Back on Track - One case

Theme : #hemepath

Generalized lymphadenopathy
Axillary lymph node

@TristanRutland7 @MattieFarzin @KMirza @pembeoltulu @TheKarenPinto @DrGeeONE @MAHoureih @SDeMicheleMD @kis_lorand @AmandaIreland1

#PathTwitter #pathology #surgpath #Liverpoolpath

What is your favored diagnosis:
A. Classic Hodgkin lymphoma (CHL)
B. Diffuse Large B-Cell lymphoma (DLBCL)
C. Angioimmunoblastic T-cell lymphoma (AITL)
D. Reactive lymphadenopathy

AITL
- Neoplastic small-medium pale/clear T cells CD3,CD2, CD5 &usually CD4 with TFH markers CD10, CXCL13, ICOS, BCL6&PD1
- High endothelial venules
- Follicular dendritic cells-CD21, CD23 &CD35
- Large B immunoblasts (usually EBV+) while T-cells neg
- Mixed inflammatory B/G

AITL
- Gen. lymphadenopathy is common & frequently involves spleen, liver, skin & bone marrow
- 3 patterns (WHO them out https://abs.twimg.com/emoji/v2/... draggable="false" alt="😊" title="Lächelndes Gesicht mit lächelnden Augen" aria-label="Emoji: Lächelndes Gesicht mit lächelnden Augen">)
- If not all classical features are met think of these sister entities:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts">Follicular T-cell lymphoma
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts">Nodal peripheral T-cell lymphoma with TFH phenotype

AITL
Extremely EASY to diagnosehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="😅" title="Lächelndes Gesicht mit offenem Mund und Angstschweiß" aria-label="Emoji: Lächelndes Gesicht mit offenem Mund und Angstschweiß"> The only issues are:
- It can look like reactive LN (pattern 1)
- Can have RS-like cells (simulate HL)
- Tumor cell–rich AITL ( if too much clear cells) can simulate PTCL,NOS

Also it can progress to EBV-DLBCL (if too much B cells)

Giveaway bonus question(s): Of the following,

The mutation associated with AITL is:

All are made up mutations expect:

All are things you can send to others except:

IDH2

Other associated mutations are:
TET2, DNMT3A, and GTPase RHOA mutations.

---END OF THREAD--- https://pubmed.ncbi.nlm.nih.gov/26268241/ ">https://pubmed.ncbi.nlm.nih.gov/26268241/...