8/22/2020 1 2020 Virtual Pathology Course Deniz Peker, MD Associate Professor Hematopathology 8/22/2020 “What makes it a lymphoma?” Deniz Peker, MD Disclosure • No conflict of interest to disclose 1 2 3
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![Page 1: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/1.jpg)
8/22/2020
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2020 Virtual Pathology Course
Deniz Peker, MDAssociate Professor
Hematopathology
8/22/2020
“What makes it a lymphoma?”
Deniz Peker, MDDisclosure
• No conflict of interest to disclose
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![Page 2: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/2.jpg)
8/22/2020
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Clinical History
89 year old male with history of Crohn’s disease was found to have multiple necrotic and ulcerating lesions in oral cavity
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![Page 3: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/3.jpg)
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• A lip biopsy was performed
Microscopy and Immunophenotype
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![Page 4: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/4.jpg)
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![Page 5: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/5.jpg)
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CD20
CD20
PAX5
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![Page 6: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/6.jpg)
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CD30
MUM1
EBER
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![Page 7: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/7.jpg)
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Diagnosis:EBV-associated lymphoproliferative disorder
What do you mean by $jfk#@?
Differential Diagnosis
1. EBV+ mucocutaneous ulcer
2. EBV+ diffuse large B-cell lymphoma, NOS
EBV+ Diffuse Large B-cell Lymphoma
EBV+ Mucocutaneous Ulcer
LocationSystemic nodal/extranodaldisease
Skin Mucosa (oral, GI)
Risk Factors Older age Immunosuppresion
Microscopy
• Large transformed immunoblasts
• Hodgkin/Reed-Sternberg-like cells
• Inflammatory background
• Large transformed immunoblasts• Hodgkin/Reed-Sternberg-like cells• Inflammatory background
Imuunophenotype
• CD19, CD20, PAX5, CD79a• MUM1• CD30• PDL1 and PDL2
• CD20, PAX5, OCT2• MUM1• CD30 and CD15*
Molecular Clonal Clonal or non-clonal
TreatmentChemo-immunotherapy Reduction of immunosuppression
RituximabLocal radiation
Prognosis Poor Good
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Clinical Information!
EBV+ MCU• No systemic symptoms
i.e. fever, night sweats, weight loss
• Localized lesion
EBV+ DLBCL• B-symptoms
• Systemic disease
EBV+ MUCOCUTANEOUS ULCER
• Age or immunosuppressant-related immunodeficiency
• Cutaneous and mucosal ulcers, no systemic disease
• Classical Hodgkin lymphoma, diffuse large B-cell lymphoma or monomorphic PTLD-like morphology and immunophenotype
• Angioinvasion and necrosis can be present
• EBER+; serum EBV titers not elevated (unlike PTLD)
• Good prognosis, often spontaneous regression with reduced immunosuppresants
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![Page 9: ^t Z u l ] o Ç u Z } u M · 2020. 10. 5. · o ] l o o •/ v ( o u u } Ç l P } µ v •> P v ( } u ] u u µ v } o •, } P l ] v lZ r^ v P r o ] l o o •/ v ( o u u } Ç l P }](https://reader036.cupdf.com/reader036/viewer/2022071216/604904b8a6838d1c251385cf/html5/thumbnails/9.jpg)
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Take Home..
• Diagnostic line: “EBV+ lymphoproliferative disorder, see comment”
• Discuss likelihood of EBV+ MCU; BUT, include large B-cell lymphoma in the differential
• Patients need to be evaluated for systemic disease
THANK YOU
ISTANBUL
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