Case 308 -- An Enlarged Axillary Lymph Node

Contributed by Yan Peng MD, PhD, and Lydia C Contis MD
Published on line in May 2002


The patient was a 73-year-old female who had a history of thyroidectomy for benign nodules. She noticed a lump in her thyroidectomy scar and her physical examination also showed an enlarged axillary lymph node. She had been asymptomatic. An excisional biopsy of the lymph node was performed.


Figure 1: There is diffuse architectural effacement of the lymph node by a predominantly nodular infiltrate of intermediate size lymphoid cells.
Figures 2 and 3: The neoplastic cells grow in a mantle zone pattern with a residual germinal center.
Figure 4: The neoplastic cells demonstrate irregular nuclei, condensed nuclear chromatin, small inconspicuous nucleoli and scant cytoplasm.
Figure 5: Hyalinized small blood vessels are prominent.


In order to further evaluate the lymph node, immunohistochemical stains were performed on paraffin-embedded tissue.

Figures 6 and 7: CD 20 is strongly positive in the neoplastic cells.
Figures 8 and 9: Cyclin D1 shows strong nuclear staining and highlights a mantle zone growth pattern.
Figures 10 and 11: CD 5 is negative in the B-cells; few T cells are positive for CD5.
Figure 12: CD 10, which is usually positive in follicular center cells, is negative in the infiltrate.
Figure 13: CD 43 is positive in the neoplastic cells.
Figure 14: CD 3 is negative in the infiltrate.


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