Quiz-summary
0 of 1 questions completed
Questions:
- 1
Information
Presented by Risa Mann, M.D. and prepared by Bahram R. Oliai, M.D.
Case 1: 83-year-old male with cheek mass.
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
Time has elapsed
Categories
- Not categorized 0%
- 1
- Answered
- Review
-
Question 1 of 1
1. Question
Week 88: Case 1
83-year-old male with cheek mass./images/2331a.jpg
/images/2331b.jpg
/images/2331c.jpg
/images/2331d.jpg
/images/2331e.jpgCorrect
Answer: Metastatic Malignant fibriohistiocytic tumor and lymphoma
Histology: The lymph node shows two processes. It contains a nodule with a hyalinized background associated with atypical spindle and giant cells. The remaining portion of the lymph node shows architectural effacement in a predominantly diffuse pattern. The lymphocytic proliferation within the node is composed of round to slightly irregular small lymphoid cells. Mitotic activity is not significant.
Discussion: The spindle cell lesion within the lymph node raises the differential diagnosis between a metastatic tumor such as a melanoma or a spindle cell carcinoma or a metastatic sarcoma. Immunostains as well as clinical history were helpful in evaluating this process. The patient has a history of an atypical fibroxanthoma-like lesion in the scalp, which was unavailable for review. The Immunostains on this case demonstrated that the neoplastic spindle and giant cells were negative for keratin, HMB45, and melan-A. The cells are positive for actin and KP-1. Based on these findings we feel the spindle cell lesion represents a metastatic fibrohistiocytic lesion in the lymph node.
The findings in the lymph node are those of involvement by a lymphocytic lymphoma. Immunoperoxidase stains demonstrated that the neoplastic cells are all CD20 positive B- cells. These B cells also cross react with CD5. This staining pattern raises the differential diagnosis between small lymphocytic lymphoma/CLL and mantle cell lymphoma. Additional staining for CD23 and cyclin-D1 are helpful in further evaluating this case. The neoplastic cells are negative for CD23 (usually positive in small lymphocytic lymphoma/CLL) and positive for cyclin-D1. The cyclin-D1 stain, which is characteristic of mantle cell lymphoma, demonstrates nuclear positivity in this case. The negative staining for CD23 and positive staining for cyclin-D1 established the diagnosis of mantle cell lymphoma. Therefore, we feel that this lymph node shows involvement by two processes; a metastatic fibrohistiocytic tumor as well as mantle cell lymphoma.
Incorrect
Answer: Metastatic Malignant fibriohistiocytic tumor and lymphoma
Histology: The lymph node shows two processes. It contains a nodule with a hyalinized background associated with atypical spindle and giant cells. The remaining portion of the lymph node shows architectural effacement in a predominantly diffuse pattern. The lymphocytic proliferation within the node is composed of round to slightly irregular small lymphoid cells. Mitotic activity is not significant.
Discussion: The spindle cell lesion within the lymph node raises the differential diagnosis between a metastatic tumor such as a melanoma or a spindle cell carcinoma or a metastatic sarcoma. Immunostains as well as clinical history were helpful in evaluating this process. The patient has a history of an atypical fibroxanthoma-like lesion in the scalp, which was unavailable for review. The Immunostains on this case demonstrated that the neoplastic spindle and giant cells were negative for keratin, HMB45, and melan-A. The cells are positive for actin and KP-1. Based on these findings we feel the spindle cell lesion represents a metastatic fibrohistiocytic lesion in the lymph node.
The findings in the lymph node are those of involvement by a lymphocytic lymphoma. Immunoperoxidase stains demonstrated that the neoplastic cells are all CD20 positive B- cells. These B cells also cross react with CD5. This staining pattern raises the differential diagnosis between small lymphocytic lymphoma/CLL and mantle cell lymphoma. Additional staining for CD23 and cyclin-D1 are helpful in further evaluating this case. The neoplastic cells are negative for CD23 (usually positive in small lymphocytic lymphoma/CLL) and positive for cyclin-D1. The cyclin-D1 stain, which is characteristic of mantle cell lymphoma, demonstrates nuclear positivity in this case. The negative staining for CD23 and positive staining for cyclin-D1 established the diagnosis of mantle cell lymphoma. Therefore, we feel that this lymph node shows involvement by two processes; a metastatic fibrohistiocytic tumor as well as mantle cell lymphoma.
