A central hematopathology referral center is reviewing diagnostic material from several lymph node excisional biopsies. To establish the definitive diagnoses, correlate each hematolymphoid malignancy with its specific pathognomonic histopathologic and immunohistochemical findings.
- Follicular lymphomaNodular architecture with neoplastic cells that strongly express CD10, BCL2, and BCL6 due to an IGH/BCL2 rearrangement.
- Mantle cell lymphomaDiffuse proliferation of small to medium-sized lymphocytes; neoplastic cells co-express CD5 and cyclin D1 due to an IGH/CCND1 rearrangement.
- Burkitt lymphomaDiffuse infiltrate of intermediate-sized lymphocytes with numerous tingible-body macrophages creating a 'starry sky' pattern; near 100% Ki-67 proliferation index; t(8;14) translocation.
- Classic Hodgkin lymphomaLarge, binucleated cells with prominent eosinophilic nucleoli within an inflammatory background; diagnostic cells are CD15+ and CD30+, but CD20- and CD45-.
Answer
Follicular lymphoma pairs with nodular architecture and BCL2 expression. Mantle cell lymphoma pairs with CD5 and Cyclin D1 expression. Burkitt lymphoma pairs with 'starry sky' morphology and a near 100% Ki-67 index. Classic Hodgkin lymphoma pairs with CD15+/CD30+ Reed-Sternberg cells.
Each hematolymphoid malignancy has a highly specific morphologic and immunophenotypic signature required for definitive diagnosis. Matching these correctly relies on recognizing the pathognomonic chromosomal translocations (e.g., t(11;14) driving Cyclin D1 in Mantle cell), unique cell morphologies (e.g., Reed-Sternberg cells in Hodgkin lymphoma), and characteristic growth patterns combined with proliferation indices (e.g., starry sky and ~100% Ki-67 in Burkitt lymphoma).
Step-by-Step Solution
Key Concept
Definitive histopathologic and immunohistochemical diagnosis of hematolymphoid malignancies.