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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, primary | 7B2 Lymphoma (2-3 day steroid Rx, Case 7) CD68 4
An immunostain for lysosomal marker CD68 shows reactivity among cells that are uniformly distributed throughout the tumor tissue. Many have ingested tumor cells and their debris ---- Other immunohistochemistry (not shown): There is cytoplasmic tumor cell reactivity for B-cell markers CD20 and CD79a, and no tumor cell reactivity for T-cell marker CD3 or cytokeratin CAM 5.2. Sections probed using in situ hybridization show dense cytoplasmic hybridization in occasional, scattered cells with a probe for immunoglobulin light chain lambda, and in extremely rare cells with a probe for light chain kappa; the majority of the tumor tissue shows only weak, equivocal hybridization with a probe for light chain lambda. ---- Subsequently medical oncology was consulted and recommended treatment with steroids and high-dose methotrexate. He was discharged to rehabilitation and returned to BJH eight days later, to start chemotherapy. Three days after beginning treatment, the patient became encephalopathic without a clear etiology and was unable to be discharged. While working with physical therapy in the hallway five days after admission for chemotherapy, the patient slumped to the side to the floor. The code team found him pulseless and initiated ACLS which was unsuccessful.
