96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

Abstracts
than the diffuse pattern. Similar results could be found concerning
the FOXP3 cells and the infiltration pattern. The nodular pattern had
significant more reactive FOXP3 positive cells than the diffuse pattern
(p=0.018). High number of CD8 cells were found in patients with lower
leucocytes counts (p=0.049) and higher lymphocytes double time (more
than 12 months, p=0.048). All other correlation between clinical, biological
and genetic correlation with T-cells accounts shows no significant
differences.
Conclusions. Lymph node biopsies with B-CLL had a significant higher
account of T-cells than bone marrow biopsies. Patients with B-CLL and
a nodular bone marrow involvement had a significant higher number of
CD3+ and FOXP+ T-Cells. High numbers of CD8+ T-cells cells might
have a positive influence on the lymphocytes double time and leukocytes
level at the time of diagnosis.
FR-P-159
Collision lymphomas in the bone marrow – a diagnostic pitfall
A .M . May1 , L . Morawietz2 , W . Dietrich3 , A . Lindemann4 , G . Faller 5 , P . Fisch1 ,
M . Werner1 1University Freiburg Medical Center, Institute of Pathology, Freiburg,
2 3 Klinikum Stuttgart, Institute of Pathology, Stuttgart, Klinikum Stuttgart,
Stuttgart, 4Oncologic Practice, Ettlingen, 5St . Vincentius-Kliniken, Institute of
Pathology, Karlsruhe
Aims. The simultaneous co-existence of two distinct lymphoma entities
in one bone marrow trephine biopsy (BMB) is rare and can be easily missed,
especially in cases with a high density of infiltration. We present the
cases of two patients with a compact infiltrate in the BMB, which turned
out be composed of two different kinds of lymphoma.
Methods. The distinct lymphoma entities in these two patients’ BMB
were extensively analyzed, using immunohistochemistry and a PCR-based
clonality analysis of immunoglobulin heavy chain gene rearrangements.
Results. One patient’s BMB was infiltrated by hairy cell leukemia (infiltration
density: 75%). In a lymph node biopsy that had been examined separately,
due to a conspicuous abdominal lymphadenopathy, mantle cell
lymphoma was diagnosed. Further studies provided a minimal presence
of mantle cell lymphoma cells in the BMB as well as a discrete population
of hairy cells in the lymph node biopsy. Clonality analysis of the immunoglobulin
heavy chain gene identified two distinct clonal B-cell populations.
In the other patient’s BMB an unusual gigantocellular variant of
B-lymphoblastic lymphoma was diagnosed. The immunohistochemical
analysis indicated a diagnosis of cALL. Flow cytometric analyses found
two separate, but only discrete B-cell populations in the peripheral blood
and bone marrow. One of these populations was immature; the other
population was suspicious of mantle cell lymphoma. Subsequent immunohistochemistry
showed a minute additional presence of mantle cell
lymphoma in the BMB.
Conclusions. In case of clinically unusual presentation, additional examinations,
such as more extensive immunohistochemistry, molecular
methods and flow cytometric analyses, need to be included into the
diagnostic spectrum of lymphomas, to be able to identify rare cases of
collision lymphomas.
134 | Der Pathologe · Supplement 1 · 2012
FR-P-160
Primary gastric ALK-negative anaplastic large cell lymphoma:
a clinicopathologic analysis of four cases
C . Liu1 , Y . Lai1 , X . Wang1 , X . Huang1 , M . Li1 , Z . Gao1 1Peking University Health Science Center, Beijing, China
Aims. To evaluate clinicopathological and immunophenotypic features
of primary gastric ALK-negative anaplastic large cell lymphomas
(ALCLs).
Methods. Formalin-fixed, paraffin embedded tissue blocks of 4 patients
diagnosed with primary gastric ALK-negative ALCL were obtained. Hematoxylin
and Eosin-stained slides were used to evaluate histological
changes and the immunophenotypic features were detected by immunohistochemistry.
In addition, the abnormality of ALK gene was determined
by interphase fluorescence in situ hybridization (FISH).
Results. The cases were comprised of three men and one woman, with
a median age of 58.5 years. All the four cases presented with epigastric
discomfort with or without gastrorrhagia. Endoscopic examination
revealed solitary gastric ulcer in all cases. Endoscopic biopsy from one
patient and surgical specimens from three patients were available. Morphologically,
the normal architecture of gastric wall was effaced by the
diffuse infiltration of tumor cells, in which the characteristic hallmark
cells were easily identified in all cases. The tumor cells of all cases showed
a consistently strong expression of CD30 but lack of the expression
of ALK1. Moreover, the tumor cells demonstrated varying expression of
T cell markers such as CD3 (3/4) and CD43 (1/1), and negative for B-cell
markers CD20 and PAX5. Chromosomal rearrangement involving ALK
gene was not detected by FISH. Three of the four cases underwent total
or partial gastrectomy followed by chemotherapy and till the last followup;
none of them developed a relapse or progression. The rest one patient
refused surgery and chemotherapy, and died 20 months after diagnosis.
Conclusions. Here we reported four ALK-negative ALCLs occurred in
the stomach. Although it’s a rare condition, we should keep in mind
to avoid misdiagnosis especially of the gastric carcinoma. The current
results suggested that ALK-negative ALCL may have a good prognosis
with surgery combined with chemotherapy.
Poster: Autopsie/Fallstudien/Sonstiges
FR-P-161
Postmortem CT in clinical autopsy
S . Westphal1 , J . Apitzsch2 , T . Penzkofer2 , A . Perez-Bouza 1 , B . Sellhaus3 ,
A . Mahnken2 , R . Knüchel-Clarke1 1 2 RWTH Aachen University, Institute of Pathology, Aachen, RWTH Aachen
University, Department of Interventional and Diagnostic Radiology, Aachen,
3RWTH Aachen University, Institute of Neuropathology, Aachen
Aims. While autopsy rates in clinical pathology are declining for the past
decades, and forensic sciences are using virtual autopsy techniques increasingly
in daily routine, pathologists are not yet tapping the potential
of modern imaging techniques. To assess the value of virtual autopsy
techniques in clinical pathology, post- mortem imaging was performed
before autopsy.
Methods. In 29 autopsy cases, a full-body high-definition pmCT (postmortem
computed tomography) scan was performed prior to autopsy.
Images were analyzed by experienced radiologists. Autopsy was performed
following a standard protocol, taking special care of macroscopical
findings, detected in the CT scan previously. Digital macroscopical
pictures of the organs and of their histology were taken. We compared
pmCT and classical autopsy findings regarding cause of death and death-related
diagnoses, reconstruction of the key pathomechanism leading
to death and side diagnoses.