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Clinical History

40 year old female with pelvic mass and friable cervix, biopsy was performed at OSH. Neoplastic cells positive for  CD20+, CD138+, MUM-1+, CD56+, EBER-/+, CD30-, HIV-. C-MYC deletion.

Choose the Correct Diagnosis: 

  1. Plasmablastic lymphoma
  2. Plasmacytoma / myeloma
  3. Large B-cell lymphoma
  4. Reactive/EBV-related neoplasm

Answer: B. Plasmacytoma / myeloma

Discussion:

IHC and molecular studies support a plasmablastic malignancy. The differential consideration include a plasmablastic lymphoma versus anaplastic plasma cell tumor/plasmacytoma. Weak EBV and CD56 expression favor plasmablastic malignancy/ plasmacytoma over plasmablastic lymphoma. However, there is a considerable overlap on the diagnostic criteria and ancillary studies. Need bone survey, bone marrow biopsy, serum protein electrophoresis, free light chain ratio (FLC), urine protein electrophoresis for accurate classification.

Plasmablastic Lymphoma

Plasmablastic myeloma/plasmacytoma

Extranodal, head-neck, oral cavity and GI. Other rare sites GU, skin & bone etc.

Medullary, extramedullary, soft-tissue and parenchymal

HIV+ (most cases) of immune deficient

HIV-

EBV (60-75%)

EBV-

CD138+, MUM1+, CD20-, CD79a (40%), PAX5-/+, CD56 (25%), CD10(10%), BCL-6-, cIg+ (k/l)

CD138+, CD56+, CD117+, CD20-, CD70a-

cIg+ (kappa/lambda)

IgH rearrangement+, complex karyotype, c-MYC translocation (50%), c-MYC protein expression

 
   

Contributed by Vishnu Reddy, M.D. Interim Division Director, Anatomic Pathology and Neuropathology; Professor, Laboratory Medicine, UAB Department of Pathology