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Gibson SE, Dojcinov S, Dotlic S, Hartmann S, Hsi ED, Klimkowska M, Melle F, Pileri SA, Ramsower CA, Rech K, Rimsza LM, Rodriguez-Pinilla SM, Tousseyn TA, de Jong D, Sabattini E. Mediastinal large B cell lymphoma and surrounding gray areas: a report of the lymphoma workshop of the 20th meeting of the European Association for Haematopathology. Virchows Arch 2023; 483:733-749. [PMID: 37530791 DOI: 10.1007/s00428-023-03550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/03/2023] [Accepted: 04/21/2023] [Indexed: 08/03/2023]
Abstract
Session 3 of the 2021 European Association for Haematopathology/Society for Hematopathology Workshop focused on mediastinal large B cell lymphomas and surrounding gray areas. One half of the session was dedicated to primary mediastinal large B cell lymphoma (PMBL) and included cases with classic clinicopathologic features, as well as cases with either morphologic or immunophenotypic variation, and PMBL-like cases with primary extramediastinal disease. The role of additional immunophenotyping and/or molecular testing to aid in the diagnosis of PMBL was discussed. The second half of the session focused on mediastinal and non-mediastinal gray zone lymphomas (GZL) with features intermediate between diffuse large B cell lymphoma (DLBCL) and classic Hodgkin lymphoma (CHL). Several cases illustrating the current challenges in separating this entity from PMBL/DLBCL and CHL were presented. There was discussion regarding the clinical and genetic differences between mediastinal and non-mediastinal GZLs. Rare cases of PMBL and GZL associated with EBV or follicular lymphoma were reviewed. Finally, several cases included in the session highlighted composite or sequential CHL and PMBL/DLBCL and/or GZL, highlighting challenges in separating such cases from GZL.
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Affiliation(s)
- Sarah E Gibson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Stefan Dojcinov
- Department of Pathology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Snjezana Dotlic
- Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Eric D Hsi
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Monika Klimkowska
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Federica Melle
- Division of Haematopathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano A Pileri
- Division of Haematopathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Karen Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lisa M Rimsza
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Thomas A Tousseyn
- Department of Imaging and Pathology, Translational Cell and Tissue Research Lab, KU Leuven, Louvain, Belgium
| | - Daphne de Jong
- Department of Pathology, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
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2
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Uczkowski D, Ashraf H, Cherry M, Dimov N. Gray zone lymphoma: A case report and comprehensive review of literature. Leuk Res Rep 2023; 19:100372. [PMID: 37287497 PMCID: PMC10242558 DOI: 10.1016/j.lrr.2023.100372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
Gray zone lymphoma is a very rare liquid malignancy that possesses intersecting features between primary mediastinal B-cell lymphoma and classic Hodgkin Lymphoma. In the case presented and accompanying literature review, we will discuss a patient with a chief complaint of shortness of breath and was found to have a mediastinal mass with biopsy consistent with mediastinal gray zone lymphoma. Herein, we explore the historical and recently updated diagnostic criteria of gray zone lymphoma from 2022 as well as the pathophysiology as it pertains to gene expression, while also reviewing the histological findings, epidemiology and treatment modalities.
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Affiliation(s)
- Dariusz Uczkowski
- Overlook Medical Center, 99 Beauvoir Ave, Summit, 07901, New Jersey, United States of America
| | - Hamza Ashraf
- Overlook Medical Center, 99 Beauvoir Ave, Summit, 07901, New Jersey, United States of America
| | - Mohamad Cherry
- Morristown Medical Center, 435 South St, Morristown, 07960, New Jersey, United States of America
| | - Nikolay Dimov
- Morristown Medical Center, 435 South St, Morristown, 07960, New Jersey, United States of America
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Güell N, Mozas P, Jimenez-Rueda A, Miljkovic M, Juncà J, Sorigue M. Methodological and conceptual challenges to the flow cytometric classification of leukemic lymphoproliferative disorders. Crit Rev Clin Lab Sci 2023; 60:83-100. [PMID: 36066070 DOI: 10.1080/10408363.2022.2114418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The diagnosis of leukemic B-cell lymphoproliferative disorders (B-LPDs) is made by integrating clinical, cytological, cytometric, cytogenetic, and molecular data. This leaves room for differences and inconsistencies between experts. In this study, we examine methodological and conceptual aspects of the flow cytometric classification of leukemic B-LPDs that could explain them. Among methodological aspects, we discuss (1) the different statistical tests used to select and evaluate markers, (2) how these markers are analyzed, (3) how scores are interpreted, (4) different degrees to which diagnostic information is used, and (5) and the impact of differences in study populations. Among conceptual aspects, we discuss (1) challenges to integrating different biological data points, (2) the under examination of the costs of misclassification (false positives and false negatives), and finally, (3) we delve into the impact of the lack of a true diagnostic gold standard and the indirect evidence suggesting poor reproducibility in the diagnosis of leukemic B-LPDs. We then outline current harmonization efforts and our personal approach. We conclude that numerous flow cytometry scores and diagnostic systems are now available; however, as long as the considerations discussed remain unaddressed, external reproducibility and interobserver agreement will not be achieved, and the field will not be able to move forward if a true gold standard is not found.
