Lei Chen

It is well known that following chemotherapy and radiation, tumor necrosis can happen in lymphomas; however, only a few studies describe histiocyte proliferation and accumulation as a sequela to ly...

Diffuse large B-cell lymphoma (DLBCL) is one of the most common non-Hodgkin lymphomas (NHL) in adults. Morphologically, it is composed of medium or large B lymphoid cells with more than twice the n...

Objective. More than 90% of gastric mucosa-associated lymphoid tissue (MALT) lymphomas are attributed to Helicobacter pylori infections. However, the pathogenesis of H. pylori-negative MALT lymphomas is controversial, and additional etiologies need to be investigated. Materials. A retrospective study of gastric MALT lymphoma cases over a 15-year period revealed 56 cases. The H. pylori status, clinical information, and body mass index (BMI) data were collected. The results of the urea breath test, serology, stool antigen, and previous biopsy results were documented. Results. The 56 cases had an average height of 166.57 cm (range, 147.3-190.5), weight of 83.98 kg (range 55-153.1), and body mass index (BMI) of 30.34 kg/m(2) (range, 17.96-49.77). Twenty-one cases were H. pylori-positive (37.5%), with a mean BMI of 27.36 kg/m(2) (range, 17.96-47.25), and BMI>30 kg/m(2) in 5 (23.8%) patients. Thirty-five cases were H. pylori-negative, with a mean BMI of 31.90 kg/m(2) (range, 18.17-49.77), and 20 (57.1%) having BMI>30 kg/m(2). A Fisher's exact test and two-tailed test showed a statistically significant difference between the two groups. Conclusion. Obesity leads to a baseline state of chronic inflammation and increased production of pro-inflammatory cytokines that can stimulate the lymphocytes, leading to lymphomatous proliferation. Our study suggests a potential correlation between obesity and the risk of development of primary gastric MALT lymphoma.

Mucosal-associated lymphoid tissue (MALT) lymphoma can typically be identified as a mass lesion or nodularity endoscopically and macroscopically. We report an incidental finding of a Helicobacter pylori gastric mucosal-associated lymphoid tissue (MALT) lymphoma in a sleeve gastrectomy specimen with no gross examination findings.

Context. Avoiding procedure-related morphologic distortion such as fragmentation and crush artifact is critical in bone marrow diagnosis. Use of a hammer or mallet, although infrequent, is a known technique of advancing the biopsy needle during specimen collection. Objectives. We performed a double-blinded, retrospective review of bone marrow biopsies collected by the Interventional Radiology department at our institution in order to assess specimen quality by using this technique. Design. We reviewed 93 bone marrow biopsy specimens collected at our hospitals, between January 2015 and June 2015. Routine bone marrow core biopsy slides were reviewed. The presence of crush artifact, specimen fragmentation, and aspiration artifact, as well as the presence of osteopenia and an overall grade of specimen adequacy, was recorded for each specimen. Results. A sterile mallet was used during the bone marrow biopsy procedure in 29 cases. Use of a mallet was significantly associated with the presence of suboptimal or inadequate specimen quality of bone marrow core biopsy (p<0.005) and was independently associated with severe specimen fragmentation (2+) (p<0.0001). There was no statistically significant association between length of the core and use of a mallet. Conclusions. Use of a mallet during bone marrow core biopsy collection is significantly associated with morphologic distortion in the form of severe specimen fragmentation and negatively affects specimen adequacy. There is no difference in length of core biopsy as previously thought by using a mallet to advance the needle during the procedure. We recommend that the use of this technique should be avoided during specimen collection.

