CASE N°20 – Systemic disease: Non Hodgkin’s Lymphoma

Clinical History:

Age: 57

Sex: Female

Two months ago she was hospitalized in a foreign clinic. During hospitalization underwent excision of multiple omental nodules which had been highlighted during an abdominal CT-SCAN performed for other reasons. Histological diagnosis: non-Hodgkin’s Lymphoma “B”, diffuse large cell type. Immunophenotype: CD20 +, CD10 +, Bcl2 +, BCL6 +, MUM1-, CD30-, CD23-, CD3-, CD5-, CiclinaD1-, Tdt-. Proliferation index (MIB-1): about 80%.

Physical examination: Currently ascites, dizziness and vomiting. Subjected to drain ascites, reduction of intracranial pressure with removal of CSF and gastroscopy

Cytological Images:

Ascites: Figure 1-4

 Figure 1: Papanicolaou 100x

 Figure 2: Papanicolaou 400x

 Figure 3: Papanicolaou 400x

 Figure 4: Giemsa stain 600x

Liquor: Figure 5-13

 Figure 5: Papanicolaou 100x

 Figure 6: Papanicolaou 400x

 Figure 7: Papanicolaou 600x

 Figure 8: Giemsa stain 400x

 Figure 9: Cytoblock, H/E 40x

 Figure 10: Cytoblock, H/E 100x

 Figure 11: Cytoblock, cd20

 Figure 12: Cytoblock, cd3

 Figure 13: Cytoblock, ki67

Cytological Report:

Ascites & Liquor have the same cytological diagnosis: cytologic findings suggestive of lymphoid cell proliferation. Histology raccomanded

Histological Images:

Histological material: gastric biopsy

 H/E 20x

 H/E 100x

 H/E 200x

 cd20

 cd3

 ki67

Histological Report:

Non-Hodgkin’s Lymphoma “B”, diffuse large cell type. Immunophenotype: CD20 +, CD10 +, Bcl2 +, BCL6 +, MUM1-, CD30-, CD23-, CD3-, CD5-

Discussion:

Non Hodgkin’s lymphoma (NHL) may occur preferentially affecting different anatomic sites, they
debut involving multiple lymph nodes and spread to the spleen, bone marrow and
to other tissues and organs. Localizations extralymphatic primitives are found in 20-30% of
cases and preferentially affecting the gastrointestinal tract, skin, central nervous system (CNS)
and testicles.

The NHL as other hematopoietic malignancies, should be considered systemic diseases,
those primitives of the gastrointestinal tract, of the Skin, of the Testis and in particular of the
CNS tend to remain confined in the tissue of origin, even in advanced stages of disease.

Treatment aim is to cure the common and aggressive lymphomas because in these groups of
cancer is now possible to obtain a high percentage of durable complete remissions.
Protocols using modern intensive chemotherapy, including treatment at high
doses with support of hemopoietic progenitors circulating. In indolent lymphomas at presentation does not now seems possible to achieve a cure with the means of treatment today
available, probably due to one of the oncogenes of drug resistance (bcl-2), therefore treatment is aimed primarily at controlling the disease using a long less aggressive therapies.

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