The online version of this article has a Supplementary Appendix. BackgroundPlasmablastic lymphoma has recently come to be considered a distinct entity among mature B cell neoplasms, although the limits with diffuse large B-cell lymphoma (DLBCL) need to be more accurately defined. Design and MethodsHere we show the results of an immunohistochemical study of 35 cases of plasmablastic lymphoma compared with a set of 111 conventional DLBCLs . ResultsOur results demonstrate that the use of a limited combination of immunohistochemical markers (PAX5&CD20, PRDM1/BLIMP1 and XBP1s) enables the identification of a plasmablastic immunophenotype highly characteristic of plasmablastic lymphoma cases and associated with an aggressive clinical behavior. Additionally, the study shows that the acquisition of a partial plasmablastic phenotype (PRDM1/BLIMP1 expression) in DLBCL is associated with shorter survival in R-CHOP-treated patients. ConclusionsThe use of a restricted combination of immunohistochemical markers (PAX5&CD20, PRDM1/BLIMP1 and XBP1s) enables a more accurate definition of terminal differentiation for large B-cell lymphoma.Key words: plasmablastic lymphoma, terminal B-cell differentiation. Citation: Montes-Moreno S, Gonzalez-Medina

BackgroundSplenic diffuse red pulp small B-cell lymphoma is an uncommon B-cell lymphoma, now recognized as a provisional entity in the 2008 update of the WHO Classification. Additional work is required to review this entity and establish its diagnostic features. Design and MethodsWe have retrospectively analyzed the disease features in a highly selected series of 17 patients diagnosed as splenic diffuse red pulp small B-cell lymphoma. ResultsThe median age was 65.5 years (range 40-79 years) and there was a predominance of males (male/female ratio: 2.4). Clinical manifestations were mainly derived from splenomegaly. Splenectomy was the front-line treatment in 11 symptomatic patients; the remaining 6 received chemotherapy initially followed by splenectomy. After a mean follow-up of 72 months, the five-year overall survival was 93%. All cases showed a purely diffuse pattern of splenic infiltration by monomorphous small cells with small round nuclei and pale cytoplasm. All bone marrow biopsies showed tumoral infiltration, with intrasinusoidal infiltration. Peripheral blood cells were small to medium-sized, with clumped chromatin and round nuclear outline and villous cytoplasm. ConclusionsOur data suggest that splenic diffuse red pulp small B-cell lymphoma is a distinct entity with morphological and immunophenotypical features that differ from those of other splenic lymphomas.Key words: splenic lymphoma, leukemia, villous cells. Haematologica 2010;95:1122-1129. doi:10.3324/haematol.2009 This is an open-access paper. Citation: Kanellis G, Mollejo M, Montes-Moreno S, Rodriguez-Pinilla S-M, Cigudosa JC, Algara P, Montalban C, Matutes E, Wotherspoon A, and Piris MA. Splenic diffuse red pulp small B-cell lymphoma: revision of a series of cases reveals characteristic clinico-pathological features. Splenic diffuse red pulp small B-cell lymphoma: revision of a series of cases reveals characteristic clinico-pathological features

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We report on a 74-year-old man with a cutaneous B-cell follicle center lymphoma, which was treated upfront with systemic rituximab and suffered several local relapses. The first of the local recurrences, 10 months after completion of treatment, was characterized by a dense T-cell infiltrate that obscured a minor population of B-cell lymphoma cells, suggesting a second primary cutaneous T-cell lymphoma. This represents a previously not reported diagnostic pitfall and underscores the importance of performing sequential biopsies when dealing with lymphoma recurrences in this setting.

Hepatosplenic T-cell lymphoma (HSTL) is an uncommon, aggressive peripheral T-cell lymphoma with a dismal prognosis, usually expressing gamma-delta T-cell receptor on immunohistochemical study. We report the second instance in the literature of a solitary skin nodule heralding recurrence of HSTL. The patient was a 40-year-old man in apparent remission from HSTL, 4 years after chemotherapy and autologous bone marrow transplant. Biopsy of a flank lesion showed atypical lymphoid cells involving the dermis with a perivascular and periadnexal pattern, and fat lobules of the subcutaneous tissue. Their phenotype mirrored that of previous biopsies, with expression of CD2, CD3, CD7, CD56, and T-cell receptor-gamma, and lack of T-cell receptor-beta, CD4, CD5, and CD8. Cutaneous involvement by HSTL has rarely been reported either at initial diagnosis or at recurrence, and represents a diagnostic pitfall for primary cutaneous gamma-delta T-cell lymphoma.

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an unusual form of T-cell non-Hodgkin lymphoma. Surgical management is essential; however, adjuvant therapy is recommended for advanced stages of cancer. Case Presentation: A 40-year-old woman with textured silicone implants placed 7 years earlier, presented with breast nodules. Physical examination and computed tomography (CT) revealed a left parasternal mass, 2 left-breast nodules, and axillary lymphadenopathies. A soft-tissue lesion in the anterior mediastinum consistent with thymic remnants was detected. BIA-ALCL was diagnosed based on ultrasound-guided core biopsies of an axillary lymph node and a breast nodule. She underwent total bilateral capsulectomy and received anthracycline-based adjuvant chemotherapy. End-of-treatment positron emission tomography-computed tomography (PET-CT) scan at 4 months showed no evidence of disease, except for the persistence of the mediastinal lesion (Deauville score 4). Three months later, a new PET-CT scan showed enlargement of the lesion and increased radiotracer uptake, suggesting metabolic progression. A mediastinal biopsy was performed and rebound thymic hyperplasia (RTH) was observed in the histopathologic study. Once complete remission (CR) was achieved, the patient was followed up continually and has shown no signs of relapse to date. Conclusions: Further studies are required to determine the best adjuvant therapy for advanced BIA-ALCL. RTH may be suspected when thymic enlargement without the involvement of other areas is observed in patients with cancer. Mediastinal biopsy is mandatory to rule out relapse.