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LYMPHOID LESSIONS

1. NON HODGKIN'S LYMPHOMA (DIFFUSE TYPE)

Clinical information:

A 70 year old male with solid, large, painless, multiple and lobulated masses in

the neck, axilla and inguinal, since 6 months ago. The lesions are attached to the

surrounding tissue. He felt weakness and pale. The biopsy was carried out and

the specimen was sent to the Department of Pathology.

Macroscopic examination:

A solid and encapsulated tissue, 3 cm in diameter, white brownish in color.

Microscopic features:

The specimen consists of diffuse, two kinds of large cells. The Large cells are upto four to five times the size of normal lymphocytes. The cells have cleaved and

non-cleaved nuclei, with prominent nucleoli and relatively abundant cytoplasm.

Part of the cells, there are some immunoblastic variant cells. The cells have a

round or multilobulated large vesicular nucleus with one or two centrally placed

prominent nucleoli. The cytoplasm is deeply stained or clear. A number of

mitoses rese found.

The result of immunohistochemistry staining:

LCA staining : positive

CD20 staining : positive

CD3 staining : negative

HODGKIN'S LYMPHOMA (MIXED- CELLULARITY TYPE)

Clinical information:

A 50 year old male with large, solid, painless, multiple and lobulated masses, in

the neck, axilla and inguinal. The lesions are attached to the surrounding tissue.

He also suffered from fever and hepatomegaly. Biopsy was carried out and the

specimen was sent to the Department of pathology.

Macroscopic examination:

A solid and encapsulated tissue, 8 cm in diameter, white brownish in colour.

Microscopic picture:

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The specimen consist of numerous Reed-Sternberg cells that are quite evenly

distributed in a mass of lymphocytic neoplastic cells with prominent mature

eosinophils, histiocytes, and plasma cells. The Reed-Sternberg cells are big cells

with abundant, usually slightly eosinophylic cytoplasm and having a multilobate

nucleus or multinucleated with large, round, prominent nucleoli. Particularly

characteristics are two mirror image nuclei, each containing a large (inclusion-

like) acidophilic nucleolus surrounded by a distinctive clear zone. Together they

impart an owl's eye appearance. The nuclear membrane is distinct. A number of

mitoses were found in this tumor. Focal necrosis may be present, but fibrosis

should be minimal or absent.

MYCOSIS FUNGOIDES

Clinical information:

A 60 year old male suffered from large plaques and generalized scaly

erythematous skin lesions since a year ago. An exicisional biopsy was done by

the clinician.

Macroscopic examination:

A skin tissue 2x1x0,5 cm in size was received, brown in color with a brown

plaque in the center of elliptical excised skin.

Microscopic picture:

The skin tissue is infiltrated by neoplastic T cells in the epidermis and dermis.

The cells invade in the epidermis forming Pautrier's microabscess, or even more

often, to line up individually along the epidermal basal layer.

The T cells have a small or medium sized lymphocytes with cerebroid nucleus,

characterized by irregular contour of the thick membrane. A number of mitoses

can be found.

The result of immunohistochemical staining:

LCA staining: positive

CD 3 staining: positive

CD 20 staining: negative

CD 4 staining: positive

CHRONIC NON SPECIFIC LYMPADENITIS

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Clinical information:

A 24 year old female with a lymphadenopaty of the neck, 1 cm in diameter,

mobile, since 2 weeks ago.

Macroscopic examination:

A firm, encapsulated tissue, 1 cnr in diarneter, white brownish in color.

Microscopic picture:

The specimen consists of lymphoid tissue with follicular hyperplasia, prominence

of postcapillary venules, increased number of immunoblasts, plasma cells, and

hystiocytes, and fibrosis. The capsule may appear inflamed and or fibrotic, and

the process may extend into the perinodal tissues.

The lymph node architecture is preserved, with normal lymphoid tissue between

germinal centers of the follicle. The lymphoid nodules have variant in shape andsize. In germinal center, there are mixed population of lymphocytes in varying

stages of "blast" transformation, and prominent phagocytic activities.

METASTATIC UNDIFFERENTIATED CARCINO MA OF THE LYMPH NODE

Clinical information:

A 48 year old male with solid, multiple masses of the neck. The patient also

suffered from deafness and epistaxis. Scanning photographs showed a diffuse

tumor of the nasopharinx

The biopsy of the lesion was done by the clinician.

Macroscopic:

A solid, encapsulated tissue was received, 2 cm in diameter, white brownish in

colour.

Microscopic picture:

The specimen consists of lymphold tissue with nests of epithelial tumor cells. The

cells are atypical and polymorphic, with spindle hyperchromatic nuclei or

vesicular nuclei with prominent nucleoli. Many mitoses can be found in this

tumor.