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Case 3
“Multiple Lymphadenopathy”
Marco Pagano – Savigliano Hospital
(Pictures by Dott. Pagano)
Clinical history
68 y.o. woman, asymptomatic, with multiple lymphadenopathies (right axilla, bilateral laterocervical, right collarbone, retroperitoneal), VES and PCR indexes increased, slight anaemia, strong polyclonal hypergamma. Antinucleus antibodies with a high titles and homogeneous fluorescence were present. A lymphadenectomy of the right axilla was performed for diagnostic purposes.
Macroscopical description
Vaguely roundish nodule, 3.5x2.5x1.6 cm in size, yellowish in colour, soft elastic consistency and a fine nodular appearance on cutting surface.
Microscopical description
The lymph node architecture was partially preserved. The capsule was slightly thickened and the margins were almost obliterated (Pict. 1).
The cortical was composed of hyperplastic follicles of different size and roundish in shape (Pict. 2).
The mantle was recognisable and the germinal centre was rich with centroblasts and macrophages (Pict. 3). The paracortex appeared worm-eaten, was rich with immunoblasts and histocytes and contained vessels with swollen endothelium and few granulocytes (Pict. 4).
The medullar sheath was packed with partly immature plasma cells (Pict. 5). Immunohistochemical reactions showed the division of the lymphocyte subsets and of the accessory cells, the absence of bcl-2 in the germinal centre, the polyclonal plasma cells and plasmablasts and the strong cell proliferation both in the germinal centre and in the paracortex (Pict. 6).
Cells were negative with immunohistochemical staining for HHV8. The type of lymphocyte flow cytometry showed the polyclonality of the lymphocytes B. Research for the B-cell and T-cell clone, with molecular methods, proved negative.
Diagnosis
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