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Presented by Pedram Argani, M.D. and prepared by Shien Micchelli, M.D.
Case 1: 64 year old female with a mediastinal mass.
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1. Question
Week 262: Case 1
64 year old female with a mediastinal mass./images/3_27_06_1a.jpg
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/images/3_27_06_1d.jpgCorrect
Answer: Lymphoma
Histology: This tumor is composed of large cells with irregular nuclear contours and pale cytoplasm. The tumor cells are somewhat compartmentalized by bands of sclerosis within the tumor. By immunohistochemistry, the tumor cells are immunoreactive for CD20 and CD45, but not for CD10 and CD5. CD15 and CD30 are negative. These findings support the diagnosis of a Mediastinal Large B Cell Lymphoma, thought to be of thymic origin.
Discussion: Metastatic Carcinoma would label for cytokeratins, as would Thymic Carcinoma. The cells would be more cohesive than the current lesion, and would generally have less irregular nuclear contours. Seminomas of the mediastinum occur almost exclusively in males, and would not label for B-cell markers.
Mediastinal Large B Cell Lymphoma is thought to originate from Thymic B Cells. The typical presentation is in young females with large, bulky, invasive, mediastinal mass, often associated with Superior Vena Caval Syndrome. Because the large tumor cells have pale cytoplasm and are compartmentalized by bands of sclerosis, the tumor may mimic a metastatic carcinoma or germ cell tumor.
Incorrect
Answer: Lymphoma
Histology: This tumor is composed of large cells with irregular nuclear contours and pale cytoplasm. The tumor cells are somewhat compartmentalized by bands of sclerosis within the tumor. By immunohistochemistry, the tumor cells are immunoreactive for CD20 and CD45, but not for CD10 and CD5. CD15 and CD30 are negative. These findings support the diagnosis of a Mediastinal Large B Cell Lymphoma, thought to be of thymic origin.
Discussion: Metastatic Carcinoma would label for cytokeratins, as would Thymic Carcinoma. The cells would be more cohesive than the current lesion, and would generally have less irregular nuclear contours. Seminomas of the mediastinum occur almost exclusively in males, and would not label for B-cell markers.
Mediastinal Large B Cell Lymphoma is thought to originate from Thymic B Cells. The typical presentation is in young females with large, bulky, invasive, mediastinal mass, often associated with Superior Vena Caval Syndrome. Because the large tumor cells have pale cytoplasm and are compartmentalized by bands of sclerosis, the tumor may mimic a metastatic carcinoma or germ cell tumor.
