Histology
MACROSCOPIC DESCRIPTION:
Right parotid biopsy: A wedge-shaped piece of rubbery fawn/yellow tissue 4mm in maximum dimension. Indicative of dense fibrotic chronic inflammation. No tumour.
Right posterior parotid biopsy: Similar appearance to above.
MICROSCOPIC DESCRIPTION:
Right parotid: Paraffin sections of the specimen submitted for frozen section shows dense fibrous tissue infiltrated by chronic inflammatory cells. No evidence of tumour is seen.
Right posterior parotid: The sections show infiltration of adipose and fibrous tissue and skeletal muscle by a population of atypical large lymphoid cells arranged in diffuse sheets. These have round and oval vesicular nuclei, many with conspicuous nucleoli and a narrow rim of pale cytoplasm. Moderate numbers of mitotic figures are identified. Strong membrane staining for CD20 is seen in the majority of atypical cells and there is strong nuclear staining for bcl-6 and patchy moderate cytoplasmic staining for bcl-2. The atypical cells are negative for CD3, CD5, CD10, CD23, cyclin D1, ALK-1 and cytokeratin AE1/AE3. The features are of non Hodgkin's diffuse large B cell lymphoma.
DIAGNOSIS:
Right parotid biopsy: Dense fibrosis and chronic inflammation.
Right posterior parotid biopsy: non Hodgkin's diffuse large B cell lymphoma.