Case 743 -- A 53 year old male with intermittent fevers, night sweats, and a chronic cough

Contributed by Stephen Hastings, MD, Marie DeFrances, MD, PhD, Miroslav Djokic, MD


CLINICAL HISTORY

The patient is a 53 year old male who presented with intermittent fevers, night sweats, and a chronic cough. The patient underwent a PET scan, which showed an enlarged supraclavicular lymph node, a lesion in the left lobe of his liver and bulky retroperitoneal lymphadenopathy. His peripheral blood showed a normocytic normochromic anemia with leukocytosis. The patient underwent excision of the supraclavicular lymph node.

HISTOLOGY

H&E Staining

IMMUNOHISTOCHEMISTRY

Image 9: CD20;   Image 10: CD3;   Image 11: CD30;   Image 12: CD15;   Image 13: MUM-1;   Image 14: PAX5;   Image 15: OCT2;   Image 16: BOB.1;   Image 17: EMA;   Image 18: EBV ISH (EBER);   Image 19: CD2;   Image 20: CD4;   Image 21: CD5;   Image 22: CD8;   Image 23: CD20;   Image 24: CD3;   Image 25: CD10;   Image 26: bcl-2  



The following immunohistochemical stains were negative in the large cells: LCA, CD45, Alk-1, PD-1, CD7, Beta-F1, TIA1, Granzyme, and AE1/AE3.

FLOW CYTOMETRY

Images 27, 28, 29, 30, 31, 32 and 33

MOLECULAR STUDIES

Image 34: PCR using BIOMED-2 primers (Framework Region 1)
Image 35: PCR using BIOMED-2 primers (Framework Region 2)
Image 36: PCR using BIOMED-2 primers (Framework Region 3)
Image 37: PCR using BIOMED-2 primers (Kappa)
Image 38: PCR using BIOMED-2 primers (Kappa Deleting Element)

FINAL DIAGNOSIS


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