B-cell lymphoma of the mesentery

Case contributed by Bruno Di Muzio

Presentation

Abdominal pain.

Patient Data

Age: 55 years
Gender: Female

Abdomen and pelvis

ct

There is a large solid and heterogeneous mesenteric mass that has indistinct limits with an adjacent jejunum loop. it shows irregular areas of necrosis and surrounding mesenteric lymphadenopathy. The jejunum is extensively edematous and partially distended, but not completely obstructed. 

Incidental left adnexa dermoid cyst (mature teratoma). 

F-18 FDG PET-CT

Nuclear medicine

Marked FDG uptake within the mesenteric mass. 

Ultrasound-guided core-biopsy

ultrasound

The mass was sampled under ultrasound guidance. 

Case Discussion

Microscopy: Both cores consist of a partly necrotic malignant tumor comprising sheets of large atypical lymphoid cells. The tumor cells have scant cytoplasm, moderately pleomorphic nuclei with vesicular chromatin. Apoptotic bodies are frequent. No well-formed follicles are evident. No Reed-Sternberg cells are seen. A focal intra tumoral infiltrate of histiocytes is present.
Immunoperoxidase stains have been performed and the tumor cells have the following immune profile:
Positive: CD10, CD20, MUM1 (30%), Bcl6, c-myc (50%).
Negative: CD3, CD5, Bcl2, CD30, cyclinD1, TdT.
Ki-67 shows a proliferative index of approximately 75%.

Conclusion: Mesenteric mass, core biopsy: High-grade B cell lymphoma. FISH will be requested in an attempt to distinguish double hit high-grade B cell lymphoma from diffuse large B-cell lymphoma. 

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