College of American Pathologists

2013 — November Case of the Month

Posted November 19, 2013

CLINICAL SUMMARY: Lymph node, left axilla  

CAP Foundation Online Case of the Month

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A 32-year-old man with no significant past medical history presented with a left axillary mass. He also noted generalized itching for the past two weeks and drenching night sweats. He had no significant weight loss or fevers. An excisional biopsy revealed an encapsulated specimen with a uniformly tan and vaguely lobular cut surface. Immunoperoxidase stains reveal that the large atypical cells are strongly positive for CD30 and variably positive for CD15 (subset); these cells are also positive for EBV-encoded RNA hybridization studies (EBER). CD20 and CD45 (LCA) highlight most of the background small lymphocytes, but are negative within the large atypical cells. CD3 shows scattered small lymphocytes in between the nodules.

The master list with the correct answer

  • Anaplastic large cell lymphoma, ALK positive
  • Florid reactive follicular hyperplasia
  • Nodular lymphocyte predominant
     Hodgkin lymphoma

  • Nodular sclerosis classical Hodgkin lymphoma
  • Primary mediastinal large B-cell lymphoma

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  • Appropriate diagnosis
  • Critique
  • References

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