Case 308 -- An Enlarged Axillary Lymph Node

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


PATIENT HISTORY:

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.

MICROSCOPIC DESCRIPTION:

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.

IMMUNOHISTOCHEMISTRY:

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.

FINAL DIAGNOSIS


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