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Presented by Pedram Argani, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 5: 63 year old female with a frontal bone lesion.
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Question 1 of 1
1. Question
Week 316: Case 5
63 year old female with a frontal bone lesionimages/argani070907_5A.jpg
images/argani070907_5b.jpg
images/argani070907_5c.jpgCorrect
Answer: Malignant lymphoma
Histology: This is a cellular neoplasm, composed of pleomorphic tumor cells with prominent nucleoli. Tumor cells appear to be packeted like an epithelial neoplasm in some areas, and are compressed by fibrous tissue to simulate spindle cell growth in other areas. Tumor cells have irregular nuclear contours, which is a clue to the diagnosis of lymphoma. By immunohistochemistry, the tumor cells show diffuse immunoreactivity for B-cell markers CD20 and CD79a, and do not label for cytokeratins, HMB45 or desmin.
Discussion: Rhabdomyosarcoma would show pinker cytoplasm, and label for muscle markers like desmin. Poorly differentiated carcinoma would label for cytokeratins. Malignant melanoma would label for HMB45.
Occasionally, malignant lymphomas may be packeted or distorted by fibrous tissue, simulating carcinoma or sarcoma. The irregular nuclear contours of the neoplastic cells are the best clue to the diagnosis of malignant lymphoma.
Incorrect
Answer: Malignant lymphoma
Histology: This is a cellular neoplasm, composed of pleomorphic tumor cells with prominent nucleoli. Tumor cells appear to be packeted like an epithelial neoplasm in some areas, and are compressed by fibrous tissue to simulate spindle cell growth in other areas. Tumor cells have irregular nuclear contours, which is a clue to the diagnosis of lymphoma. By immunohistochemistry, the tumor cells show diffuse immunoreactivity for B-cell markers CD20 and CD79a, and do not label for cytokeratins, HMB45 or desmin.
Discussion: Rhabdomyosarcoma would show pinker cytoplasm, and label for muscle markers like desmin. Poorly differentiated carcinoma would label for cytokeratins. Malignant melanoma would label for HMB45.
Occasionally, malignant lymphomas may be packeted or distorted by fibrous tissue, simulating carcinoma or sarcoma. The irregular nuclear contours of the neoplastic cells are the best clue to the diagnosis of malignant lymphoma.
