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Fulltext An unusual presentation of lymphoma of the head and neck region

Teh CS, Chong SY

Med J Malaysia, 2011 Aug;66(3):264-5.
PMID: 22111456 MyJurnal

A 33-year-old Malay lady presented to us with 1-month history of globus sensation in the throat. Clinically, she had a 3cmx2cmx1cm sessile soft mass arising from the right tongue base and was treated as hypertrophied lingual tonsil. Biopsy of the mass was done when the patient developed bleeding and was reported as diffuse non-Hodgkin's B-cell lymphoma. Globus sensation is a common complaint in the ORL clinic. It is important to be able to decide if further investigation is warranted to differentiate a malignant from a benign lesion as at times, a malignant lesion can masquerade as a harmless lesion.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/diagnosis*; Lymphoma, Large B-Cell, Diffuse/therapy
Fulltext Globus sensation in throat, the lymphoid and non-lymphoid origin of tongue base lesions

Irfan M

Med J Malaysia, 2011 Dec;66(5):525.
PMID: 22390121
Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/diagnosis*
Clinical significance of aberrant microRNAs expression in predicting disease relapse/refractoriness to treatment in diffuse large B-cell lymphoma: A meta-analysis

Ting CY, Liew SM, Price A, Gan GG, Bee-Lan Ong D, Tan SY, et al.

Crit Rev Oncol Hematol, 2019 Dec;144:102818.
PMID: 31733445 DOI: 10.1016/j.critrevonc.2019.102818

The clinical significance of aberrantly expressed microRNAs in predicting treatment response to chemotherapy in diffuse large B-cell lymphoma patients (DLBCL) remains uncertain. Feasibility of microRNA testing to predict treatment outcome was evaluated. Twenty-two types of aberrantly expressed microRNAs were associated with poor treatment response; pooled hazard ratio (HR) was 2.14 [95%CI:1.78-2.57, P

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse*
Pathological case of the month. Ki-1-positive anaplastic large cell lymphoma involving muscle

Menon BS, Maziah W, Samarendra M, Toha A

Arch Pediatr Adolesc Med, 2001 Mar;155(3):411-2.
PMID: 11231812
Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/classification; Lymphoma, Large B-Cell, Diffuse/diagnosis*; Lymphoma, Large B-Cell, Diffuse/drug therapy
Rituximab biosimilar RTXM83 versus reference rituximab in combination with CHOP as first-line treatment for diffuse large B-cell lymphoma: a randomized, double-blind study

Candelaria M, González DE, Delamain MT, Bär DO, Beniwal SK, Dasappa L, et al.

Leuk Lymphoma, 2019 12;60(14):3375-3385.
PMID: 31272251 DOI: 10.1080/10428194.2019.1633632

This multicenter, double-blind, randomized study compared the efficacy, pharmacokinetics (PKs)/pharmacodynamics (PDs), safety and immunogenicity profile of RTXM83 vs. reference rituximab (R-rituximab), both with CHOP, as first-line treatment of diffuse large B-cell lymphoma (DLBCL). A total of 272 patients <65 years of age, with good prognosis (136 per arm) were randomized (1:1) to receive six cycles of either RTXM83 or R-rituximab. The primary efficacy endpoint was achieved (overall response rate of 83.6% for RTXM83 and 82.9% for R-rituximab) with a difference 0.7% between arms (95%CI: [-8.77% to 10.17%]) fulfilling the predefined non-inferiority margin (-13%). Similar number of patients reported at least one adverse event (AE) (131 per arm) or one serious AE (47 with RTXM83 and 45 with R-rituximab). Anti-drug antibody development was comparable between the arms. PK/PD secondary endpoint results support similarity between the compounds. RTXM83 exhibits non-inferior efficacy and similar safety/immunogenicity to R-rituximab, being an accessible alternative for the treatment of patients with previously untreated DLBCL.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse
Fulltext Diffuse large B-cell lymphoma presenting with extensive cutaneous infiltration

