Case 11

Clinical history

57 year old woman. Multi-organ dysfunction and stroke.

Primary image

Pons. Intermediate magnification. H&E stain.

High magnification
High magnification. H&E stain.

Very high magnification
Very high magnification. H&E stain.

Differential diagnosis

Differential diagnosis
leukemia (blast crisis)

Additional tests

More history

More history
WBC significantly elevated.

Ask a friend

Ask a friend
It looks intravascular and lymphoid.

Stains

Alcian blue/PAS to Bilirubin Test Result Alcian blue/PAS Dr T would ask why! Alican blue pH 1.0 Dr T would ask why! Alcian blue pH 2.5 Dr T would ask why! Auramine Dr T would ask why! Bielchowsky Dr T would ask why! Bilirubin Dr T would ask why!	Colloidal iron to Fontana-Masson Test Result Colloidal iron Dr T would ask why! Congo red Dr T would ask why! Cresyl violet Dr T would ask why! Dieterle Dr T would ask why! Diff Quik Dr T would ask why! Fontana-Masson Dr T would ask why!	Gallyas to Gremelius Test Result Gallyas Dr T would ask why! Giemsa Dr T would ask why! GMS Dr T would ask why! Gomori's trichrome Dr T would ask why! Gram Dr T would ask why! Gremelius Dr T would ask why!	JMS to Mucicarmine Test Result JMS Dr T would ask why! Jones Dr T would ask why! Kinyoun Dr T would ask why! Luxol fast blue Dr T would ask why! Masson trichrome Dr T would ask why! M-MAS Dr T would ask why! Movat Dr T would ask why! Mucicarmine Dr T would ask why!	Oil red O to Prussian blue Test Result Oil red O Dr T would ask why! Orecein Dr T would ask why! PAS Dr T would ask why! PASD Dr T would ask why! PASF Dr T would ask why! PTAH Dr T would ask why! Prussian blue Dr T would ask why!	Reticulin to Ziehl-Neelsen Test Result Reticulin Dr T would ask why! Sudan black B Dr T would ask why! Toluidine blue Dr T would ask why! Verhoeff Dr T would ask why! Von Kossa Dr T would ask why! Warthin-Starry Dr T would ask why! Ziehl-Neeslen Dr T would ask why!

IHC

Alpha-1 AT to Cathepsin K Test Result alpha-1 AT Dr T would ask why! ACTH Dr T would ask why! AE1/AE1 Dr T would ask why! alpha-fetoprotein Dr T would ask why! Alk-I Dr T would ask why! AMACR Dr T would ask why! AR Dr T would ask why! ATRX Dr T would ask why! Beta2-microglobulin Dr T would ask why! B72.3 Dr T would ask why! Beta-catenin Dr T would ask why! BCL2 Dr T would ask why! BCL6 Dr T would ask why! BCLxL Dr T would ask why! C3 comp Dr T would ask why! CA9 Dr T would ask why! Calcitonin Dr T would ask why! Calponin Dr T would ask why! Calretinin Dr T would ask why! CAM5.2 Dr T would ask why! Cathepsin K Dr T would ask why!	CD10 to Chromogranin Test Result CD10 Dr T would ask why! CD117 Dr T would ask why! CD138 Dr T would ask why! CD15 Dr T would ask why! CD1a Dr T would ask why! CD20 POSITIVE CD21 Dr T would ask why! CD23 Dr T would ask why! CD3 NEGATIVE CD30 Dr T would ask why! CD31 Dr T would ask why! CD34 NEGATIVE CD35 Dr T would ask why! CD4 Dr T would ask why! CD43 Dr T would ask why! CD45 (LCA) POSITIVE CD5 Dr T would ask why! CD56 Dr T would ask why! CD57 Dr T would ask why! CD68 Dr T would ask why! CD7 Dr T would ask why! CD79a Dr T would ask why! CD8 Dr T would ask why! CD99 Dr T would ask why! CDX2 Dr T would ask why! CEA-m Dr T would ask why! Chromogranin Dr T would ask why!	CK17 to Glypican 3 Test Result CK17 Dr T would ask why! CK19 Dr T would ask why! CK20 Dr T would ask why! CK34betaE12 Dr T would ask why! CK5/6 Dr T would ask why! CK7 Dr T would ask why! CMV Dr T would ask why! c-MYC Dr T would ask why! Cyclin D1 Dr T would ask why! D2-40 Dr T would ask why! Desmin Dr T would ask why! DOG1 Dr T would ask why! EBV Dr T would ask why! EMA Dr T would ask why! ER and PR Dr T would ask why! Factor VIII Dr T would ask why! Factor XIIIa Dr T would ask why! Fascin Dr T would ask why! FH Dr T would ask why! FSH Dr T would ask why! Gastrin Dr T would ask why! GATA3 Dr T would ask why! GCDFP-15 (BRST2) Dr T would ask why! GFAP Dr T would ask why! GH Dr T would ask why! Glucagon Dr T would ask why! Glypican-3 Dr T would ask why!	HBME-1 to IgM Test Result HBME-1 Dr T would ask why! HBV core Dr T would ask why! HBV surface Dr T would ask why! H-caldesmon Dr T would ask why! HCG Dr T would ask why! Helicobacter Dr T would ask why! Hepatocyte Dr T would ask why! HER2/neu Dr T would ask why! HHV-8 Dr T would ask why! HMB-45 Dr T would ask why! HNF1beta Dr T would ask why! HPV Dr T would ask why! HSV-I Dr T would ask why! HSV-II Dr T would ask why! IDH-1 Dr T would ask why! Inhibin Dr T would ask why! INI1 (BAF47) Dr T would ask why! Insulin Dr T would ask why! Kappa Dr T would ask why! Ki-67 Dr T would ask why! Lambda Dr T would ask why! Leu 7 Dr T would ask why! IgA Dr T would ask why! IgG Dr T would ask why! IgM Dr T would ask why!	LH to PDGFR Test Result LH Dr T would ask why! LIN28 Dr T would ask why! Lysozyme Dr T would ask why! mammoglobin Dr T would ask why! MAP2 Dr T would ask why! MCV Dr T would ask why! Melanin A Dr T would ask why! MHC class I Dr T would ask why! MITF Dr T would ask why! MUM1 Dr T would ask why! Myeloperoxidase Dr T would ask why! MYO D1 Dr T would ask why! Myoglobin Dr T would ask why! Napsin Dr T would ask why! NF Dr T would ask why! NKX3.1 Dr T would ask why! NSE Dr T would ask why! OCT3/4 Dr T would ask why! p16 Dr T would ask why! P501S Dr T would ask why! p53 Dr T would ask why! p57 Dr T would ask why! p63 Dr T would ask why! Pankeratin Dr T would ask why! PAX2 Dr T would ask why! PAX5 Dr T would ask why! PAX8 Dr T would ask why! PCNA Dr T would ask why! PDGFR Dr T would ask why!	PLAP to WT1 Test Result PLAP Dr T would ask why! PNL-2C Dr T would ask why! Prolactin Dr T would ask why! PSA Dr T would ask why! PSAP Dr T would ask why! RCC Dr T would ask why! S-100 Dr T would ask why! SALL4 Dr T would ask why! Smooth muscle actin Dr T would ask why! Somatostatin Dr T would ask why! STAT6 Dr T would ask why! Synaptophysin Dr T would ask why! TdT Dr T would ask why! TFE3 Dr T would ask why! TFEB Dr T would ask why! Thyroglobulin Dr T would ask why! Toxoplasma Dr T would ask why! TSH Dr T would ask why! TTF-1 Dr T would ask why! Ubiquitin Dr T would ask why! UCHL1 (PGP9.5) Dr T would ask why! Ulex Europaeus Dr T would ask why! Vimentin Dr T would ask why! VIP Dr T would ask why! VZV Dr T would ask why! WT-1 Dr T would ask why!

