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Presented by Justin A. Bishop, M.D. and prepared by Matthew Olson, M.D.
Case 3: 60 year old man presents with a history of a mass of the base of tongue as well as enlarged neck lymph nodes.
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1. Question
Week 495: Case 3
60 year old man presents with a history of a mass of the base of tongue as well as enlarged neck lymph nodes.images/1Alex/09052011_3_1.jpg
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images/1Alex/09052011_3_2b.jpgCorrect
Answer: Lymphoma
Histology: The specimen consists of lingual tonsillar tissue with abundant crush artifact. Close inspection of the tissue fragments reveals markedly enlarged cells in the background of small lymphocytes. The large cells are dyscohesive and have irregular nuclear borders. Immunohistochemistry showed that the tumor cells were strongly positive for CD45 and CD20.
Discussion: In the oropharynx, the most common malignancy is now HPV-related squamous cell carcinoma (HPV-SCC). Increasing experience with routine HPV testing of oropharyngeal carcinomas has uncovered a spectrum of morphologies, including a lymphoepithelial-like variant that, when well-developed, can highly mimic lymphoma. It is worth remembering that other tumors can affect this region, and among non-epithelial tumors, lymphomas are the most common. In this case, the lack of any cell cohesion and presence of irregular nuclear borders point towards lymphoma, but a comprehensive panel of immunohistochemistry including epithelial, lymphoid, and even melanocytic markers is warranted to precisely classify the neoplasm.
Incorrect
Answer: Lymphoma
Histology: The specimen consists of lingual tonsillar tissue with abundant crush artifact. Close inspection of the tissue fragments reveals markedly enlarged cells in the background of small lymphocytes. The large cells are dyscohesive and have irregular nuclear borders. Immunohistochemistry showed that the tumor cells were strongly positive for CD45 and CD20.
Discussion: In the oropharynx, the most common malignancy is now HPV-related squamous cell carcinoma (HPV-SCC). Increasing experience with routine HPV testing of oropharyngeal carcinomas has uncovered a spectrum of morphologies, including a lymphoepithelial-like variant that, when well-developed, can highly mimic lymphoma. It is worth remembering that other tumors can affect this region, and among non-epithelial tumors, lymphomas are the most common. In this case, the lack of any cell cohesion and presence of irregular nuclear borders point towards lymphoma, but a comprehensive panel of immunohistochemistry including epithelial, lymphoid, and even melanocytic markers is warranted to precisely classify the neoplasm.
