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Case 3
Cervical mass
B.E. Leone
– San Gerardo Hospital - Monza
(Pictures by dr. Leone)
Clinical history
A 7y.o. boy is submitted first to a biopsy (December 2002) and then to a radical excision (February 2003) of a right cervical mass, initially diagnosed as a lymphoma involving a lymph node. In both the occasion with the neoplasia some enlarged but reactive lymph node are removed.
Macroscopical description
The first biopsy measures 1cm in diameter; during the second operation, some whitish, fasciculated and elastic fragments, the largest 4 cm in diameter, were removed. In the interval between the operations the neoplastic mass appears increased in volume.
Microcopical description
The tumor, which has round, well defined but ill evaluating borders, because of the fragmentation of the examined material ( Picture 1), shows a homogeneous proliferation of spindled cells, arranged in intertwined fascicles with monomorphic, round nucleus with vesicular chromatin and poorly evident nucleolus, with fibrillary, strongly eosinophilic cytoplasm ( Picture 2 - Picture 3 - Picture 4 - Picture 5).
There are occasional, epithelioid-like features ( Picture 6) and areas with calcification ( Picture 7). There are no necrosis or vascular invasion; the mitotic count is 2 mitoses/10HPF.
The immuno-phenotype of the neoplastic cells is: Actin positive ( Picture 8), Desmin positive ( Picture 9), pan-Cytokeratin positive (weak and focal) ( Picture 10), bcl2 positive, EMA negative, CD117 negative, S100 negative, CD68 negative, Myogenin negative; the proliferation index (Ki67) is 6%.
Diagnosis
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