title: Precursor B lymphoblastic lymphoma presenting as lytic bone lesions.
abstract: Precursor B lymphoblastic lymphoma is an aggressive but potentially curable disease. This lymphoma most often manifests in the skin and lymph nodes and, less commonly, as lytic bone lesions. In the bone, this lymphoma must be differentiated from small round blue cell tumors, diffuse large B-cell lymphoma, and acute myelogenous leukemia. We describe the morphologic and immunophenotypic features in 4 patients, 2 children, 1 teenager, and 1 adult, who initially presented with bone pain and osteolytic lesions but without peripheral blood or iliac bone marrow involvement. Positive immunohistochemical staining of the neoplastic cells was observed for anti-CD10 (3/4), CD20 (3/4), CD34 (1/4), CD43 (4/4), CD45/CD45RB (2/4), CD79a (4/4), CD99 (MIC2) (2/4), and terminal deoxynucleotidyl transferase (4/4). CD3 was absent in all cases. Immunophenotyping these neoplasms is essential to establish the correct diagnosis of precursor B lymphoblastic lymphoma, and a panel of antibodies is required because of the immunophenotypic heterogeneity.
authors.affiliation: Department of Pathology, University of Michigan Medical School, Ann Arbor 48109-0602, USA.
authors.forename: S
authors.initials: S
authors.lastname: Iravani
authors.forename: T P
authors.initials: TP
authors.lastname: Singleton
authors.forename: C W
authors.initials: CW
authors.lastname: Ross
authors.forename: B
authors.initials: B
authors.lastname: Schnitzer
mesh_terms: D000293:Adolescent; D015703:Antigens, CD / Q000032:analysis; D018952:Antigens, CD34 / Q000032:analysis; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001842:Bone and Bones / Q000473:pathology*; D051925:CD79 Antigens; D002648:Child; D004253:DNA Nucleotidylexotransferase / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D005434:Flow Cytometry; D006412:Hematopoietic Stem Cells / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015260:Neprilysin / Q000032:analysis; D010014:Osteolysis; D010146:Pain; D011947:Receptors, Antigen, B-Cell / Q000032:analysis
chemical_list: D015703:Antigens, CD; D018952:Antigens, CD34; D051925:CD79 Antigens; C497881:CD79A protein, human; D011947:Receptors, Antigen, B-Cell; D004253:DNA Nucleotidylexotransferase; D015260:Neprilysin