PMC5806413_01
(a) Left leg with multiple subcutaneous swellings and few ulcerated nodules. (b) Axial computed tomography: Homogeneously enhancing relatively hypodense left suprarenal mass with loss of fat plane in anterior pararenal space. (c) Axial computed tomography: Heterogeneously enhancing left inguinal lymph nodal mass
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F1
Three of these swellings, around knee joint were ulcerated [Figure 1a]. Abdominal and pelvic contrast-enhanced computed tomography (CECT) scans revealed an ill-defined heterogeneously enhancing mass lesion, 6.8 cm x 5.7 cm x 5.2 cm in size in the left suprarenal gland, seen infiltrating into the upper pole of left kidney with loss of fat planes, likely metastasis [Figure 1b]. Another large heterogeneously enhancing mass lesion in the left inguinal region infiltrating into overlying skin and underlying muscles was noted, suggestive of neoplastic lymph node [Figure 1c].
(a) Cellular aspirates comprising dispersed population of intermediate to large lymphocytes (Giemsa, x100). (b) Polymorphous background with scattered histiocytes (Giemsa, x200). (c) Dispersed moderately pleomorphic atypical lymphoid cells (Giemsa, x400). (d-g) Atypical large lymphoid cells with high-grade nuclear atypia; high nucleus-cytoplasm ratio, nuclear membrane irregularity, opened up chromatin, and prominent nucleoli (Giemsa, x400)
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F2
Cytomorphological features were suggestive of Non-Hodgkins lymphoma, large cell type [Figure 2a-g].
(a) Tumor cells localized in the dermis (H and E, x200). (b) Sheet and cords of atypical lymphoid cells displaying nuclear atypia (H and E, x400). (c) CD20 positive tumor cells (Vulcan Fast Red Chromogen). Few scattered CD3 positive lymphocytes also seen. Inset: Leukocyte common antigen diffuse surface expression (DAB chromogen) (IHC, x400). (d) Positive nuclear staining for Bcl-6 (IHC, x400)
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F3
Mitosis was frequent and apoptosis evident [Figure 3a and b]. On immunohistochemistry the atypical lymphoid cells expressed leukocyte common antigen, CD20, and Bcl-6 [Figure 3c and d] while they were negative for CD3, CD5, CD10, CD23, CD30, cyclinD1, MUM-1, c-myc, Bcl-2, and EBER.