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NK/T-cell Lymphoma : Differential Diagnosis

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Several entities enter into the differential diagnosis of NK/T-cell lymphoma. They are listed below (along with diagnostic features favoring them in parenthesis): reactive lymphoid hyperplasia (EBER neg, aggregates of CD20+ B-cells); Wegener's granulomatosis (white patients, ANCA positive, kidney & lung involvement, granulomas with multinucleated giant cells, EBV negative); large B-cell lymphoma (no angiocentric growth, CD20+, cytoplasmic CD3 negative); lymphomatoid granulomatosis (mainly affects lungs, CD20+ large atypical cells); subcutaneous panniculitis-like T-cell lymphoma (subcutaneous nodules, uncommon angiocentric growth, CD8+, CD56 negative, EBV negative, TCR genes rearranged); blastoid plasmacytoid dendritic cell neoplasm (monomorphic leukemic-type infiltrate, angioinvasion and necrosis infrequent, CD56+, CD4+, CD123+, TdT+/-, cytoplasmic CD3 negative, EBV negative). The image of NK/T-cell lymphoma, nasal type, is composed predominantly of small lymphocyte-like cells and resembles reactive lymphoid hyperplasia.

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