case_images: PMC6343450_01
case_images: (A) Peripheral smear showing blasts. Jenner Giemsa x400. (B) Cellular bone marrow with infiltration by large blasts scant to moderate amounts of agranular, pale basophilic cytoplasm with only rare vacuoles, and irregular nuclei with dispersed chromatin and multiple prominent nucleoli. Jenner Giemsa x400. (C) Bone marrow biopsy showing near total replacement of the marrow by large atypical lymphoid cells. H & E stain, x200. (D) Retroperitoneal LN biopsy, shows diffuse effacement by large atypical lymphoid cells with hyperchromatic nuclei, frequent mitosis. H & E stain, x400. (E) CD20 diffuse membranous positivity, x400. (F) Bcl-2 IHC, diffuse membranous positivity, x400. (G) Bcl-6 IHC, diffuse nuclear, x400. (H) Ki-67 labelling index is ~80% to 90%, x400. H & E indicates haematoxylin and eosin; LN, lymph node; IHC, immunohistochemistry.
case_images: 10.1177_1179545X18821160-fig1.jpg
case_images: PMC6343450_01_10.1177_1179545X18821160-fig1.jpg
case_images: fig1-1179545X18821160
case_images: Bone marrow aspirate smears were cellular and showed infiltration by ~30% myeloperoxidase (Fig 1(a)) (MPO) negative blasts with scant to moderate amounts of agranular, pale basophilic cytoplasm with rare vacuolations, irregular nuclei with dispersed chromatin, and multiple prominent nucleoli. B-cell lymphoma (HGBL) (fig 2), DLBCL in leukaemic phase was rendered. Bone marrow Fig (1c) and retroperitoneal lymph node Fig 1(d) biopsies revealed diffuse involvement by atypical lymphoid cells, positive for CD20, CD10, BCL2, and BCL6, negative for cyclin D1 and c-MYC with a high Ki-67 labelling index (85%) fluorescent in situ hybridization (FISH) done by dual colour break apart probe was negative for c-MYC rearrangements (fig e-h).
case_images: Side scatter (SSC)/CD45 gated cell cluster was positive for CD19, CD10, CD20, CD22, kappa, sIgM, and negative for CD34, CD13, CD33, CD117, CD14, CD3, CD7, and CD23. FITC indicates fluorescein isothiocyanate; ECD indicates Phycoerythrin Texas Red-X; PC7 indicates Phycoerythrin Cyanin 7; PE indicates phycoerythrin.
case_images: 10.1177_1179545X18821160-fig2.jpg
case_images: PMC6343450_01_10.1177_1179545X18821160-fig2.jpg
case_images: fig2-1179545X18821160
case_images: B-cell lymphoma (HGBL) (fig 2), DLBCL in leukaemic phase was rendered. Bone marrow Fig (1c) and retroperitoneal lymph node Fig 1(d) biopsies revealed diffuse involvement by atypical lymphoid cells, positive for CD20, CD10, BCL2, and BCL6, negative for cyclin D1 and c-MYC with a high Ki-67 labelling index (85%) fluorescent in situ hybridization (FISH) done by dual colour break apart probe was negative for c-MYC rearrangements (fig e-h).