Siba El Hussein, MD Profile picture
Feb 8, 2022 13 tweets 10 min read Read on X
The many faces of plasma cell neoplasm, diagnostic challenges of the great imitator in #hemepath ➡️bit.ly/3B3jMC1 with @ljmedeirosMD & @ShiminHuMDPhD #mmsm #lymsm #pathtwitter #leusm
1) The small cell variant (mimicking B-cell lymphoma, particularly mantle cell lymphoma➡️CyclinD1 positive) #hemepath #pathtwitter
2) Cleaved cell variant (mimicking follicular lymphoma) #hemepath #pathtwitter
3) Monocytoid variant (mimicking acute leukemia with monocytic differentiation) #hemepath #pathtwitter
4) Erythroid variant (mimicking pure erythroid leukemia) #hemepath #pathtwitter
5) Megakaryocytoid variant #hemepath #pathtwitter
6) Blastoid variant (mimicking AML) #hemepath #pathtwitter
7) Crystal storing histiocytoisis-like variant #hemepath #pathtwitter
8) Signet ring cell-like variant #hemepath #pathtwitter
9) Oncocytic variant #hemepath #pathtwitter
10) Lobular carcinoma-like variant #hemepath #pathtwitter
11) Pseudoalveolar variant #hemepath #pathtwitter
12) Aberrant cytokeratin expression

And many other unusual morphologic and immunophenotypic presentations here ➡️bit.ly/3B3jMC1

Take home message: If things are not adding up (clinical vs pathology findings), throwing in a CD138 stain will sometimes solve the puzzle

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More from @SibaElHussein

Dec 18, 2023
Patient with history of myelomonocytic leukemia post treatment, below is a follow up flow cytometry analysis of his peripheral blood months later, showing an expanded population in the CD45-dim gate (aka "blast-gate") #hemepath #PathTwitter #leusm #MedEd #MedTwitter #MedX @saada_vsaadaImage
This population is negative for CD14, CD33, CD34, C64, CD117, CD123 & HLA-DR expression; However, it shows subset CD13 expression #hemepath #PathTwitter #leusm #MedEd #MedTwitter #MedX


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By morphologic examination, no myeloblasts or blast equivalents are identified; However, many cells with the following morphology are appreciated:

#hemepath #PathTwitter #leusm #MedEd #MedTwitter #MedX
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Read 5 tweets
Dec 17, 2023
Viral infections may show striking T-cell atypia; which in the absence of adequate clinical history, may be worked-up for T-cell lymphoma

Below are pictures from a peripheral blood smear of a patient with an acute viral illness & remarkable lymphocytic atypia #hemepath #lymsm Image
Flow cytometry analysis confirms the nature of these numerous atypical cells by morphology as lymphocytes, with a predominant CD3-positive T-cell population #hemepath #lymsm #PathTwitter #PathX #SoMe #MedTwitter Image
This T-cell population consists predominantly CD8+large granular lymphocytes #hemepath #lymsm #PathTwitter #PathX #SoMe #MedTwitter Image
Read 7 tweets
Dec 11, 2023
Tricky case of Cyclin-D1-positive neoplasm➡️

Patient presented with "pancytopenia, rule out MDS"

Flow cytometry of a limited marrow aspirate revealed a CD20-positive Kappa restricted population that appeared to be negative for CD19 expression #hemepath #lymsm #mmsm #MedTwitter
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Morphologic examination showed a hypercellular marrow almost completely involved by a "lymphoid" infiltrate with a low grade morphology
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Although by flow cytometry, CD19 was negative, which is odd in a baseline presentation of a low grade lymphoma, CD20 stain was diffusely postive in the infiltrate (below)

Additional IHC workup targeting mantle cell lymphoma, follicular lymphoma, CLL/SLL, LPL/MZL was done
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Read 12 tweets
Nov 30, 2023
An incredibly challenging case of ALK-rearranged poorly differentiated lung adenocarcinoma with diffuse CD30 positivity, mimicking ALK-rearranged Anaplastic Large Cell Lymphoma, first authored by future #hemepath🌟@gibyvgeorge ➡️ #lymsm @Histo_Journalonlinelibrary.wiley.com/doi/10.1111/hi…
Patient presented with a mediastinal mass, composed of sheets of anaplastic cells. Cytokeratin stains along with CD45 & all B-cell & T-cell markers were negative
#hemepath #lymsm #pathtwitter #pathX #molpath #medtwitter #surpath #cytopath #thoracicpath

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However, CD30 & ALK1 stains were diffusely & homogeneously positive

#hemepath #lymsm #pathtwitter #pathX #molpath #medtwitter #surpath #cytopath #thoracicpath
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Read 13 tweets
Nov 29, 2023
Patient with history of CLL/SLL clinically progressing; Below bone marrow biopsy shows complete involvement by lymphoma

#lymsm #hemepath #PathTwitter #pathx #surgpath #MedTwitter #bmtsm Image
High power evaluation: 2 components detetcted, the yellow circle is the CLL/SLL component, and the yellow arrows point at larger pleomorphic cells #lymsm #hemepath #PathTwitter #pathx #surgpath #MedTwitter #bmtsm
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In other areas, the background is histiocyte-rich (green arrows) with admixed sacttered large pleomorphic lymphocytes. The first thought one can jump to is: This is classic Hodgkin lymphoma arising from CLL/SLL #lymsm #hemepath #PathTwitter #pathx #surgpath #MedTwitter #bmtsm
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Read 9 tweets
Nov 27, 2023
CLL/SLL with an inter & peri-follicular architecture ⬇️⬇️

#hemepath #PathTwitter #lymsm #pathX #surgpath Image
The neoplastic lymphocytes surround germinal centers; If the neoplastic cells had more of a "monocytoid" look, with this perifollicular architecture, this lymphoma could be easily misinterpreted as nodal marginal zone lymphoma, particularly in limited core-nedle biopsy

#hemepath


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CD20 stain below highlights the germinal centers in the background (bright expression) #hemepath #PathTwitter #lymsm #pathX #surgpath Image
Read 8 tweets

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