PMC5624137_01
Morphologic features of the L5 lesion. (a) The core needle biopsy specimen is extensively replaced with atypical lymphoid infiltrate with predominantly medium-sized cells fine chromatin, occasional distinct nucleoli, and scant cytoplasm (H&E, 400x). (b-d) Immunohistochemical stains show that the neoplastic cells are positive for CD19 ((b), 400x), CD20 ((c), 400x), and TdT ((d), 400x).
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fig1
We subsequently performed a core needle biopsy of the patient's L5 vertebral lesion which was also consistent with B-LBL (Figure 1).
Fluorescence in situ hybridization analysis with a LSI BCR/ABL1 ES probes (Abbott Molecular, Inc.) on a formalin-fixed paraffin-embedded L5 vertebral body biopsy. Cells with a signal pattern of 1 red, 1 green, and 2 yellow (fusion signal) are positive for BCR/ABL1 rearrangement (marked by arrow); cells with 2 red and 2 green are normal (marked by arrow head).
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fig2
Given the presence of low-level BCR-ABL1 fusion in the bone marrow detected by PCR, we performed FISH analysis for BCR/ABL1 rearrangement in both the testicular biopsy and the L5 vertebral biopsy, which showed that 90% (testes) and 80% (L5 vertebral body) were positive for BCR/ABL1 rearrangement (Figure 2).
Morphologic features of the soft tissue lesion upon relapse. (a) The core needle biopsy specimen is extensively replaced with atypical lymphoid infiltrate with predominantly medium-sized cells with fine chromatin, occasional distinct nucleoli, and scant cytoplasm (H&E, 200x). (b-d) Immunohistochemical stains show that the neoplastic cells are positive for CD20 ((b), 200x), PAX-5 ((c), 200x), and TdT ((d), 200x).
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fig3
A biopsy revealed relapsed B-LBL (Figure 3).