Click to edit Master title style

Click to edit Master title style

• Edit Master text styles
• Second level

Case Presentation
• Third level
• Fourth level
• Fifth level

Presented by : Adham Alaa El-Din,

Pathology TA at Badr University
Supervised by: Prof. Dr. Marwa Mosaad
Faculty of Medicine, Ain Shams Univesity
Click to edit Master title style
History
• Edit Master text styles
• Second level
• A •71-year-old
Third levelgentleman presented with a 6-month history of
progressive dysphagia,
• Fourth level
weight loss and nausea.
• Examination revealed
• Fifth level a cachexic, frail gentleman who had clear
dysphagia to solids and liquids.
Click to edit Master title style
Findings
• His initial blood investigations revealed a Hb of 125 g/L, WCC 3.6
• Edit Master
x10 9 text styles
/L (neutrophils 2.14, lymphocytes 1.03, eosinophils 0.07), Plt
Second
• 132 level
x109/L.
• Third
• Urea level
and electrolytes, liver function tests, albumin, calcium and
phosphate were level
• Fourth all normal. Erythrocyte sedimentation rate was 26
mm and c-reactive protein was 43 mg/dL.
• Fifth level
• Given the suspicion of gastro-intestinal pathology he underwent an
upper gastro-intestinal endoscopy, which revealed a stricture at 25
cm.
• A staging CT of chest and abdomen was performed revealing a
generally thickened oesophagus, with no significant
lymphadenopathy in the chest or abdomen. The solid intra-
abdominal organs were unremarkable.
Click to edit Master title style
Initial endoscopy (a), and repeat procedure with stent insertion (b).
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
Microscopic
• Second level
• Third level
examination
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click What
to editisMaster title style
your diagnosis?
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to editDiagnosis
Master title style
• Edit Master text styles
Isolated oesophageal
• Second level
• Third level

Hodgkin lymphoma
• Fourth level
• Fifth level

Mixed cellularity subtype

 IHC title style
Click to edit Master
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
 CD15
Click to edit Master titleCD30
style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master
Differential title style
diagnosis
Tumors characterised by dual population of
cells (small
• Edit Master cells and large RS like cells)
text styles
Second level
•T-cell–rich large B-cell lymphoma (TCRLBCL) variant of
• Third level
DLBCL •
Fourth level
• Fifth level
Follicular lymphoma

Anaplastic large cell lymphoma

Thymoma type B1
 T-cell–rich large B-cell lymphoma (variant of
Click
DLBCL)to edit Master title style
• Edit Master infiltrate
• Diffuse text styleswithout sclerosis or nodularity
• Second level
• Scattered
• Third level
large, mononuclear neoplastic cells in
a background
• Fourth level of small reactive lymphocytes that
are almost• Fifthall T cells
level

• Large neoplastic B-cells are positive for CD45

and CD20, negative for CD15 and CD30
• Background T-cells are positive for CD3 and
CD8
 Hodgkin TCRLBCL
Click to edit Master title
CD20
style
CD15
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

CD30 CD3
 Nodular Lymphocyte Predominance HL vs.
Click to edit
T-cell rich Master
large B-cell title style
lymphoma

• Edit Master text styles CD20

• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master
Differential title style
diagnosis
Tumors characterised by dual population of
cells (small
• Edit Master cells and large RS like cells)
text styles
• Second level
T-cell–rich
• Third large
level B-cell lymphoma (TCRLBCL) variant of
DLBCL • Fourth level
• Fifth level

Follicular lymphoma

Anaplastic large cell lymphoma

Thymoma type B1
Click to editlymphoma
Follicular Master title style
• Edit Masterare
• Patients text styles older than 40 years.
usually
• Second level
• Variable mixture of centrocytes and centroblasts
• Third level
without polymorphic
• Fourth level reactive cell background.
• Fifth level
• Reed-Sternberg–like cells rarely present; sclerosis is
incidental.
• Both small and large cells are CD20-positive B
cells; may express CD10 and usually express Bcl-2.
• Characteristic t(14;18) chromosomal translocation
(IGH on chromosome 14, Bcl-2 on chromosome 18)
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
 Hodgkin Follicular
Click to edit Master title style
CD15 CD20
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

CD30
BCl2
Click to edit Master
Differential title style
diagnosis
Tumors characterised by dual population of
cells (small
• Edit Master cells and large RS like cells)
text styles
• Second level
T-cell–rich
• Third large
level B-cell lymphoma (TCRLBCL) variant of
DLBCL • Fourth level
• Fifth level

Follicular lymphoma

Anaplastic large cell lymphoma

Thymoma type B1
 Anaplastic
Click to editlarge cell lymphoma
Master title style
• Large cells are usually predominant and often
• Edit Master atext
resemble largestyles
cell lymphoma or metastatic
Second level
• carcinoma
• Third level
• Hallmark cells
• Fourth level are large, anaplastic cells containing
horseshoe-shaped
• Fifth level nuclei and voluminous cytoplasm

• Abnormal large cells are positive for CD30; usually

T cells but may not express common T-cell antigens
or CD45
• Tumor cells are typically positive for EMA and
often anaplastic lymphoma kinase (ALK-1)
• Negative for CD15, PAX5, and fascin
Click to edit Master title style
CD30
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
 Hodgkin ALCL
Click to edit Master title
ALK style
CD15
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

CD30 CD30
Click to edit Master title style
H&E
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level

ALK
Click to edit Master
Differential title style
diagnosis
Tumors characterised by dual population of
cells (small
• Edit Master cells and large RS like cells)
text styles
• Second level
T-cell–rich
• Third large
level B-cell lymphoma (TCRLBCL) variant of
DLBCL • Fourth level
• Fifth level

Follicular lymphoma

Anaplastic large cell lymphoma

Thymoma type B1
Click to edit(Type
Thymoma Master
B1)title style
• Large
• Edit Masternumber of small T lymphocytes.
text styles
Second
• Few level scattered round or polygonal thymic
isolated,
epithelial cells with minimal cytologic atypia.
• Third level
• Fourth level
• Medullary islands
• Fifth level with Hassall corpuscle-like
elements.
• Tumor cells are typically positive for pan-
cytokeratin.
• Reactive small T lymphocytes are positive for CD3.
• Thymocytes are positive for TdT.
• Negative for CD30, CD15.
Click to edit Master title style
• Edit Master text styles
AE1/
Second
•AE3 level
• Third level
• Fourth level
• Fifth level

TdT
Click to edit Master
Take-Home Messagetitle style
• Esophageal lymphoma is rare, accounting for less than 1%
• Editof Master
all gastrointestinal
text styleslymphomas.
•• The incidence
Second level of oesophageal involvement in gastro-
intestinal lymphoma is about 1% and most cases are low
• Third level
grade B-cell mucosa associated lymphoid tissue (MALT
• Fourth level
lymphoma) or diffuse
• Fifth level large B-cell types.
• No definite specific aetiological factors and oesophageal
infections have been identified as predisposing factors,
although there remains an increased risk of lymphoma in
patients with immunodeficiency.
• Surgery has a limited place in the treatment of primary
oesophageal lymphoma. The standard treatment is tailored
to the stage and usually includes a combination of chemo
and radiotherapy.
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level
Click to edit Master title style
• Edit Master text styles
• Second level
• Third level
• Fourth level
• Fifth level