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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 1: This is an 88 year old male with an enlarged lymph node and a history of skin cancer.
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Question 1 of 1
1. Question
Week 545: Case 1
This is an 88 year old male with an enlarged lymph node and a history of skin cancer.images/vincent/5655_1_low res.jpg
Correct
Answer: Metastatic Melanoma and chronic lymphocytic leukemia/small lymphocytic lymphoma
Histology: The lymph node contains a mass lesion of epithelioid cells forming nests. While the morphology suggests the possibility of a metastatic carcinoma, the lesional cells are immunoreactive for Melan A and HMB45 not but for cytokeratin, supporting the diagnosis of Melanoma. The background lymph node lacks the open sinus and polarized germinal centers of the typical reactive lymph node. Instead, it is composed of a monotonous population of small round lymphocytes with focal rounded nodules of larger lymphoid cells, forming proliferation centers. These lymphocytes label for CD20, CD43, and CD5, supporting the diagnosis of a background chronic lymphocytic leukemia/small lymphocytic lymphoma.
Discussion: Follicular lymphoma would feature effacement of the node by non-polarized, uniform follicles which label for BCL2. Mantle cell lymphoma could have a nodular or diffuse architecture, but should label for cyclin D1.
Incorrect
Answer: Metastatic Melanoma and chronic lymphocytic leukemia/small lymphocytic lymphoma
Histology: The lymph node contains a mass lesion of epithelioid cells forming nests. While the morphology suggests the possibility of a metastatic carcinoma, the lesional cells are immunoreactive for Melan A and HMB45 not but for cytokeratin, supporting the diagnosis of Melanoma. The background lymph node lacks the open sinus and polarized germinal centers of the typical reactive lymph node. Instead, it is composed of a monotonous population of small round lymphocytes with focal rounded nodules of larger lymphoid cells, forming proliferation centers. These lymphocytes label for CD20, CD43, and CD5, supporting the diagnosis of a background chronic lymphocytic leukemia/small lymphocytic lymphoma.
Discussion: Follicular lymphoma would feature effacement of the node by non-polarized, uniform follicles which label for BCL2. Mantle cell lymphoma could have a nodular or diffuse architecture, but should label for cyclin D1.