Molecular testing

Chromosomal translocations

Translocations Chr 1-10 Test Result t(1;13) PAX7-FKHR Dr Torres would ask why! t(2,13) PAX3-FKHR Dr Torres would ask why! t(8;14) MYC-IGH Dr Torres would ask why! t(9;22) BCR-ABL Dr Torres would ask why! t(9;22) CHN-EWS Dr Torres would ask why!	Translocations Chr 11-13 Test Result t(11;14) CCND1-IGH Dr Torres would ask why! t(11;22) EWS-WT1 Dr Torres would ask why! t(11;22) FLI1-EWS Dr Torres would ask why! t(12;15) ETV6-NTRK3 Dr Torres would ask why! t(12;16) FUS-ATF1 Dr Torres would ask why! t(12;16) CHOP-TLS Dr Torres would ask why! t(12;22) EWS-ATF1 Dr Torres would ask why!	Translocations Chr 14-22 Test Result t(14,18) IGH-BCL2 Dr Torres would ask why! t(15;17) PML-RARA Dr Torres would ask why! t(16;21) FUS-ERG Dr Torres would ask why! t(17;22) COLA1-PDGFB Dr Torres would ask why! t(21;22) EWS-ERG Dr Torres would ask why!	Translocations Chr X & Y Test Result t(X;1) PRCC-TFE3 Dr Torres would ask why! t(X;17) TFE3-ASPL Dr Torres would ask why! t(X;18) SYT-SSX Dr Torres would ask why!

Other molecular tests

Molecular tests (A-B) Test Result ALK sequencing Dr Torres would ask why! B cell clonality Southern / PCR Clonality PRESENT BCL2 PCR Dr Torres would ask why! BRAF sequencing Dr Torres would ask why!	Molecular tests (C-H) Test Result EBV PCR Dr Torres would ask why! EGRF sequencing Dr Torres would ask why! H3F3A sequencing Dr Torres would ask why! HHV-8 PCR Dr Torres would ask why!	Molecular tests (I-J) Test Result Identity testing PCR Dr Torres would ask why! IDH1/2 PCR Dr Torres would ask why! JAK2 V617F ARMS Dr Torres would ask why!	Molecular tests (K-Z) Test Result KIT sequencing Dr Torres would ask why! LOH 1p/19q PCR Dr Torres would ask why! T cell clonality Southern / PCR Clonality ABSENT

Diagnosis

Diagnosis
Intravascular large B-cell lymphoma. Comment: This uncommon lymphoma is not infrequently an autopsy diagnosis.