Anaplastic Variant of Diffuse Large B Cell Lymphoma (DLBCL) – A Rare and Dilemmatic Entity
Bargotya Mona, Agarwal Kiran and shukla Shailaja
World Journal of Surgical Medical and Radiation Oncology 2014, 3:9
Anaplastic variant of DLBCL is a morphological variant of DLBCL (NOS) characterized by presence of large to very large round, oval or polygonal cells with bizarre pleomorphic nuclei that may resemble Reed –Sternberg cells and tumor cells of anaplastic large cell lymphoma(ALCL), thereby rendering them diagnostically challenging.
A 36 year old male presented with rapidly growing swelling measuring about 10x8cm in upper lateral half of left pectoral region extending upto axilla, associated with fever and pain radiating to left arm since one month. Clinical diagnosis was suggestive of soft tissue sarcoma. CT scan revealed a large heterogeneously enhancing soft tissue mass in left axilla and anterolateral chest wall with internal necrotic areas and encasement of blood vessls . Fine needle aspiration cytology as well as excisional biopsy from left pectoral mass was done and revealed similar cytomorphological features. There was presence of large round, oval to polygonal bizarre cells with moderate amount of eosinophilic cytoplasm, marked nuclear pleomorphism and irregular nuclear membrane. Many of these cells showed embryoid nucleus and wreath like arrangement of nuclei. The presence of these neoplastic cells posed a morphological dilemma. However, immunohistochemistry turned out to be of utmost utility and helped to make the correct diagnosis of Anaplastic variant of DLBCL.
Because of high degree of nuclear anaplasia posing diagnostic difficulties, accurate clinical approach, morphological assessment and immunohistochemical correlation is the precise and recommended method to achieve the correct diagnosis.
Anaplastic large cell lymphoma, Diffuse large cell lymphoma