Pay attention to that what structures or cells are stained(connect with the cells in tissue block, ………..)
A) Bone marrow biopsy with low grade non Hodgkin lymphoma - risk of wrong classification as high grade lymphoma if attention not payed to the localization of high Ki-67 index and distribution of CD20+ lymhoma cells.
HE. Bone marrow with low grade non-Hodgkin B-cell lymphoma diagnosed as high grade lymphoma (DLBCL) since high Ki67 index in normal bone marrow cells interpreted as high Ki67 index in lymphoma cells (interpretation of wrong type of cells).
Hemoglobin A. Bone marrow with low grade non-Hodgkin B-cell lymphoma diagnosed as high grade lymphoma (DLBCL) since high Ki67 index in normal bone marrow cells interpreted as high Ki67 index in lymphoma cells (interpretation of wrong type of cells). Staining highlights concentration of erythroid cells.
MPO. Bone marrow with low grade non-Hodgkin B-cell lymphoma diagnosed as high grade lymphoma (DLBCL) since high Ki67 index in normal bone marrow cells interpreted as high Ki67 index in lymphoma cells (interpretation of wrong type of cells). Staining highlights concentration of myeloid cells.
CD20. Bone marrow with low grade non-Hodgkin B-cell lymphoma diagnosed as high grade lymphoma (DLBCL) since high Ki67 index in normal bone marrow cells interpreted as high Ki67 index in lymphoma cells (interpretation of wrong type of cells). Staining highlights concentration of lymphoma cells.
Ki67. High Ki67 index of normal bone marrow cells can be missinterpreted as high index of lymphoid cells if you do not pay attention to the distribution of CD20+ cells and bone marrow cells (MPO+ and Hemoglobin A+)
B) Pigmented olfactory neuroblastoma with the risk of being diagnosed as malignant melanoma based on the misinterpretation of the presence of melanin-like pigment and presence S-100+ cells (sustentacular!).
HE. Pigmented esthesioneuroblastoma (olfactory neuroblastoma). Notice presence of heavy pigmented cells. 40x.
Fig. 4. Staining of pigmented esthesioneuroblastoma if interpreted as positive (without paying attention to which cells are stained) could lead to erroneous diagnosis of malignant melanoma. 10x
S100. Higher magnification shows that only subpopulation of cells (sustentacular cells) is positive while tumor cells are not stained. This is one of the clues to the right diagnosis of pigmented esthesioneuroblastoma (olfactory neuroblastoma). 40x.
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