Clinical Image | Open Access
Volume 2023 - 2 | Article ID 231 | http://dx.doi.org/10.51521/WJCRCI.2023.220124
Academic Editor: John Bose
Aaron Niblock1,2 S Rajendran3,
1Haematology department, Antrim Area Hospital, Northern
Ireland
2School of Medicine, Ulster University, Northern Ireland
3Pathology Department, Antrim Area Hospital, Northern
Ireland
Corresponding Author: Aaron Niblock, Haematology
department, Antrim Area Hospital, Northern Ireland; School of Medicine, Ulster
University, Northern Ireland
Citation: Aaron Niblock, S Rajendran (2023). Follicular
Lymphoma Mimicking ‘Adenocarcinoma with Clear Cells and Signet Ring Morphology’.
2023 October-November; 2(2)1-4.
Copyrights © 2023, Aaron Niblock, et al. This article is licensed under the Creative
Commons Attribution-Non-Commercial-4.0-International-License-(CCBY-NC)
(https://worldjournalofcasereports.org/blogpage/copyright-policy). Usage and
distribution for commercial purposes require written permission.
Case Presentation
91-year-old female
who presented with epigastric pain. CT showed a 13 cm mass in the right lower
quadrant encasing the right colon and enlarged lymph nodes. Histology of the CT
guided biopsy of the mass showed malignant tumour which was composed mainly of cells
with clear, vacuolated cytoplasm and eccentric nuclei (signet-ring like). The
cells were surrounded by sclerotic stroma and arranged in a nested
configuration (Image 1). Morphological features of carcinoma including
keratinisation and glandular differentiation were not evident. Melanin pigment
in indicate melanoma was not seen. On immunohistochemistry broad spectrum
cytokeratin (AE1/3 and CAM5.2) and SOX10 were negative which would exclude
carcinoma and melanoma respectively. The tumour was diffusely positive with
CD45 and CD20 confirming B-cell lineage (Image 2). There was positivity with
BCL2 and germinal centre makers BCL6 and CD10. Staining with antibodies to CD21
and CD23 confirms the presence of at least partial follicular architecture.
Kappa and lambda shows lambda light chain restriction (Image3). EBER was negative. The final diagnosis was non-Hodgkin B-cell lymphoma, most likely a follicular lymphoma with signet-ring like morphology which is difficult to grade due to the unusual morphology. FISH showed BCL2 rearrangement confirming diagnosis of follicular lymphoma.
This case was challenging due to the extra
nodal location and unusually morphology which resembled a signet ring cell
carcinoma. Within follicular architecture highlighted by CD21 and CD23 there
were some centrocyte and centroblast like cells however no conventional areas
of follicular lymphoma were seen. Grading is difficult due to the non-standard morphology and extra nodal
location. Very few cases of follicular lymphoma with signet ring morphology has
been previously described. The vacuoles are believed to be composed of
intracytoplasmic immunoglobulin deposits. The lambda restriction would support
this theory.
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