Shamsudin N, Chang CC

Singapore Med J, 2012 Sep;53(9):e198-200.
PMID: 23023915

We report a case of systemic diffuse large B-cell lymphoma presenting with extensive infiltration of the skin. A 56-year-old woman presented with a two-month history of pruritic erythematous plaques and nodules over the neck, trunk and upper limbs. She also had night sweats, weight loss, lethargy and reduced effort tolerance. Systemic examination revealed a pale, ill appearance with hepatosplenomegaly and lymphadenopathy. Blood investigations showed pancytopenia (haemoglobin 6.3 g/dL, total white cell count 3.0 × 10(9)/L, platelet count 138 × 10(9)/L) with a few suspicious mononuclear cells and a mildly elevated lactate dehydrogenase level (478 U/L). Skin biopsy demonstrated diffuse sheets and nodular infiltrates of CD20 and CD79a positive neoplastic cells in the dermis and subcutis. Computed tomography revealed multiple cervical, axillary, mediastinal, para-aortic and mesenteric lymph nodes. Bone marrow aspiration and trephine biopsy confirmed marrow involvement by non-Hodgkin's lymphoma. The patient was treated with chemotherapy, which resulted in resolution of the skin lesions.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/complications; Lymphoma, Large B-Cell, Diffuse/drug therapy; Lymphoma, Large B-Cell, Diffuse/pathology*
Fulltext Small cell variant of anaplastic large cell lymphoma with positive immunoreactivity for CD99

Shiran MS, Tan GC, Sabariah AR, Chye PC, Pathmanathan R

Med J Malaysia, 2008 Jun;63(2):150-1.
PMID: 18942305 MyJurnal

A 13 year old boy presented with a huge mass on his right arm of 6 months duration. Histopathological examination revealed sheets of malignant small round blue cells with immunopositivity for LCA, CD43, CD45Ro, CD30, EMA, ALK-1 and CD99, and negativity for CD20, TdT, myogenin, myoD1, NSE, bcl-6, bcl-2 and CD10. Fluorescent In-Situ Hybridization (FISH) testing excluded the diagnosis of Ewing's sarcoma/PNET. Pathologists need to be aware of the diagnosis of a small cell variant of ALCL, as well as of the fact that CD99 expression commonly occurs in cases of ALK-positive ALCL, in order to distinguish this entity from Ewing's sarcoma/PNET.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/immunology*; Lymphoma, Large B-Cell, Diffuse/pathology
Primary mediastinal large B-cell lymphoma and its mimickers: a rare case report with literature review

Win TT, Kamaludin Z, Husin A

Malays J Pathol, 2016 Aug;38(2):153-7.
PMID: 27568673 MyJurnal

Primary mediastinal large B-cell lymphoma (PMLBL) is an uncommon non-Hodgkin lymphoma with a distinct clinicopathological entity in the WHO classification of lymphoid malignancies. It is known to originate from B-cells of the thymus. It mimics thymic neoplasms and other lymphomas clinically and histopathologically. We reported a 33-year-old obese man who presented with shortness of breath off and on for 4 years. Radiologically, there was a huge anterior mediastinal mass. Tru-cut biopsy was initially diagnosed as type-A thymoma. Histopathological examination of the excised specimen revealed PMLBL with stromal fibrosis and sclerosis which created a diagnostic difficulty. The neoplastic cells varied from medium-sized to large pleomorphic cells, including mononuclear cells with centroblastic and immunoblastic features as well as bi-lobed Reed Sternberg (RS)-like cells and horse-shoe like hallmark cells. Some interlacing spindle cells and epithelioid cells were also present. Immunohistochemically, tumour cells expressed diffuse positivity for LCA, CD20, CD79a, CD23, Bcl2, MUM-1 and heterogenous positivity for CD30 and EMA, and were negative for CD10, CD15 and ALK. Ki67 scoring was very high. Tumour cells infiltrated into peri-thymic fat and pericardium. No malignant cells were detected in the pleural fluid and there was no bone marrow infiltration. The patient showed partial response to 6 cycles of RICE chemotherapy, and was planned for second line chemotherapy using hyper-CVAD regimen followed by autologous stem cell transplantation. This case illustrates the importance of thorough sampling and immunohistochemistry in differentiating PMLBL from its differential diagnoses.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/diagnosis*; Lymphoma, Large B-Cell, Diffuse/pathology
DNMT1 is predictive of survival and associated with Ki-67 expression in R-CHOP-treated diffuse large B-cell lymphomas

Loo SK, Ch'ng ES, Lawrie CH, Muruzabal MA, Gaafar A, Pomposo MP, et al.

