Verma Anuj, Shet Tanuja
Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Pathol Microbiol. 2015 Oct-Dec;58(4):537-9. doi: 10.4103/0377-4929.168860.
Trans-differentiation of follicular lymphoma (FL) into a histiocytic sarcoma (HS) is a rare event and usually occurs as a sequential event. We report a case where in the same node with two distinct areas one of low-grade FL and another with HS was observed. This patient was a 58 years old with generalized lymphadenopathy and Ann Arbor Stage III disease. The cervical node biopsy on histological examination revealed two distinct areas, firstly a FL with nodular architecture and the other a smaller focus of sheets of pleomorphic histiocytic cells diffusely arranged at the edge of the section contiguous with FL with few cells in transiting phase. On immunohistochemistry the FL was positive for CD20, CD10, PU.1, PAX5 and Bcl2, while the large histiocytic cells were positive for CD163, CD68, LCA, and PU.1, weakly for PAX5 and negative for CD20, CD10, CD30, CD3, CD1a, Bcl2, S100, and Alk-1. The therapeutic implications of this diagnosis and postulated theories on trans-differentiation are discussed.
滤泡性淋巴瘤（FL）向组织细胞肉瘤（HS）的转分化是一种罕见事件，通常呈序贯性发生。我们报告一例病例，在同一淋巴结中有两个不同区域，一个为低级别FL，另一个为HS。该患者为58岁，有全身淋巴结肿大，Ann Arbor分期为III期。颈部淋巴结活检的组织学检查显示两个不同区域，首先是具有结节状结构的FL，另一个是较小的区域，由多形性组织细胞成片弥漫性排列在切片边缘，与FL相邻，处于过渡阶段的细胞很少。免疫组化显示，FL对CD20、CD10、PU.1、PAX5和Bcl2呈阳性，而大组织细胞对CD163、CD68、LCA和PU.1呈阳性，对PAX5呈弱阳性，对CD20、CD10、CD30、CD3、CD1a、Bcl2、S100和Alk-1呈阴性。本文讨论了该诊断的治疗意义以及关于转分化的假定理论。