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Affiliation(s)
- Nadia Güell
- Hematology Laboratory, Unitat de citometria ICO-Badalona (CITICOB), Hospital Germans Trias i Pujol, IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Pablo Mozas
- Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alba Jimenez-Rueda
- Hematology Laboratory, Unitat de citometria ICO-Badalona (CITICOB), Hospital Germans Trias i Pujol, IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain.,Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | | | - Jordi Juncà
- Hematology Laboratory, Unitat de citometria ICO-Badalona (CITICOB), Hospital Germans Trias i Pujol, IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Marc Sorigue
- Hematology Laboratory, Unitat de citometria ICO-Badalona (CITICOB), Hospital Germans Trias i Pujol, IJC, LUMN, Universitat Autònoma de Barcelona, Badalona, Spain
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Bosch-Schips J, Granai M, Quintanilla-Martinez L, Fend F. The Grey Zones of Classic Hodgkin Lymphoma. Cancers (Basel) 2022; 14:cancers14030742. [PMID: 35159009 PMCID: PMC8833496 DOI: 10.3390/cancers14030742] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Classic Hodgkin lymphoma (CHL) is a well-defined lymphoid neoplasm with a minority of characteristic neoplastic cells of B cell origin, namely Hodgkin and Reed–Sternberg cells immersed in a rich reactive inflammatory infiltrate in the background. Although CHL has always been set apart from non-Hodgkin lymphomas, cases with morphological and phenotypic features intermediate between CHL and other lymphomas have been described. Whereas some of these lymphomas only represent morphological mimics, others exhibit mutational and gene expression profiles which overlap with CHL, indicating that these cases, frequently termed grey zone lymphomas, reside on the biological boundary between CHL and large B-cell lymphomas. In the present review, we aim to describe the current knowledge of these rare lymphomas, address diagnostic issues and summarize today’s concepts on the classification of grey zone lymphomas and related tumors. Abstract Classic Hodgkin lymphoma (CHL) is a well-defined neoplasm characterized by the presence of a minority of pathognomonic Hodgkin and Reed–Sternberg (HRS) cells in a reactive inflammatory background. Although genotypically of B cell origin, HRS cells exhibit a downregulated B cell program and therefore are set apart from other B cell lymphomas in the current WHO classification. However, cases with morphological and phenotypic features overlapping with CHL have been recognized, and the category of B cell lymphoma—unclassifiable—with features intermediate between diffuse large B cell lymphoma (DLBCL) and CHL, also termed grey zone lymphoma, was first introduced into the WHO classification in 2008 as provisional entity. These cases, as well as others raising a differential diagnosis of CHL can present diagnostic problems, as well as therapeutic challenges. Whereas some of these lymphomas only represent biologically unrelated morphological mimics, others, especially mediastinal grey zone lymphoma, exhibit genetic and gene expression profiles which overlap with CHL, indicating a true biological relationship. In this review, we address areas of diagnostic difficulties between CHL and other lymphoma subtypes, discuss the biological basis of true grey zone lymphoma based on recent molecular studies and delineate current concepts for the classification of these rare tumors.
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Affiliation(s)
- Jan Bosch-Schips
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
- Department of Pathology, Hospital Universitari de Bellvitge—Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Massimo Granai
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
| | - Falko Fend
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
- Correspondence: ; Tel.: +49-7071-2982266
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Abstract
Hodgkin lymphomas (HLs) are lymphoid neoplasms uniquely characterized by a paucity of neoplastic cells embedded in a supportive heterogenous cellular microenvironment. Although first described in the 19th century, systematic biological understanding of HLs has been hindered due to the challenges presented in studying the complex tumor microenvironment and scarce tumorigenic cells. Recent advances in single-cell isolation and characterization, sensitive mutational analytic tools, and multiplex immunohistochemical strategies have allowed further advances in understanding the development and progression of HL. Here we provide a current update on the chromosomal and mutational abnormalities seen in HL, the impact of Epstein-Barr virus infection on driving a subset of HLs, and the possibility of disease monitoring via high-sensitivity detection of genetic aberrations. We also discuss recent developments in understanding the intricate microenvironment through intercellular cross-talk, and describe novel potential biomarkers to aid in distinction of HL from other overlapping entities.
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