Cytological Features of Fibrin-associated Diffuse Large B-cell Lymphoma Arising in Retroperitoneal Pseudocyst: The First Case Report

KIYONG NA; SO-WOON KIM; HYUN-SOO KIM

doi:10.21873/invivo.13594

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Figure 1.
Imaging and gross findings of fibrin-associated diffuse large B-cell lymphoma arising in retroperitoneal pseudocyst. (A) Abdominopelvic computed tomography image reveals large, unilocular, thick-walled, fluid-filled cystic mass (yellow arrow) in left retroperitoneum. (B) The resected specimen shows unilocular cyst with thick fibrous wall, with inner surface partially covered with yellow-to-brown, mud-like, fibrinous exudate and necrotic material. (C) The exudate and necrotic material are gently detached from the inner surface, and cell block is prepared using pelleted necrotic material.
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Figure 2.
Cytological features of fibrin-associated diffuse large B-cell lymphoma. (A) Liquid-based preparation (LBP) reveals several large, atypical cells individually dispersed in a necrotic background. (B) The large, atypical cells possess hyperchromatic nuclei with irregular nuclear contour and scant cytoplasm. (C) Karyorrhectic debris (yellow arrows) is observed (D) Mitotic figures (blue arrows) are also abundant. (E and F) Conventional smear reveals amorphous necrotic material and some karyorrhectic debris (green arrows). Compared with LBP, viable tumor cells are scant in conventional smear. A-F, Papanicolaou staining. Original magnification: A, 200×; B-F, 600×.
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Figure 3.
Histological features of fibrin-associated diffuse large B-cell lymphoma. (A) The cystic wall consists of dense fibrosis and lymphoplasmacytic infiltration with secondary lymphoid follicles (blue arrows). The inner surface contains some scattered large, atypical cells (yellow arrow) within fibrinous exudate. (B) The cell block section also shows loosely aggregated, large, atypical cells (yellow arrow) in a background of fibrinoid necrosis. (C) The atypical cells have hyperchromatic, pleomorphic nuclei with irregular nuclear contours and scant cytoplasm. Apoptotic bodies are evidently visible (green arrows). (D) The tumor cells have nuclear immunoreactivity for Epstein-Barr virus-encoded RNA in situ hybridization. Staining method: A-C, hematoxylin and eosin staining; D, immunostaining. Original magnification: A, 40×; B, 100×; C, 400×; D; 200×.