Pathology, 2017 Dec;49(7):731-739.
PMID: 29074044 DOI: 10.1016/j.pathol.2017.08.009

DNMT1 is a target of approved anti-cancer drugs including decitabine. However, the prognostic value of DNMT1 protein expression in R-CHOP-treated diffuse large B-cell lymphomas (DLBCLs) remains unexplored. Here we showed that DNMT1 was expressed in the majority of DLBCL cases (n = 209/230, 90.9%) with higher expression in germinal centre B-cell-like (GCB)-DLBCL subtype. Low and negative DNMT1 expression (20% cut-off, n = 33/230, 14.3%) was predictive of worse overall survival (OS; p < 0.001) and progression-free survival (PFS; p < 0.001). Nonetheless, of the 209 DNMT1 positive patients, 33% and 42% did not achieve 5-year OS and PFS, respectively, indicating that DNMT1 positive patients showed considerably heterogeneous outcomes. Moreover, DNMT1 was frequently expressed in mitotic cells and significantly correlated with Ki-67 or BCL6 expression (r = 0.60 or 0.44, respectively; p < 0.001). We demonstrate that DNMT1 is predictive of DLBCL patients' survival, and suggest that DNMT1 could be a DLBCL therapeutic target due to its significant association with Ki-67.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/diagnosis*; Lymphoma, Large B-Cell, Diffuse/drug therapy; Lymphoma, Large B-Cell, Diffuse/metabolism; Lymphoma, Large B-Cell, Diffuse/pathology
Fulltext Clinical Characteristics and Treatment Outcome of Gastrointestinal Non-Hodgkin's Lymphoma

Praveen S, Ho CC, Fadilah S, Sagap I

Med J Malaysia, 2010 Jun;65(2):98-100.
PMID: 23756789

Primary gastrointestinal (GIT) lymphoma constitutes only 5 - 10% of all gastrointestinal tumours. The optimal therapy for these lymphomas is poorly defined and still controversial. We present our experience in the treatment and outcome of primary GIT lymphomas in UKM Medical Center, Malaysia. A retrospective review of all patients with primary GIT lymphoma from the year 2002 until 2007 was done. Our series has shown that primary GIT lymphoma is a rare disease as it comprises only 6.5% of all lymphomas treated in this institution. We had a female predominance of this disease with a large majority at an advanced stage of the disease. There was equal distribution involving stomach, small and large intestines. The incidence of primary GIT lymphomas was 6.5% with a female predominance. The majority had advanced diseases (stage III and IV) with equal distribution involving the stomach, small and large intestines. The most common histological variant was diffuse large B cell lymphoma (66%). Most (83%) patients with intestinal lymphoma had surgical resection and adjuvant chemotherapy. All patients with gastric lymphomas had chemotherapy alone. The mortality rate was 22% predominantly in younger patients with aggressive histology subtypes and advanced disease.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse
Expression and alteration of p16 in diffuse large B cell lymphoma

Lee ES, Kim LH, Abdullah WA, Peh SC

Pathobiology, 2010;77(2):96-105.
PMID: 20332669 DOI: 10.1159/000278291

This study aimed to examine (1) the expression of P16 protein relative to sites of presentation, immunophenotypic subgroups and proliferative indices of tumour cells, and (2) the relationship between p16 gene alterations and P16 protein overexpression in 70 cases of diffuse large B cell lymphoma (DLBCL).

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/genetics; Lymphoma, Large B-Cell, Diffuse/metabolism*; Lymphoma, Large B-Cell, Diffuse/pathology
Clinical relevance of CD10, BCL-6 and multiple myeloma-1 expression in diffuse large B-cell lymphomas in Malaysia

Peh SC, Gan GG, Lee LK, Eow GI

Pathol. Int., 2008 Sep;58(9):572-9.
PMID: 18801072 DOI: 10.1111/j.1440-1827.2008.02273.x

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, and it is recognized to constitute a heterogenous group of neoplasms. It can be divided into germinal center B-cell-like (GCB) and non-GCB subgroups. The aim of the present study was to evaluate the utility of immunophenotype subgrouping of DLBCL in a cohort of multi-ethnic Asian patients. A total of 84 reconfirmed de novo DLBCL were immunostained for the expression of CD10, BCL-2, BCL-6 and multiple myeloma-1. Thirty-three (39.3%) had the GCB phenotype, and the remainder (60.7%), the non-GCB phenotype. The results concur with most reports using a similar method of stratification. Forty-five patients had complete demographic and phenotype studies and 42 patients did not have rituximab treatment and had sufficient data for survival rate analysis. Similar to other studies, patients with combined low and low-intermediate International Prognostic Index score had better overall survival (P = 0.006). But patients with GCB phenotype did not have better prognosis, and BCL-2 expression was not associated with better prognosis. The expression of BCL-6 was associated with lower overall survival rate (P = 0.038). No apparent difference in overall and disease-free survival was noted between patients with GCB and non-GCB disease. BCL-6 expression by tumor cells appears to be associated with poorer prognosis.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/metabolism*; Lymphoma, Large B-Cell, Diffuse/mortality; Lymphoma, Large B-Cell, Diffuse/pathology
Higher frequency of p53 gene mutations in diffuse large B-cell lymphoma with MALT component

