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Case Reports
. 2018 Apr;68(4):251-255.
doi: 10.1111/pin.12653. Epub 2018 Feb 25.

Anaplastic Variant of Diffuse Large B-cell Lymphoma With Hallmark Cell Appearance: Two Cases Highlighting a Broad Diversity in the Diagnostics

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Case Reports

Anaplastic Variant of Diffuse Large B-cell Lymphoma With Hallmark Cell Appearance: Two Cases Highlighting a Broad Diversity in the Diagnostics

Ayako Sakakibara et al. Pathol Int. .

Abstract

The anaplastic variant of diffuse large B-cell lymphoma (A-DLBCL) is morphologically defined but remains an enigmatic disease in its clinicopathologic distinctiveness. Here, we report two cases involving Japanese women aged 59 years, both with A-DLBCL with the hallmark cell appearance and both indistinguishable from common and giant cell-rich patterns, respectively, of anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma. Case 1 was immunohistochemically positive for CD20, CD79a and OCT-2 but not for the other pan-B-cell markers, CD30 and ALK. Case 2 showed CD20 and CD30 positivity for 50% and 20% of tumor cells in addition to strong expression of p53 and MYC. Both were positive for fascin without Epstein-Barr virus association. Our cases provide additional support for the earlier reports that A-DLBCL exhibits clinicopathologic features distinct from ordinal diffuse large B-cell lymphoma (DLBCL), and documented its broader morphologic diversity than previously recognized. They also shed light on the unique feature of absent expression of pan-B-cell markers except for CD20 and CD79a, suggesting that A-DLBCL may biologically mimic a gray zone or intermediate lymphoma between DLBCL and classic Hodgkin lymphoma.

Keywords: anaplastic variant; classic Hodgkin lymphoma; diffuse large B-cell lymphoma; gray zone lymphoma; hallmark cell.

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