Case 11

Clinical history

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

Primary image

Pons. Intermediate magnification. H&E stain.

Expand High magnification
High magnification. H&E stain.

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

Differential diagnosis

Expand Differential diagnosis
leukemia (blast crisis)

Additional tests

More history

Expand More history
WBC significantly elevated.

Ask a friend

Expand Ask a friend
It looks intravascular and lymphoid.

Stains

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

IHC

ExpandAlpha-1 AT to Cathepsin K Test Result alpha-1 AT Expand Dr T would ask why! ACTH Expand Dr T would ask why! AE1/AE1 Expand Dr T would ask why! alpha-fetoprotein Expand Dr T would ask why! Alk-I Expand Dr T would ask why! AMACR Expand Dr T would ask why! AR Expand Dr T would ask why! ATRX Expand Dr T would ask why! Beta2-microglobulin Expand Dr T would ask why! B72.3 Expand Dr T would ask why! Beta-catenin Expand Dr T would ask why! BCL2 Expand Dr T would ask why! BCL6 Expand Dr T would ask why! BCLxL Expand Dr T would ask why! C3 comp Expand Dr T would ask why! CA9 Expand Dr T would ask why! Calcitonin Expand Dr T would ask why! Calponin Expand Dr T would ask why! Calretinin Expand Dr T would ask why! CAM5.2 Expand Dr T would ask why! Cathepsin K Expand Dr T would ask why!	ExpandCD10 to Chromogranin Test Result CD10 Expand Dr T would ask why! CD117 Expand Dr T would ask why! CD138 Expand Dr T would ask why! CD15 Expand Dr T would ask why! CD1a Expand Dr T would ask why! CD20 Expand POSITIVE CD21 Expand Dr T would ask why! CD23 Expand Dr T would ask why! CD3 Expand NEGATIVE CD30 Expand Dr T would ask why! CD31 Expand Dr T would ask why! CD34 Expand NEGATIVE CD35 Expand Dr T would ask why! CD4 Expand Dr T would ask why! CD43 Expand Dr T would ask why! CD45 (LCA) Expand POSITIVE CD5 Expand Dr T would ask why! CD56 Expand Dr T would ask why! CD57 Expand Dr T would ask why! CD68 Expand Dr T would ask why! CD7 Expand Dr T would ask why! CD79a Expand Dr T would ask why! CD8 Expand Dr T would ask why! CD99 Expand Dr T would ask why! CDX2 Expand Dr T would ask why! CEA-m Expand Dr T would ask why! Chromogranin Expand Dr T would ask why!	ExpandCK17 to Glypican 3 Test Result CK17 Expand Dr T would ask why! CK19 Expand Dr T would ask why! CK20 Expand Dr T would ask why! CK34betaE12 Expand Dr T would ask why! CK5/6 Expand Dr T would ask why! CK7 Expand Dr T would ask why! CMV Expand Dr T would ask why! c-MYC Expand Dr T would ask why! Cyclin D1 Expand Dr T would ask why! D2-40 Expand Dr T would ask why! Desmin Expand Dr T would ask why! DOG1 Expand Dr T would ask why! EBV Expand Dr T would ask why! EMA Expand Dr T would ask why! ER and PR Expand Dr T would ask why! Factor VIII Expand Dr T would ask why! Factor XIIIa Expand Dr T would ask why! Fascin Expand Dr T would ask why! FH Expand Dr T would ask why! FSH Expand Dr T would ask why! Gastrin Expand Dr T would ask why! GATA3 Expand Dr T would ask why! GCDFP-15 (BRST2) Expand Dr T would ask why! GFAP Expand Dr T would ask why! GH Expand Dr T would ask why! Glucagon Expand Dr T would ask why! Glypican-3 Expand Dr T would ask why!	ExpandHBME-1 to IgM Test Result HBME-1 Expand Dr T would ask why! HBV core Expand Dr T would ask why! HBV surface Expand Dr T would ask why! H-caldesmon Expand Dr T would ask why! HCG Expand Dr T would ask why! Helicobacter Expand Dr T would ask why! Hepatocyte Expand Dr T would ask why! HER2/neu Expand Dr T would ask why! HHV-8 Expand Dr T would ask why! HMB-45 Expand Dr T would ask why! HNF1beta Expand Dr T would ask why! HPV Expand Dr T would ask why! HSV-I Expand Dr T would ask why! HSV-II Expand Dr T would ask why! IDH-1 Expand Dr T would ask why! Inhibin Expand Dr T would ask why! INI1 (BAF47) Expand Dr T would ask why! Insulin Expand Dr T would ask why! Kappa Expand Dr T would ask why! Ki-67 Expand Dr T would ask why! Lambda Expand Dr T would ask why! Leu 7 Expand Dr T would ask why! IgA Expand Dr T would ask why! IgG Expand Dr T would ask why! IgM Expand Dr T would ask why!	ExpandLH to PDGFR Test Result LH Expand Dr T would ask why! LIN28 Expand Dr T would ask why! Lysozyme Expand Dr T would ask why! mammoglobin Expand Dr T would ask why! MAP2 Expand Dr T would ask why! MCV Expand Dr T would ask why! Melanin A Expand Dr T would ask why! MHC class I Expand Dr T would ask why! MITF Expand Dr T would ask why! MUM1 Expand Dr T would ask why! Myeloperoxidase Expand Dr T would ask why! MYO D1 Expand Dr T would ask why! Myoglobin Expand Dr T would ask why! Napsin Expand Dr T would ask why! NF Expand Dr T would ask why! NKX3.1 Expand Dr T would ask why! NSE Expand Dr T would ask why! OCT3/4 Expand Dr T would ask why! p16 Expand Dr T would ask why! P501S Expand Dr T would ask why! p53 Expand Dr T would ask why! p57 Expand Dr T would ask why! p63 Expand Dr T would ask why! Pankeratin Expand Dr T would ask why! PAX2 Expand Dr T would ask why! PAX5 Expand Dr T would ask why! PAX8 Expand Dr T would ask why! PCNA Expand Dr T would ask why! PDGFR Expand Dr T would ask why!	ExpandPLAP to WT1 Test Result PLAP Expand Dr T would ask why! PNL-2C Expand Dr T would ask why! Prolactin Expand Dr T would ask why! PSA Expand Dr T would ask why! PSAP Expand Dr T would ask why! RCC Expand Dr T would ask why! S-100 Expand Dr T would ask why! SALL4 Expand Dr T would ask why! Smooth muscle actin Expand Dr T would ask why! Somatostatin Expand Dr T would ask why! STAT6 Expand Dr T would ask why! Synaptophysin Expand Dr T would ask why! TdT Expand Dr T would ask why! TFE3 Expand Dr T would ask why! TFEB Expand Dr T would ask why! Thyroglobulin Expand Dr T would ask why! Toxoplasma Expand Dr T would ask why! TSH Expand Dr T would ask why! TTF-1 Expand Dr T would ask why! Ubiquitin Expand Dr T would ask why! UCHL1 (PGP9.5) Expand Dr T would ask why! Ulex Europaeus Expand Dr T would ask why! Vimentin Expand Dr T would ask why! VIP Expand Dr T would ask why! VZV Expand Dr T would ask why! WT-1 Expand Dr T would ask why!

Molecular testing

Chromosomal translocations

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

Other molecular tests

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

Diagnosis

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