Surgical Pathology Criteria–

Precursor B Lymphoblastic Lymphoma

Differential Diagnosis

Precursor B Lymphoblastic Leukemia / Lymphoma Precursor T Lymphoblastic Leukemia / Lymphoma
10% of precursor lymphoblastic lymphomas 90% of precursor lymphoblastic lymphomas
Frequently involves skin and bone Frequent mediastinal mass
B lineage (usually CD19+, CD79a+ at a minimum) T lineage (usually CD3+, CD7+ at a minimum)
Both are TdT+ and may be CD34+


Burkitt Lymphoma Lymphoblastic Lymphoma, T and B
Median age 30 years Median age 17-20 years
B lineage markers positive 90% T, 10% B
Multiple nucleoli Inconspicuous nucleoli
Coarse chromatin Fine chromatin
Thin rim of cytoplasm Scant cytoplasm
Frequently GI or ovary T frequently mediastinal, B frequently cutaneous
TdT negative TdT virtually always positive
Translocation involving myc gene No myc translocation
Both have extremely high mitotic rates and starry sky macrophages although Burkitt lymphoma typically has a higher mitotic rate and the starry sky pattern is more uniform


Lymphoblastic Lymphoma, T or B Blastic Mantle Cell Lymphoma
Median age 17-20 years Rare under 30 years
Histiocytes infrequent (tingible body macrophages frequent) Scattered histiocytes frequent
No prior diagnosis of mantle zone lymphoma Frequent diagnosis of mantle zone lymphoma
T lineage 90%, B lineage 10% B lineage markers positive
bcl1 negative bcl1 85%
CD5 negative if B lineage CD5 80%

 

Lymphoblastic Lymphoma, B or T Extramedullary Myeloid Tumor
90% T lineage, 10% B lineage CD43+ but other T and B markers negative
Myeloperoxidase negative Myeloperoxidase >90%
Lysozyme negative Lysozyme 90%

 

Lymphoblastic Lymphoma, B or T DLBCL
Median age 17-20 years Median age 60 years
90% T lineage, 10% B lineage B lineage
Starry sky macrophages present Starry sky pattern infrequent
Fine chromatin Vesicular chromatin
None or small nucleoli May have prominent nucleoli
Uniform cells Heterogeneous cells
Generally only a problem in suboptimally processed specimens

 

Lymphoblastic Lymphoma, B or T SLL/CLL
Median age 17-20 years Rare under 30 years
Starry sky macrophages frequent Starry sky macrophages rare
High mitotic rate Mitoic figures only in proliferation centers
T lineage 90%, B lineage 10% B lineage
CD23 negative CD23 85%
Generally only a problem in suboptimally prepared specimens in which cytologic detail is obscured

 

  Rhabdomyosarcoma PPNET Neuroblastoma Lymphoblastic Lymphoma, B or T
Muscle markers positive negative negative negative
CD99 positive negative negative positive
LCA and or B/T lineage negative negative negative 90% T, 10% B
TdT negative negative negative positive
Cytoplasm abundant, eosinophilic scant fibrillar scant

 

 

 

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