Contributed by Christopher Suciu, MD and Raymond E. Felgar, MD, PhD
A 61-year-old female with bipolar disease and hypertension presented with a one month history of an enlarged mass in the right supraclavicular area. She did not report having fevers and/or chills, but she stated that she lost five pounds over the past few months.
Imaging studies showed an ill-defined large mass at the right lung base, asymmetric fullness of the right supraclavicular region, and mild erosion of the right mid clavicle.
The patient was admitted for an excisional biopsy of the supraclavicular region and overlying skin.
The excised specimen consisted of a 3 x 2 x 1 cm tan, elliptical skin excision with a 2 x 1 cm disrupted, indurated, and depressed defect, as well as attached subcutaneous tissue. There was also a 4 x 3 x 1.5 cm aggregate of dense, pink-tan, and yellow fibrofatty tissue that was focally disrupted.
Histologic sections demonstrated a soft tissue mass effaced by sheets of pleomorphic lymphoid cells with abnormal eccentric nuclei that included multilobated and multinucleated variants with prominent nucleoli. The infiltrate approached, but did not involve, the overlying skin (Figures 1A and 1B). There were variable numbers of admixed small lymphocytes and neutrophils present.
Immunohistochemical stains were also performed and the results are as follows:
CD 20 marks scattered positive cells (Figure 2A), whereas CD3 marks numerous small cells (Figure 2B).
The large cells were diffusely CD30 positive (Figure 3A), CD43 positive, CD2 positive, CD4 positive, CD7 focally positive, TIA-1 positive (Figure 3B), and mostly CD3 negative, mostly CD8 negative, CD5 negative, CD15 negative (Figure 3C), PAX-5 negative, and also ALK-1 negative (Figure 3D).