spleen. Splenectomy was performed. Lining cells were positive for CD31/CD68 markers. Our case was associated with a serrated colonic adenoma. LCA is a benign vascular tumor of the spleen that needs to be included in the differential diagnosis of multiple splenic nodules.

AA-type amyloid tumor as an unsuspected cause of residual mass in a patient with large B-cell non-Hodgkin's lymphoma.

Amyloidosis is a rare complication of non-Hodgkin's lymphoma (NHL). AL amyloid deposits are usually localized in areas adjacent to the lymphoma, despite the presence of circulating light chains. However, AA-type amyloidosis is extremely unfrequent as a residual mass in patients with NHL. We report a case with diffuse large B-cell non-Hodgkin's lymphoma in which a residual tumoral mass corresponding to AA-type amyloidosis was found.