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Presented by Fred Askin, M.D. and prepared by Kara Judson, M.D.
Case 2: The patient is a 55 year-old man with a history of orpharyngeal carcinoma.
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Question 1 of 1
1. Question
Week 254: Case 2
The patient is a 55 year-old man with a history of orpharyngeal carcinoma. A limited neck dissection was performed and a lymph node from the neck dissection was found to contain the lesion illustrated here.images/12306 case 2 1.jpg
images/12306 case 2 2.jpg
images/12306 case 2 3.jpg
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images/12306 case 2 5.jpgCorrect
Answer: Langerhans cell histiocytosis
Histology: none provided
Discussion: The histologic characteristics are those of a combination of eosinophils and large histiocytoid cells with vesicular and often grooved nuclei. The large eosinophilic cells were positive with immunostains containing antibodies directed against S-100 protein and against CD1A. This is an example of unifocal intranodal Langerhans Cell Histiocytosis associated with metastatic carcinoma. The subject has been reviewed (Archives of Pathology and Laboratory Medicine 1996;120:1085). It has been described in patients with metastatic breast carcinoma, and thyroid carcinoma among other primary solid tumors. In this case, there was also metastatic carcinoma in the soft tissue of the neck, but LCH has been reported in lymph nodes from areas draining primary neoplasms without recognizable nodal metastasis. The etiologic theory would involve stimulation of the Langerhans’ cells by antigens from the offending neoplasm. This lesion lacks the characteristic Reed-Sternberg cells of Hodgkin’s disease. The epithelioid cells would be cytokeratin negative, generally excluding metastatic carcinoma.
Incorrect
Answer: Langerhans cell histiocytosis
Histology: none provided
Discussion: The histologic characteristics are those of a combination of eosinophils and large histiocytoid cells with vesicular and often grooved nuclei. The large eosinophilic cells were positive with immunostains containing antibodies directed against S-100 protein and against CD1A. This is an example of unifocal intranodal Langerhans Cell Histiocytosis associated with metastatic carcinoma. The subject has been reviewed (Archives of Pathology and Laboratory Medicine 1996;120:1085). It has been described in patients with metastatic breast carcinoma, and thyroid carcinoma among other primary solid tumors. In this case, there was also metastatic carcinoma in the soft tissue of the neck, but LCH has been reported in lymph nodes from areas draining primary neoplasms without recognizable nodal metastasis. The etiologic theory would involve stimulation of the Langerhans’ cells by antigens from the offending neoplasm. This lesion lacks the characteristic Reed-Sternberg cells of Hodgkin’s disease. The epithelioid cells would be cytokeratin negative, generally excluding metastatic carcinoma.