Tai YC, Tan JA, Peh SC

Pathol. Int., 2004 Nov;54(11):811-8.
PMID: 15533223

p53 gene mutation is not a frequent event in the tumorigenesis of lymphomas and the expression of p53 protein is independent of p53 gene mutations. The present study aimed to investigate mutations in the p53 gene in a series of extranodal B-cell lymphomas, and its association with p53 protein expression. A total of 52 cases were graded histologically into Grade 1, Grade 2 and Grade 3 tumors and p53 protein expression was detected using immunohistochemistry. Mutations in the p53 gene were analyzed using polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) and mobility shifts were confirmed by direct sequencing. The tumors comprised 26 (50%) Grade 1, 9 (17%) Grade 2 and 15 (29%) Grade 3. A high proportion of Grade 2 (25%) tumors expressed p53 protein (P = 0.051) and carried p53 gene mutation (33%) (P = 0.218). However, p53 protein expression was not associated with p53 gene mutations (P = 0.057). Transversion mutations (88%) were more frequently detected than transition mutations (12%). The present study revealed that p53 gene mutations and p53 protein expression occurred in higher frequencies in Grade 2 tumors, which may be of pathogenetic importance. The high frequency of transversion mutations may reflect the influence of an etiological agent in the tumorigenesis of mucosa-associated lymphoid tissue (MALT lymphoma).

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/genetics*; Lymphoma, Large B-Cell, Diffuse/metabolism; Lymphoma, Large B-Cell, Diffuse/pathology*
TARC, a CC chemokine, is frequently expressed in classic Hodgkin's lymphoma but not in NLP Hodgkin's lymphoma, T-cell-rich B-cell lymphoma, and most cases of anaplastic large cell lymphoma

Peh SC, Kim LH, Poppema S

Am. J. Surg. Pathol., 2001 Jul;25(7):925-9.
PMID: 11420464

Thymus and activation-regulated chemokine (TARC) has been identified as a lymphocyte-directed CC chemokine that attracts activated T-helper type 2 (Th2) cells in humans. Recent studies showed that the T cells surrounding Reed-Sternberg cells in Hodgkin's lymphomas (HL) are Th2 type. Anaplastic large cell lymphomas (ALCL), T-cell-rich B-cell lymphoma (TCRBCL) can mimic HL in some instances. This study aimed to establish the pattern of TARC expression in these diseases. Immunohistochemical stain using a polyclonal goat anti-human antibody to TARC was performed on 119 cases of confirmed HL; 99 were classical type (43 mixed cellularity, 43 nodular sclerosis, 5 lymphocyte depleted, 4 lymphocyte rich, 4 unclassifiable) and 20 lymphocyte predominant HL. Additional 27 ALCL (9 T-, 18 null-cell phenotype), 16 T-cell and 8 B-cell non-Hodgkin's lymphoma (NHL) were studied. A total of 85.8% of the classical HL, one case of ALCL, and one case of large cell B-cell lymphoma with anaplastic morphology showed positive TARC expression in the tumor cells. The expression was paranuclear and/or diffuse in the cell cytoplasm. The tumor cells in all cases of lymphocyte predominant HL, TCRBCL, null ALCL, and T-NHL did not express TARC. The high frequency of TARC expression in the Reed-Sternberg cells of classical HL may explain the characteristic T-cell infiltrate in this disease. The absence in other types that may be morphologically similar indicates that staining for TARC may aid in differential diagnosis.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/metabolism*; Lymphoma, Large B-Cell, Diffuse/pathology; Lymphoma, Large B-Cell, Diffuse/virology
Characterisation of immunogenotypes of diffuse large B-cell lymphoma

