Aberrant expression of multiple T cell markers on diffuse large B cell lymphoma: a case report
Tóm tắt
Aberrant T cell antigen expression has been well documented in diffuse large B cell lymphomas. However, co-expression of multiple T cell antigens including CD3, which has been considered a specific marker for T cells is extremely rare. Awareness about such aberrant expression is important so as not to misdiagnose or wrongly classify a lymphoma. The aim of this article is to report such a case. A 68-year-old postmenopausal lady, diabetic and hypertensive, presented with an axillary lump of one week’s duration. There was no other relevant medical history. Ultrasonography revealed multiple hypoechoic cystic lesions varying in size from 3.9 to 4.2 cm3. Aspiration was suggestive of an infective pathology. Excision biopsy of the mass was diagnosed as diffuse large B cell lymphoma with aberrant T cell antigen expression. She received 4 cycles of chemotherapy after which she was lost to follow-up. The case presented as a diagnostic dilemma for the pathologist. The predicament lies in classifying it as a B cell lymphoma with an aberrant expression of T cell markers versus a T cell lymphoma with an aberrant B cell marker expression which has a significant implication on the treatment offered. This can be solved by looking at the expression of the B cell specific transcription factors. The key to diagnosis lies in the knowledge of their existence and the application of a panel of markers.
Tài liệu tham khảo
Gascoyne RD, Campo E, Jaffe ES, Chan WC, Chan JKC, Rosenwald A, et al. Diffuse large B cell lymphoma, not otherwise specified. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2017. p. 291–7.
Hussaini MO, Kreisel FH, Hassan A, Nguyen TT, Frater JL. CD4 positive diffuse large B-cell lymphoma: a variant with aggressive clinical potential. World J Methodol. 2016;6(3):181–6. https://doi.org/10.5662/wjm.v6.i3.181.
Wallentine JC, Perkins SL, Tripp SR, Bruggman RD, Bayerl MG. Diffuse large B-cell lymphoma with coexpression of CD3 in a pediatric patient: a case report, review of the literature, and tissue microarray study. J Pediatr Hematol Oncol. 2009;31(2):124–7. https://doi.org/10.1097/MPH.0b013e31818b354a.
Suzuki Y, Yoshida T, Wang G, Aoki T, Katayama T, Miyamoto S, et al. Incidence and clinical significance of aberrant T-cell marker expression on diffuse large B-cell lymphoma cells. Acta Haematol. 2013;130(4):230–7. https://doi.org/10.1159/000348550.
Wang J, Chen C, Lau S, Raghavan R, Rowswell EH, Said J, et al. CD3-positive large B-cell lymphoma. Am J Surg Pathol. 2009;33(4):505–12. https://doi.org/10.1097/PAS.0b013e318185d231.
Kaleem Z, White G, Zutter MM. Aberrant expression of T-cell-associated antigens on B cell non-Hodgkin lymphomas. Am J Clin Pathol. 2001;115(3):396–403. https://doi.org/10.1309/V8YG-8PP4-B4TE-9X6J.
Inaba T, Shimazaki C, Sumikuma T, Okano A, Hatsuse M, Okamoto A, et al. Expression of T-cell-associated antigens in B-cell non-Hodgkin’s lymphoma. Br J Haematol. 2000;109(3):592–9. https://doi.org/10.1046/j.1365-2141.2000.02006.x.
Schmidt CJ, Domenico L, Ward P, Barcos MP, Stewart CC. Aberrant antigen expression detected by multiparameter three color flow cytometry in intermediate and high grade B cell lymphomas. Leuk Lymphoma. 1999;34(5-6):539–44. https://doi.org/10.3109/10428199909058481.
Sangle NA, Agarwal AM, Smock KJ, Leavitt MO, Warnke R, Bahler D, et al. Diffuse large B-cell lymphoma with aberrant expression of the T-cell antigens CD2 and CD7. Appl Immunohistochem Mol Morphol. 2011;19(6):579–83. https://doi.org/10.1097/PAI.0b013e318221c672.
Sangle NA, Miles RR, Kelley TW, Perkins SL. Aberrant expression of multiple T antigens: CD4, CD5, and CD8 on diffuse large B-cell lymphoma. Appl Immunohistochem Mol Morphol. 2014;22(10):e45–8. https://doi.org/10.1097/PAI.0b013e31829cc54c.
Oliveira JL, Grogg KL, Macon WR, Dogan A, Feldman AL. Clinicopathologic features of B-cell lineage neoplasms with aberrant expression of CD3: a study of 21 cases. Am J Surg Pathol. 2012;36(9):1364–70. https://doi.org/10.1097/PAS.0b013e31825e63a9.
Lee M, Cha HJ, Yoon DH, Suh C, Huh J. EBV-positive diffuse large B-cell lymphoma of the elderly with aberrant expression of CD3 and TIA-1. Blood Res. 2013;48(2):156–9. https://doi.org/10.5045/br.2013.48.2.156.
Matutes E, Pickl WF, Van’t Veer M, Morilla R, Swansbury J, Strobl H, et al. Mixed-phenotype acute leukemia: clinical and laboratory features and outcome in 100 patients defined according to the WHO 2008 classification. Blood. 2011;117(11):3163–71. https://doi.org/10.1182/blood-2010-10-314682.
Sáez AI, Artiga MJ, Sánchez-Beato M, Sánchez-Verde L, García JF, Camacho FI, et al. Analysis of octamer-binding transcription factors Oct2 and Oct1 and their coactivator BOB.1/OBF.1 in lymphomas. Mod Pathol. 2002;15(3):211–20. https://doi.org/10.1038/modpathol.3880518.