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Case Study: January 2017
History
A 45 year old female with bowel problems presents with an left inferior forniceal pink fleshy nodule.
This is biopsied and sent for histopathological examination.
Figure 1-low power of conjunctival biopsy
Figure 2-higher power to show cytology of lesional cells.
Figure 3-Cyclin D1 immunohistochemistry.
Questions
1. What do figures 1 and 2 show?
2. What is the histological differential diagnosis?
3. Which immunohistochemistry panel needs to be selected and why?
4. What is the overall diagnosis?
Answers
1. A dense infiltrate of small lymphocytes with irregular nuclear outlines.
2. The differential diagnosis is for an indolent B-cell lymphoma eg: Maltoma, CLL, Follicular lymphoma, LPL, mantle cell lymphoma.
3. The key is to distinguish between MALToma, CLL, follicular and mantle cell lymphoma. The panel would include CD3, CD20, CD5, CD10, CD23, Ki67, Sox 11, Bcl2. Bcl6, IRTA-1.
4. The Cyclin D1 and cytology make this a mantle cell lymphoma.
References
Bilateral ocular panadnexal mass as initial presentation of systemic blastoid variant of mantle-cell lymphoma. Rašić DM, Knežević M, Terzić T, Vlajković G.Surv Ophthalmol. 2017 Jan – Feb;62(1):83-88
Malignant lymphoma of the conjunctiva.Kirkegaard MM, Coupland SE, Prause JU, Heegaard S.Surv Ophthalmol. 2015 Sep-Oct;60(5):444-58.
Follicular conjunctivitis caused by a mantle cell lymphoma. Amstutz CA, Michel S, Thiel MA.Klin Monbl Augenheilkd. 2004 May;221(5):398-400
