T-cell/histiocyte rich B-cell lymphoma of mass in caecum and part of ascending colon

Paras R Udhreja; Brijeshkumar J Sapariya

doi:10.4103/0377-4929.56129

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LETTER TO EDITOR

Year : 2009 | Volume : 52 | Issue : 4 | Page : 585-586

T-cell/histiocyte rich B-cell lymphoma of mass in caecum and part of ascending colon

Paras R Udhreja, Brijeshkumar J Sapariya
Department of Pathology, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India

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Date of Web Publication

1-Oct-2009

How to cite this article:
Udhreja PR, Sapariya BJ. T-cell/histiocyte rich B-cell lymphoma of mass in caecum and part of ascending colon. Indian J Pathol Microbiol 2009;52:585-6

How to cite this URL:
Udhreja PR, Sapariya BJ. T-cell/histiocyte rich B-cell lymphoma of mass in caecum and part of ascending colon. Indian J Pathol Microbiol [serial online] 2009 [cited 2023 Sep 30];52:585-6. Available from: https://www.ijpmonline.org/text.asp?2009/52/4/585/56129

Sir,

Caecum and ascending colon are uncommon sites for primary or secondary involvement by non-Hodgkin's lymphoma . T-cell/histiocyte rich B-cell lymphoma (T/HRBCL) is an uncommon morphologic variant of diffuse large B-cell lymphoma (DLBCL) representing 1 to 3% of all DLBCLs in recent series.^[1] The entity was first described as "T-cell rich B-cell lymphoma" in 1988 by Ramsay et al.^[2] who reported five cases that had previously been misdiagnosed as peripheral T-cell lymphoma because of the presence of a majority T-cell population surrounding scant large B cell. The definition was expanded in 1992 by Delabie et al.^[3] who introduced the term "histiocyte-rich B-cell lymphoma." T/HRBCL is distinguished by <10% malignant B cells and a majority population of reactive T lymphocytes and histiocytes.

We have presented this case of a 55-year-old female patient presented with symptoms of pain in abdomen and vomiting of 4 months duration. On ultrasonography thickened caecum and part of ascending colon was identified. Multiple enlarged mesenteric, lower paraaortic, paracaecal, and few iliac lymph nodes were seen. Carcino embryonic antigen (CEA) level was normal. Exploratory laprotomy with limited resection of mass involving caecum and ascending colon was performed. Histopathology and immunohistochemistry on the excised mass was done.

Gross features - An ulcerated mass was identified in caecum and part of ascending colon measuring 17 Χ 6 Χ 4 cms occupying full thickness.

Microscopic features showed a predominant submucosal neoplasm characterized by loose groups and contiguous sheets of round to oval malignant cells of apparent lymphoid origin. The cells contained hyperchromatic nuclei with nucleoli and acidophilic cytoplasm. Malignant cells surrounded by marked reactive lymphocytes. Patchy necrosis was present. The mucosa was totally destroyed and tumor occupies submucosa, muscle, and serosa [Figure 1].

Immunohistochemistry stains revealed epithelial membrane antigen negative [Figure 2] D, CD₃ positive in small reactive lymphocytes [Figure 2] C, CD₂₀ positive in 60% of tumor cells [Figure 2] A, and CD₃₀ negative [Figure 2] B.

In 2001, the World Health Organization (WHO) formally defined T/HRBCL as a morphologic variant of DLBCL characterized by fewer than 10% large neoplastic B cells amid a prominent inflammatory infiltrate, the majority of which are small polyclonal T cells, with or without the presence of histiocytes.^[1] On immunohistochemical analysis malignant B cells of T/HRBCL mark positively for CD₄₅ and CD₂₀ .^[4] The cells are uniformly negative for CD₁₅ and only rarely show weak positivity for CD₃₀ .^[4] Background cells in T/HRBCL are small polyclonal T cells that are positive for CD₃ .^[5] The inflammatory response is further notable for the paucity of small B cells and other reactive cells, including neutrophils, eosinophils, and plasma cells.^[4] Diagnosis of this entity is occasionally difficult, as it may appear similar to other lymphoid disease such as nodular lymphocyte-predominant Hodgkin's lymphoma and classic Hodgkin's lymphoma. Accurate diagnosis therefore rests with careful immunohistochemical analysis of the tumor cells and the inflammatory microenvironment.

References

1.	Abramson JS. T-cell / Histiocyte-Rich B- cell lymphoma. Biology, diagnosis and management. Oncologist 2006;11:384-92.
2.	Ramsay AD, Smith WJ, Issacson PG. T- cell rich B- cell lymphoma. Am J Surg pathol 1998;12:433-43.
3.	Delabie J, Vandenberghe E, Kennes C, Verhoef G, Foschini MP, Stul M, et al. Histiocyte-rich B-cell lymphoma. A distinct clinicopathologic entity possibly related to lymphocyte predominant Hodgkin's disease, paragranuloma subtype: Am J Surg Pathol 1992;16:37-48.
4.	Lim MS, Beaty M, Sorbara L, Cheng RZ, Pittaluga S, Raffeld M, et al, T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Heterogeneous Entity Withderivation from Germinal Center B Cells. Am J Surg Pathol 2002;26:1458-66.
5.	Chittal SM, Brousset P, Voigt JJ, Delsol G. Large B-cell lymphoma rich in T-cells and simulating Hodgkin's disease. Histopathology 1991;19: 211-20.