Presentation
Rapidly increasing widespread soft lymph node enlargement.
Patient Data
CHEST: Paratracheal soft tissue masses, indicative of bilateral mediastinal lymphadenopathy.
Fullness in the neck suggests cervical lymphadenopathy.
The lungs are clear.
ABDOMEN: Soft-tissue in the upper abdomen displacing stomach medially and bowel into the pelvis.
Case Discussion
Radiographs can show lymphadenopathy and soft tissue masses. This patient lived in an endemic area for Burkitt's lymphoma and cervical lymph node biopsy was diagnostic.
Pathology:
The lymph node architecture is diffusely effaced by sheets of lymphoblastic cells with admixed tingible (stainable) body macrophages. There are abundant mitotic figures and necrotic cells. There is focal tumor necrosis.
Immunocytochemical studies show lymphoid cells are positive for CD10, CD20, PAX5 and bcl6, and are negative for CD3, CD5, CD30, CD79a, c-myc, bcl2 and MUM-1. Ki67 / MIB-1 proliferative index is approximately 90%.
DIAGNOSIS: Lymph node right neck: Burkitt’s lymphoma.
(Tingible body macrophages are non-specific but can occur in malignant lymphomas such as Burkitt’s lymphoma which have a rapid cell turnover.)