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Presented by Dr. Pedram Argani and prepared by Dr. Monica Butcher
This case talks about a 45 year old male with enlarged retroperitoneal lymph nodes
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1. Question
This is a 45 year old male with enlarged retroperitoneal lymph nodes
Diagnosis:
Correct
Answer: B
Histologic Description: The sections reveal lymph nodes which are distended by necrotic material. There is a wall of fibrous tissue surrounding necrosis. Closer inspection of the necrosis reveals the ghosts of dead neoplastic cells, with enlarged nuclei. The cytologic features of the necrotic cells are highlighted on a Trichrome stain, which brings out the round nuclei and prominent nucleoli of the necrotic cells. The cytologic features are consistent with necrotic seminoma. This patient had a prior history of a testicular germ cell tumor and had undergone chemotherapy, resulting in a complete response.
Differential Diagnosis: Lymph node infarction would typically not show the nodules of fibrosis seen in the current case, and is often associated with occult malignant lymphoma. Necrotizing granulomas would feature disordered necrotic debris, associated with histiocytic (granulomatous) reaction. Necrobiosis is often basophilic or “grungy” appearing, and is often seen in patients who have collagen vascular disease.
Incorrect
Answer: B
Histologic Description: The sections reveal lymph nodes which are distended by necrotic material. There is a wall of fibrous tissue surrounding necrosis. Closer inspection of the necrosis reveals the ghosts of dead neoplastic cells, with enlarged nuclei. The cytologic features of the necrotic cells are highlighted on a Trichrome stain, which brings out the round nuclei and prominent nucleoli of the necrotic cells. The cytologic features are consistent with necrotic seminoma. This patient had a prior history of a testicular germ cell tumor and had undergone chemotherapy, resulting in a complete response.
Differential Diagnosis: Lymph node infarction would typically not show the nodules of fibrosis seen in the current case, and is often associated with occult malignant lymphoma. Necrotizing granulomas would feature disordered necrotic debris, associated with histiocytic (granulomatous) reaction. Necrobiosis is often basophilic or “grungy” appearing, and is often seen in patients who have collagen vascular disease.
