Composite small lymphocytic lymphoma and extra-medullary myeloid tumor: a potential diagnostic pitfall.
Reported herein is a case of composite small lymphocytic lymphoma (SLL) and extramedullary myeloid tumor (EMT) occurring in the same lymph node. Routine morphologic examination revealed a diffuse proliferation of small mature lymphocytes with numerous irregularly dispersed nodules, closely resembling SLL with prominent proliferation centers or Richter's transformation. Flow cytometric immunophenotyping and immunohistochemical stains demonstrated the presence of SLL cells as well as myeloblasts, confirming the diagnosis of a composite SLL and EMT. Conventional cytogenetics and fluorescence in situ hybridization studies revealed inversion 16 chromosome involving the core binding factor beta and myosin heavy chain 11 genes, characteristic of acute myeloid leukemia with abnormal bone marrow eosinophils and inv(16) or t(16;16) [CBFbeta/MYH11]. In conclusion, the occurrence of SLL and EMT in the same lymph node is rare and multiparameter approach is essential for a definitive diagnosis.
Li
Shiyong
S
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, GA, USA. sli2@emory.edu
Mann
Karen P
KP
Holden
Jeannine T
JT
Semin Oncol. 2006 Apr;33(2):250-6
16616072
Ann Oncol. 2006 Apr;17(4):683-90
16524977
Am J Clin Pathol. 2005 Sep;124(3):445-52
16191514
J Histochem Cytochem. 1981 Apr;29(4):577-80
6166661
Am J Pathol. 2002 Sep;161(3):957-68
12213724
Am J Surg Pathol. 1993 Oct;17(10):1011-9
8372941
Am J Clin Pathol. 2003 Feb;119(2):205-12
12579990
J Clin Oncol. 2006 May 20;24(15):2343-51
16710033
Blood. 1999 Sep 15;94(6):1840-7
10477712
Blood. 2002 Feb 1;99(3):1023-9
11807008
Am J Surg Pathol. 2002 May;26(5):624-9
11979092
Histopathology. 1999 May;34(5):391-8
10231412
Arch Pathol Lab Med. 1995 Sep;119(9):790-8
7668936