Right hilar follicular lymphoma
Shortness of breath and cough for a few weeks.
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Lymphadenopathy isolated to the right hilum results in narrowing of bronchus intermedius. No left hilar, mediastinal, axillary or upper abdominal lymphadenopathy. No pulmonary lesion.
The patient proceeded to bronchoscopy and biopsy.
MICROSCOPIC DESCRIPTION: The sections show a proliferation of atypical lymphoid cells, forming abnormal follicular structures. No diffuse areas are seen. There are mixed centrocytes and centroblasts. The latter cells have enlarged clefted and hyperchromatic nuclei, prominent nucleoli and scanty cytoplasm. More than 15 centroblasts per high power field are identified. The atypical lymphoid cells are CD20, PAX-5, CD10, bcl-2 and bcl-6 positive. The Ki-67 index is about 40% within the follicles. The cells are CD3, CD5, CD23, Cyclin D1, c-Myc and MUM1 negative. The features are those of grade 3A follicular lymphoma. There is no diffuse large B-cell lymphoma.
DIAGNOSIS: Grade 3A follicular lymphoma.
This case demonstrates lymphadenopathy that has a radiographic appearance good for lymphoma (homogeneous appearance, sandwich sign [although described in mesenteric lymphoma]) but the location is atypical. Nevertheless biopsy demonstrated lymphoma.