Contributed by Uma Krishnamurti, MD, PhD and Fiona Craig, MD
Published on line in March 2002
A 78-year-old male presented with a 6-month history of cervical adenopathy. Slides and blocks from a lymph node biopsy were received for consultation.
Histologic sections reveal lymph node with recognizable compartments (Image 1). There are germinal centers that appear reactive. There is an interfollicular infiltrate that focally has the appearance of monocytoid B cells (Image 2). In focal interfollicular areas plasma cells are seen in aggregates (Image 3). In addition, in focal areas there are large cells that form ill-defined nodules that appear to encroach upon the germinal centers (Image 4). These cells have a moderate amount of pale eosinophilic cytoplasm, vesicular chromatin with 1-2 prominent nucleoli. These areas also display high mitotic activity and abundant apoptosis (Image 5).
The differential diagnosis includes the following: