A Wolf In T-Cell Clothing: Unveiling the Diagnostic Masquerade of T Cell / Histiocyte Rich Large B Cell Lymphoma
Keywords:
T cell/histiocyte-rich large B cell lymphoma (THRLBCL), Bone marrow infiltration, ImmunohistochemistryAbstract
T cell/histiocyte-rich large B cell lymphoma (THRLBCL) is an uncommon and aggressive form of non-Hodgkin lymphoma (NHL) characterized by sparse neoplastic B cells within a predominant reactive T-cell background. A female patient aged 53 years presented with generalized constitutional symptoms accompanied by laboratory findings of cytopenias and elevated serum calcium levels. FDG PET-CT revealed widespread lymphadenopathy, skeletal involvement, and dural uptake. Bone marrow biopsy showed diffuse and sinusoidal infiltration by monomorphic lymphoid cells without fibrosis. Immunohistochemistry demonstrated scattered CD20+ B cells, abundant CD3+ T cells, co-expression of CD15 and BCL2, and the absence of CD30 and ALK, confirming THRLBCL with marrow involvement. This case highlights the diagnostic challenge posed by THRLBCL and emphasizes the critical role of integrated clinical, imaging, histopathologic, and immunophenotypic assessment for accurate diagnosis and management.
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