Quiz-summary
0 of 1 questions completed
Questions:
- 1
Information
Presented by Edward G. Weir, M.D. and prepared by Jon Davison, M.D.
Case 5: An enlarged axillary lymph node was biopsied from a 55-year-old woman.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
- Not categorized 0%
- 1
- Answered
- Review
-
Question 1 of 1
1. Question
Week 228: Case 5
An enlarged axillary lymph node was biopsied from a 55-year-old woman who was recently diagnosed with infiltrating breast carcinoma. The patient otherwise had no medical problems./images/JMD_6-27-05_SPWC/Case_5/1.jpg
/images/JMD_6-27-05_SPWC/Case_5/2.jpg
/images/JMD_6-27-05_SPWC/Case_5/3.jpg
/images/JMD_6-27-05_SPWC/Case_5/4.jpgCorrect
Answer: Vascular transformation of lymph nodes sinuses
Histology: Histologic sections of lymph node parenchyma are notable for a complex spindle cell proliferation replacing the normal architecture of intranodal sinuses. The spindle cell proliferation respects and surrounds lymph node cortex. The spindle cells are associated with largely attenuated and blood-filled channels, which mature into round, relatively well-defined vessels at the periphery of the lesion. On high power examination, the spindle cells are bland and mitotically inactive. While extravasation of red cells is present, intracytoplasmic hyaline globules are noticeably absent. Only rare neutrophils and eosinophils and occasional plasma cells are identified. By immunohistochemistry (not shown), the spindle cells were positive for CD34 and uniformly negative for keratin, desmin and S-100 protein.
Discussion: Vascular transformation of lymph node sinuses (VTS) is
characterized by a conversion of lymph node sinuses into capillary-like
channels, often accompanied by fibrosis. While many cases comprise rounded
vascular channels, others are characterized by a proliferation of spindled
endothelial cells that may form nodules. The spindle cell proliferation is
frequently solid and appears to be penetrated by scattered thin lumina;
moreover, the vascular lumina typically become more patent and round toward the
periphery of the lesion. However, VTS does not infiltrate or extend beyond the
lymph node capsule. Immunophenotypically, VTS is typically positive for CD34
and negative for desmin and cytokeratin; the lesions are variably positive for
Factor VIII-related antigen. Furthermore, spindle cell variants are commonly
positive for smooth muscle actin and show ultrastructural features of smooth
muscle cells, suggesting possible pericytic origin.Though VTS is often associated with malignancies, and less commonly, venous thromboses or recent radiotherapy, it confers no risk of malignant transformation. A popular pathogenetic theory suggests that obstruction of efferent lymphatics or veins represent the probable mechanism
through which VTS develops.Incorrect
Answer: Vascular transformation of lymph nodes sinuses
Histology: Histologic sections of lymph node parenchyma are notable for a complex spindle cell proliferation replacing the normal architecture of intranodal sinuses. The spindle cell proliferation respects and surrounds lymph node cortex. The spindle cells are associated with largely attenuated and blood-filled channels, which mature into round, relatively well-defined vessels at the periphery of the lesion. On high power examination, the spindle cells are bland and mitotically inactive. While extravasation of red cells is present, intracytoplasmic hyaline globules are noticeably absent. Only rare neutrophils and eosinophils and occasional plasma cells are identified. By immunohistochemistry (not shown), the spindle cells were positive for CD34 and uniformly negative for keratin, desmin and S-100 protein.
Discussion: Vascular transformation of lymph node sinuses (VTS) is
characterized by a conversion of lymph node sinuses into capillary-like
channels, often accompanied by fibrosis. While many cases comprise rounded
vascular channels, others are characterized by a proliferation of spindled
endothelial cells that may form nodules. The spindle cell proliferation is
frequently solid and appears to be penetrated by scattered thin lumina;
moreover, the vascular lumina typically become more patent and round toward the
periphery of the lesion. However, VTS does not infiltrate or extend beyond the
lymph node capsule. Immunophenotypically, VTS is typically positive for CD34
and negative for desmin and cytokeratin; the lesions are variably positive for
Factor VIII-related antigen. Furthermore, spindle cell variants are commonly
positive for smooth muscle actin and show ultrastructural features of smooth
muscle cells, suggesting possible pericytic origin.Though VTS is often associated with malignancies, and less commonly, venous thromboses or recent radiotherapy, it confers no risk of malignant transformation. A popular pathogenetic theory suggests that obstruction of efferent lymphatics or veins represent the probable mechanism
through which VTS develops.
