Lymphoma - mediastinal

Case contributed by A.Prof Frank Gaillard

Patient Data

Age: 35 years
Gender: Female

CT chest

Modality: CT

.

Core biopsy was performed. 

Histology

The cores show sclerosis with an infiltrate of small lymphocytes, neutrophils, eosinophils and plasma cells. Within this background infiltrate are moderate numbers of atypical lymphoid  cells whose morphology is not well preserved. These cells form a nodule and are large and  pleomorphic  with nuclear  irregularities with  many showing  nuclear   lobularity  or  multinucleation.     Some  cells  have prominent eosinophilic nucleoli.  Occasional binucleate cells are present.  

Immunohistochemistry: The large  atypical  cells  are negative  for CD45,  CD79a, ALK  and CD3.   There  is  variable CD20  staining  with  some cells  positive and some  negative. CD30 and  CD15 are both  positive. CD23 stains  some large cells. EBER stain is negative.

Final diagnosis

Left  mediastinal  mass  biopsy consisten with lymphoma.

Comment:  the  morphology   of the  large  atypical   cells,   polymorphous background,  and   immunohistochemistry  findings  favour  classic  Hodgkin lymphoma  over the  differential diagnosis of mediastinal  large  B cell lymphoma. The  CD23 positive  staining  is more  typically seen  however in mediastinal  large  B cell  lymphoma as is the negative EBER  stain.

Case Discussion

This case illustrates how although pathology is considered the gold standard, even histology sometimes cannot establish a precise diagnosis 100% of the time. 

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Case Information

rID: 16223
Case created: 31st Dec 2011
Last edited: 6th Dec 2016
System: Chest
Inclusion in quiz mode: Included

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