Contributed by Allene Gagliano, MD Published on line in June, 2004
Contributed by Allene Gagliano, MD
Published on line in June, 2004
CLINICAL HISTORY:
26 year old female presented with a 3-4 week history of pharyngitis, odynophagia and dysphagia. She had initially been treated with two courses of Augmentin (amox/clav) and one course of Avelox (moxifloxacin), and her symptoms seemed to improve, but then came back to the point where she was having trouble swallowing and had airway problems, with a fever as high as 104.7F.
On exam, she had marked cervical lymphadenopathy, as well as axillary lymphadenopathy, tonsils 2+ to 3+ (L > R), with exudates. She also had a few small nodes in the groin area which she stated she'd had 8 weeks before. She was also noted to have a genital lesion on her labia that was cultured for viral and herpetic activity. Herpes simplex virus was isolated. WBC count was 16.9 x 109/L at time of admission. A tonsillectomy was performed at an outside hospital and sent to UPMC on consult.
HISTOMORPHOLOGY:
) | Hyperplastic follicles with few remaining germinal centers, surrounded by interfollicular expansion. |
) | Polymorphous interfollicular expansion composed of small lymphs, transformed cells, histiocytes and plasma cells. |
) | Monocytoid B-cells surrounding crypt epithelial cells. |
) | Areas of necrosis. |
) | Multinucleated cells with characteristic "molding" of nuclei and margination of chromatin to the periphery of the nucleus. |
) | Same as above. |
IMMUNOSTAINS:
) | CD3. | ) | CD20. | ) | HSV 1 & 2. |
OTHER PERTINENT IMMUNOSTAINS PERFORMED:
| EBV: | negative |
| CD15: | No RS-like staining |
| CD45: | numerous + cells |
| CD30: | No RS-like staining |
| Kapa/Lamda: | both many scat. cells little staining in pale cell areas |
| bcl2: | GCs "-" as well as |
| bcl6: | many "+" cells in GCs |
| CD10: | GCs "+" in patchy/weak stain w/bg staining |
| Alk1: | negative |
| CD43: | sim. to CD3; B-cells negative |
| EBER-ish: | rare scat. "+" cells |
OTHER RESULTS:
CMV serologies negative.
EBV serologies indicate prior infection, but no active infection.