Phang KC, Hussin NH, Abdul Rahman F, Tizen NMS, Mansoor A, Masir N

Malays J Pathol, 2019 Aug;41(2):101-124.
PMID: 31427546

INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive type of non-Hodgkin lymphoma with variable clinical outcomes. The immunogenotypic features of this heterogeneous disease in Malaysia were not well characterized.
MATERIALS & METHODS: In total 141 local series of DLBCL cases from UKM Medical Centre were retrospectively studied.
RESULTS: Of these cases, we classified our patients into two subtypes: 32.7% (37/113) GCB and non-GCB 67.3% (76/113) by Hans algorithm and the results showed strong agreement with the results by Choi algorithm (κ = 0.828, P<0.001). Survival analysis indicated significant difference in between GCB and non-GCB subtypes (P=0.01), elevated serum LDH (P=0.016), age more than 60-year-old (P=0.021) and the presence of B symptoms (P=0.04). We observed 12% DLBCL cases were CD5 positive and 81.8% of them died of the disease (P=0.076). Analysis on the dual expression of MYC/BCL2 revealed that there is no significant difference in DE and non-DE groups (P=0.916). FISH study reported there were 9.22% (13/141) rearranged cases observed in our population at which highest frequency of BCL6 gene rearrangement (76.9%), followed by MYC (15.4%) and BCL2 (7.7%); no BCL10 and MALT-1 gene rearrangement found regardless of using TMAs or whole tissue samples. More cases of MYC protein overexpression observed compared to MYC translocation.
CONCLUSION: Relatively lower frequency of GCB tumours and low gene rearrangement rates were observed in Malaysian population. A national study is therefore warranted to know better the immunogenotypic characteristics of DLBCL in Malaysia and their implications on the survival.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse
Prognostic subgroup distribution in diffuse large B-cell lymphoma of the upper aerodigestive tract

Wong KK, Prepageran N, Peh SC

Pathology, 2009 Feb;41(2):133-9.
PMID: 18972319 DOI: 10.1080/00313020802436790

AIMS: To stratify upper aerodigestive tract (UAT) diffuse large B-cell lymphoma (DLBCL) into prognostic subgroups by immunohistochemical staining (IHC) method, and to evaluate the association rate of UAT DLBCL with Epstein-Barr virus (EBV).
METHODS: Using a panel of antibodies to CD10, Bcl-6, MUM1 and CD138, consecutive cases of primary UAT DLBCL were stratified into subgroups of germinal centre B-cell-like (GCB) and non-GCB, phenotype profile patterns A, B and C, as proposed by Hans et al. and Chang et al., respectively. EBER in situ hybridisation technique was applied for the detection of EBV in the tumours.
RESULTS: In this series of 32 cases of UAT DLBCL, 34% (11/32) were GCB, and 66% (21/32) were non-GCB types; 59% (19/32) had combined patterns A and B, and 41% (13/32) had pattern C. Statistical analysis revealed no significant difference in the occurrence of these prognostic subgroups in the UAT when compared with series of de novo DLBCL from all sites. There was also no site difference in phenotype protein expressions, with the exception of MUM1. EBER in situ hybridisation stain demonstrated only one EBV infected case.
CONCLUSIONS: Prognostic subgroup distribution of UAT DLBCL is similar to de novo DLBCL from all sites, and EBV association is very infrequent.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/classification*; Lymphoma, Large B-Cell, Diffuse/metabolism; Lymphoma, Large B-Cell, Diffuse/pathology
Common ALK gene rearrangement in Asian CD30+ anaplastic large cell lymphoma: an immunohistochemical and fluorescence in situ hybridisation (FISH) study on paraffin-embedded tissue

Tai YC, Kim LH, Peh SC

Pathology, 2003 Oct;35(5):436-43.
PMID: 14555389

AIMS: The most common recurrent genetic aberration in anaplastic large cell lymphoma (ALCL) is translocation involving the ALK gene that results in ectopic expression of ALK protein in lymphoid tissue. This study aims to investigate the frequency of ALK gene rearrangement in a series of Asian ALCL.
METHODS: ALK gene rearrangement was detected by immunostaining of ALK protein and fluorescence in situ hybridisation (FISH) targeting at the 2p23 region.
RESULTS: The expression of ALK protein was detected in 24/34 (71%) of the cases, and it was significantly higher in childhood cases (100%) when compared to adult cases (47%). The analyses by FISH were consistent with the results from immunostaining of ALK protein, but the analyses were only successful in 15/34 (44%) cases. FISH analyses detected extra copies of ALK gene in three cases, including one case that expressed ALK protein and showed 2p23 rearrangement.
CONCLUSIONS: The current series revealed a high frequency of ALK gene rearrangement, especially in the children. Immunostaining of ALK protein is a reliable indication of ALK gene rearrangement, and is superior to FISH. However, FISH analysis is useful in detecting other genetic aberrations that are not related to ALK gene rearrangement.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/genetics*; Lymphoma, Large B-Cell, Diffuse/metabolism; Lymphoma, Large B-Cell, Diffuse/pathology
Comparison of protein-based cell-of-origin classification to the Lymph2Cx RNA assay in a cohort of diffuse large B-cell lymphomas in Malaysia

