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Presented by Jonathan Epstein, M.D. and prepared by Angelique W. Levi, M.D.
Case 5: Axillary lymph nodes in a 52 year old male
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1. Question
Week 9: Case 5
Axillary lymph nodes in a 52 year old male
Correct
Answer: Capsular blue nevus
Histology: Within the capsule of the lymph node are heavily pigmented spindled cells. The pigment is fine, dusty, and brown typical of melanin. The spindled morphology of the cells with long tapering dendritic processes is typical of a blue nevus.
Discussion: Nevocellular aggregates also represent nevus cells within the capsule of the lymph node. Nevocellular aggregates typically are non-pigmented and consist of benign nevus cells similar to what is seen within an intradermal nevus. Metastatic melanoma would not consist of dendritic pigmented cells and would be present within the sinuses rather than the capsule of the lymph node. A greater degree of cytologic atypia would also be expected. Hemosiderin deposition within the lymph node would have a different morphology consisting of a more clumped refractile, granular, orange pigment. Hemosiderin deposition would also be present within histiocytes rather than in spindled dendritic cells.
Incorrect
Answer: Capsular blue nevus
Histology: Within the capsule of the lymph node are heavily pigmented spindled cells. The pigment is fine, dusty, and brown typical of melanin. The spindled morphology of the cells with long tapering dendritic processes is typical of a blue nevus.
Discussion: Nevocellular aggregates also represent nevus cells within the capsule of the lymph node. Nevocellular aggregates typically are non-pigmented and consist of benign nevus cells similar to what is seen within an intradermal nevus. Metastatic melanoma would not consist of dendritic pigmented cells and would be present within the sinuses rather than the capsule of the lymph node. A greater degree of cytologic atypia would also be expected. Hemosiderin deposition within the lymph node would have a different morphology consisting of a more clumped refractile, granular, orange pigment. Hemosiderin deposition would also be present within histiocytes rather than in spindled dendritic cells.
