Clear cell variant of diffuse large B-cell lymphoma: a case report

Abstract

IntroductionDiffuse large B-cell lymphoma is a diffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to or exceeding the normal macrophage nuclei. We report a case of a clear cell variant of diffuse large B-cell lymphoma involving a lymph node in the neck, which was clinically suspected of being metastatic carcinoma.Case presentationA 39-year-old Caucasian ethnic Albanian man from Kosovo presented with a rapidly enlarging lymph node in his neck, but he also disclosed B symptoms and fatigue. A cytological aspirate of the lymph node revealed pleomorphic features. Our patient underwent a cervical lymph node biopsy (large excision). The mass was homogeneously fish-flesh, pale white tissue replacing almost the whole structure of the lymph node. The lymph node biopsy showed a partial alveolar growth pattern, which raised clinical suspicion that it was an epithelial neoplasm. With regard to morphological and phenotypic features, we discovered large nodules in diffuse areas, comprising large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. In these areas, there was high mitotic activity, and in some areas there were macrophages with tangible bodies. Staining for cytokeratins was negative. These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6-, CD5-, CD3-, CD21+ (in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).ConclusionAccording to the immunohistochemical findings, we concluded that this patient has a clear cell variant of diffuse large B-cell lymphoma of activated cell type, post-germinal center cell origin. Our patient is undergoing R-CHOP chemotherapy treatment.

Gastrointestinal Tract Plasmablastic Lymphoma in HIV-Infected Adults: A Histopathological Review

“…There are only a few cases of clear cell lymphomas described in the literature, including DLBCL and primary cutaneous anaplastic lymphoma. 36 -38 The origin of the clearing of the cells in this case remains elusive and might represent tissue fixation artefact.…”

Carcinoma de Células Claras Variedad No Hialinizante de Parótida: Comunicación de Dos Casos con Diferente Grado de Diferenciación

“…HMB45 resultó negativo en los CCC estudiados por nosotros y S-100 sólo dio una marcación aislada en el Caso 1 (Zubovits et al, 2009;Elshenaway et al, 2011. ) Se descartó, además, metástasis de linfoma a células B variante células claras y de linfoma anaplásico de células grandes, tumores citoqueratinas negativos (Shi et al, 2002;Manxhuka-Kerliu et al, 2011).…”

Diffuse Large B-Cell Lymphoma With Clear Cell Morphology

“…4 Out of 10 reported cases of DLBCL with clear cell morphology, including this case, only 1 case was presented in a cervical lymph node, 3 2 had a primary intraabdominal presentation, 2 and 7 had a primary retroperitoneal presentation, 4 suggesting that the retroperitoneum and the abdominal cavity may be sites of preference for this rare morphological variant. Finally, a common feature of DLBCLs with clear cell morphology is the fibrotic stroma, which separates the neoplastic cells in nodules, resulting in an alveolar growth pattern 2-4 that may mimic carcinoma or melanoma. 1 The coexistence of a clear cell DLBCL with a carcinoma can mislead both clinicians and pathologists, considering the mesenteric mass as a metastatic disease.…”

“…A review of the literature revealed 2 case reports of DLBCLs with clear cell morphology, 2,3 and 1 case series of 9 DLBCLs with primary retroperitoneal presentation, 7 of which had clear cell morphology. 4 Out of 10 reported cases of DLBCL with clear cell morphology, including this case, only 1 case was presented in a cervical lymph node, 3 2 had a primary intraabdominal presentation, 2 and 7 had a primary retroperitoneal presentation, 4 suggesting that the retroperitoneum and the abdominal cavity may be sites of preference for this rare morphological variant. Finally, a common feature of DLBCLs with clear cell morphology is the fibrotic stroma, which separates the neoplastic cells in nodules, resulting in an alveolar growth pattern 2-4 that may mimic carcinoma or melanoma.…”