Diffuse Large B-cell Lymphoma with Clear Cells Morphology

Diffuse large B-cell lymphoma is a rare type of non-Hodgkin lymphoma composed ofdiffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to orexceeding the normal macrophage nuclei. It has become clear that diffuse large B-celllymphoma is not a uniform category. Several recognizable variants have clinically distinctfeatures and, frequently, require specific treatment approaches. Recognition of thesevariants and utilization of the appropriate treatments will improve the outcome for thepatients. We report a case of a clear cell variant of diffuse large B-cell lymphomainvolving a lymph node in the neck, which was clinically suspected of being metastaticcarcinoma. A 50-year-old Libyan woman from Misurata presented with cervicallymphadenopathy and rapidly enlarging retrosternal mass which radiologically was 15.0 x7.0 cm. Core biopsy of the cervical mass was performed at Misurata Cancer Center (MCC).The biopsy showed a malignant infiltration exhibiting diffuse areas comprising large cellswith slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. Inthese areas, there was high mitotic activity, staining for cytokeratins was negative. Theseareas had the following phenotypes: cluster designation marker 20 (CD20) positive, CD10positive, B-cell lymphoma (Bcl)-2 positive, Bcl-6 positive, CD5 negative, CD3 negative,melanoma marker (S100) negative, cytokeratin-7 negative, and exhibited a high mitoticindex marker (Ki-67= 80%). According to the immunohistochemical (IHC) findings, weconcluded that this patient has a clear cell variant of diffuse large B-cell lymphoma ofgerminal cell type. Our patient is undergoing R-CHOP chemotherapy