Presentation
History of weight loss and poor appetite. Large left neck node/mass.
Patient Data
Large volume cervical lymphadenopathy at levels 2 and 3.
16G core biopsy was undertaken under ultrasound guidance.
CLINICAL DETAILS Pathological left cervical lymphadenopathy. CT suggests lymphoma.
MACROSCOPY
Two cores of cream tissue measuring 16 mm and 12 mm. Block key: A1 = 16 mm core.
MICROSCOPY
These are two cores of lymphoid tissue showing a diffuse effacement of the nodal architecture by large areas of necrosis with intervening viable foci showing a mixture of small lymphocytes, eosinophils, histiocytes, plasma cells and large lobulated cells with irregular nuclear outlines. Some of them have a Hodgkin/Reed Sternberg cell morphology. Scattered mummified cells are also seen.
On immunohistochemistry: CD30 (occasional with Golgi pattern accentuation), MUM1, PAX5 (weak) are expressed in the large cells. CD15- tissue largely cut out but expressed in a few. CD20, ALK1, OCT2 are not expressed. CD3 - expressed in T-cells without rimming. BCL6 shows patchy weak staining. EMA- negative. The cells are in cycle and express Ki-67. EBER is positive in the HRS cells. T
The appearances favor classic Hodgkin lymphoma.
Case Discussion
This large volume of pathological cervical lymphadenopathy was biopsied under ultrasound guidance and proved to be a Hodgkin lymphoma.
Its is my usual practice to take two 16G cores from neck nodes. It is down to personal preference as to whether an 18G core or a single core is taken.
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