T-cell/histiocyte-rich large B-cell lymphoma is uncommon in children population. There were few cases reported in the literature with wide range clinical presentations including advanced stage, and more involvement of liver, spleen and bone marrow. Head and neck lymphadenopathy tends to present in younger children. We report a case of 10-year-old boy who initially presented intermittent fever, headaches and neck lymphadenopathy. Subsequently, he developed diffuse lymphadenopathy and hepatosplenomegaly. T-cell/histiocyte-rich large B-cell lymphoma was diagnosed on a cervical lymph node biopsy. Cervical lymphadenopathy in this age group is most commonly reactive or non-malignant processes. Lymphoma is much less frequent; mainly are non-Hodgkin lymphomas. However, a subset of large B-cell lymphoma called T-cell/histiocyte- rich B-cell lymphoma is rare in children.

Objectives: Harris Health System (HHS) is a safety net system providing health care to the underserved of Harris County, Texas. There was a 6-month waiting period for a rheumatologist consult for patients with suspected systemic lupus erythematosus (SLE). The objective of the intervention was to improve access to specialty care. Methods: An algorithmic approach to testing for SLE was implemented initially through the HHS referral center. The algorithm was further offered as a “one-click” order for physicians, with automated reflex testing, interpretation, and case triaging by clinical pathology. Results: Data review revealed that prior to the intervention, 80% of patients did not have complete laboratory workups available at the first rheumatology visit. Implementation of algorithmic testing and triaging of referrals by pathologists resulted in decreasing the waiting time for a rheumatologist by 50%. Conclusions: Clinical pathology intervention and case triaging can improve access to care in a county health care system.

Perifollicular granuloma is a unique histologic feature and whether it is associated with immunoglobulin G4 (IgG4)-related disease is controversial. We report a case of a 38-year-old man who presented with worsening left eye pain, proptosis, tearing, gritty sensation, blurred vision and multiple lymphadenopathy. An axillary lymph node resection showed reactive follicular and interfollicular lymph node hyperplasia, and increased eosinophils and plasma cells (at least 80% of IgG(+) plasma cells were positive for IgG4). A distinct feature was the presence of multifocal, perifollicular histiocytic granulomas, which formed a wreath around the entire follicles. The human herpes virus 8 was not detected by immunohistochemistry. In addition, an extensive panel of special stains, immunohistochemistry, and flow cytometry was negative for lymphoma, fungal, or mycobacterial infection. The findings were suggestive of IgG4-related sclerosing disease-associated lymphadenopathy. Further laboratory testing showed a significant increase of serum immunoglobulin E (> 23000 IU/mL) and slight increase of total IgG, but normal serum IgG4. Even though perifollicular granuloma is a nonspecific histopathologic feature and can be seen in other diseases, such as nodular lymphocyte predominant Hodgkin lymphoma, IgG4-related lymphadenopathy should be listed in the differential diagnoses of benign reactive lymph nodes, especially when perifollicular granuloma and plasmacytosis coexist.

Intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive and often fatal non-Hodgkin lymphoma characterized by preferential growth of malignant B-cells within the lumina of small vessels. Rituximab plus anthracycline-based chemotherapy is the current standard regimen for IVLBCL, however it has minimal efficacy in relapsed or refractory diseases. Recent clinical trials have shown a significant anti-lymphoma activity of mammalian target of rapamycin (mTOR) inhibitors in relapsed and refractory diffuse large B-cell lymphoma (DLBCL); however, the activation status of the mTOR pathway and the therapeutic potential of mTOR inhibitors in IVLBCL have not yet been studied. Here we described the clinicopathological features of 3 cases of IVLBCL diagnosed at our institutions, and evaluated the activation status of the mTOR signaling in these tumors. Our results showed that the mTOR complex 2 pathway was selectively upregulated in IVLBCL, as evidenced by a predominant nuclear localization of the activated form of mTOR (p-mTOR at Ser2448) with concomitant overexpression of nuclear p-Akt (Ser473) and vascular endothelial growth factor (VEGF)-A in the lymphoma cells. These data suggest that overactivation of mTOR pathway may play a role in lymphomagenesis of IVLBCL and mTORC2 inhibitors may be beneficial in treating IVLBCL.