Uso racional de la...
Transcript of Uso racional de la...
G. MassarelliUniversidad de Sassari
Italia
Uso racional de la
InmunohistoquímicaPatología linfáticaAplicación práctica
XV Congreso de la Sociedad Cubana de
Anatomía Patológica (SCAP) &
V Congreso de la División Cubana de la
International Academy of Pathology (IAP)
Curso Post-Congreso
15 de noviembre de 2019
INOR - La Habana CUBA
Case 1 (S-18-610)
Female patient, 45 yrs
Bilateral cervical, mediastinal and abdominal lymph node
enlargement
Surgical biopsy: Right supraclavicular lymph node
Lymph node (1 cm in diameter) with soft consistency,
grayish-brown in color. Small fragments, the longest of them
of about 0.8 mm in length
Clinical presentation
Case 1(S-18-610)
Differential diagnoses
DLBCL (polymorphic)
BL
ALCL
CHL anaplastic
T/HRLBCL
CD 20
CD 3
CD 30
1st line antibodies
CD 20
CD 3
CD 30
Case 1(S-18-610)
CD 20 all cells are positive
CD 3 only a few mature T cells
CD 30 negative on polymorphic cells
Results Exclusion
T/HRLBCL
ALCL
CHL
Remain
DLBCL
BL
CD 10, BCL 6, MUM 1
MYC, BCL 2, EBV, Ki 67, CD 138
2nd line antibodies
CD 10
BCL 6
MUM 1
Ki 67
MYC
CD 138 LMP1
BCL 2
Case 1(S-18-610)
Results Interpretation
CD 10 all cells are negative
BCL 6 scarce positivity
MUM 1 good positivity
BCL 2 > 60% positivity
EBV negativeNo Burkitt lymphoma
Non-GCB lymphoma
MYC > 70% positivity
Ki 67 > 75% positivity
Final diagnosis
Case 1(S-18-610)
High grade B-cell lymphoma,
MYC & BCL 2 double expressor
Case 2(S-18-2091)
Clinical presentation
Female patient, 52 yrs
Paravertebral (lumbar region) mass
Retroperitoneal lymphadenopathy
Core biopsy TC-guided:
Three filaments, the longest of them was
about 1.4 cm.
Case 2(S-18-2091)
Differential diagnoses
DLBCL (polymorphic)
BL
T/HCRLBCL
1st line antibodies
CD 20
CD 3
CD 20
CD 20
CD 3
Case 2(S-18-2091)
CD 20 all cells are positive
CD 3 only a few mature T cells
Results Exclusion
T/HRLBCL
Remain
DLBCL
BL
CD 10, BCL 6, MUM 1
MYC, BCL 2, EBV, Ki 67, CD 138
2nd line antibodies
CD 10
BCL 6
MUM 1
Ki 67
MYC
LMP 1 BCL 2
Case 2(S-18-2091)
Results
Non-GCB lymphoma
Interpretation
No Burkitt lymphoma
CD 10 all cells are negative
BCL 6 negative
MUM 1 good positivity
BCL 2 > 75% positivity
EBV negative
MYC > 85% positivity
Ki 67 > 85% positivity
Final diagnosis
Case 2(S-18-2091)
High grade B-cell lymphoma,
MYC & BCL 2 double expressor