Phang KC, Akhter A, Tizen NMS, Rahman FA, Zahratul Azma R, Elyamany G, et al.

J Clin Pathol, 2018 Mar;71(3):215-220.
PMID: 28775174 DOI: 10.1136/jclinpath-2017-204548

AIMS: The cell of origin (COO) based molecular characterisation into germinal centre B-cell-like (GCB) and activated B-cell-like (ABC) subtypes are central to the pathogenesis and clinical course in diffuse large B-cell lymphoma (DLBCL). Globally, clinical laboratories employ pragmatic but less than ideal immunohistochemical (IHC) assay for COO classification. Novel RNA-based platforms using routine pathology samples are emerging as new gold standard and offer unique opportunities for assay standardisation for laboratories across the world. We evaluated our IHC protocols against RNA-based technologies to determine concordance; additionally, we gauged the impact of preanalytical variation on the performance of Lymph2Cx assay.
METHODS: Diagnostic biopsies (n=104) were examined for COO classification, employing automated RNA digital quantification assay (Lymph2Cx). Results were equated against IHC-based COO categorisation. Assay performance was assessed through its impact on overall survival (OS).
RESULTS: 96 (92%) informative samples were labelled as GCB (38/96; 40%) and non-GCB (58/96; 60%) by IHC evaluation. Lymph2Cx catalogued 36/96 (37%) samples as GCB, 45/96 (47%) as ABC and 15/96 (16%) as unclassified. Lymph2Cx being reference, IHC protocol revealed sensitivity of 81% for ABC and 75% for GCB categorisation and positive predictive value of 81% versus 82%, respectively. Lymph2Cx-based COO classification performed superior to Hans algorithm in predicting OS (log rank test, p=0.017 vs p=0.212).
CONCLUSIONS: Our report show that current IHC-based protocols for COO classification of DLBCL at UKM Malaysia are in line with previously reported results and marked variation in preanalytical factors do not critically impact Lymph2Cx assay quality.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/classification*; Lymphoma, Large B-Cell, Diffuse/diagnosis; Lymphoma, Large B-Cell, Diffuse/pathology
Fulltext Multifocal nodal and extranodal Rosai-Dorfman disease initially diagnosed as histiocytic lymphoma

Shiran MS, Tan GC, Kenali MS, Sabariah AR, Pathmanathan R

Malays J Pathol, 2008 Jun;30(1):63-5.
PMID: 19108414 MyJurnal

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy (SHML), is a systemic disease involving nodal and extranodal tissues. We report a 48-year-old female with recurrent nasal obstruction due to polypoidal masses involving the nasal sinuses, turbinates and septum bilaterally, and lumps in the right infra-orbital region and region of the right lacrimal sac. A 4 cm right upper neck mass was also noted, which was initially diagnosed as histiocytic lymphoma. Histopathology of the nasal and infraorbital lesions revealed fibro-inflammatory masses containing histiocytic cells with large vesicular nuclei and abundant foamy cytoplasm exhibiting emperipolesis and lymphophagocytosis, admixed with scattered plasma cells and lymphocytes. These histiocytes revealed immunohistochemical positivity for S-100 protein and CD68, but were negative for CDla. The findings supported a diagnosis of RDD. This report serves to remind pathologists and clinicians of the extranodal manifestations of RDD and its potential confusion with lymphomas.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse/diagnosis*
Primary extranodal diffuse large B-cell lymphoma of the uterine cervix

Akkour K, Alhulwah M, Alhalal H, Alqahtani N, Arafah M

Malays J Pathol, 2021 Aug;43(2):327-331.
PMID: 34448797

BACKGROUND: Small bowel volvulus is defined as the torsion of the small intestine, potentially leading to bowel obstruction, gangrene and perforation. It is a rare condition, especially in adults.
CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.
CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.

Matched MeSH terms: Lymphoma, Large B-Cell, Diffuse*

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