PMC7273153_01
The initial excisional specimen shows epithelioid tumor cells with co-expression of CD4 and CD30. (A) Epithelioid tumor cells arrange in nested and alveolar patterns with small lymphocytes scattered through the lesion (Magnification: 200 x). (B) The tumor cells are large to pleomorphic with slightly irregular nuclei and abundant eosinophilic cytoplasm (Magnification: 400 x). (C,D) The tumor cells are strongly positive for CD4 (C) and moderately positive for CD30 (D) (Magnification: 400 x).
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F1
An excisional biopsy demonstrated a tonsil extensively replaced by epithelioid cells in nested and alveolar patterns (Figures 1A,B).
The reexcised tumor exhibits multiple morphologic components. (A) Pleomorphic spindle cells grow in fascicles or a storiform pattern (Magnification: 200 x). (B) The tumor cells show nuclear pseudoinclusions (Magnification: 400 x). (C) Relative monotonous plump spindle cells arrange in meningioma-like whorls (Magnification: 400 x). (D) Clusters of foamy cells and inflammatory cells with foreign body-giant cell reaction are presented (Magnification: 200 x). (E,F) The tumor cells are diffusely and strongly positive for CD4 (E) and CD21 (F) (Magnification: 200 x).
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F2
Histologic examination of the excised mass revealed a tumor exhibiting multiple morphologic components with numerous pleomorphic spindle cells growing in fascicles or a storiform pattern being the major component (Figures 2A,B). Relative monotonous plump spindle or ovoid cells arranged in meningioma-like whorls (Figure 2C) and epithelioid tumor cells seen in the initial biopsy were also presented focally. Clusters of foamy cells and cholesterol-like crystal deposit with foreign body-giant cell reaction were seen peripherally (Figure 2D). The tumor cells were positive for CD4, CD21, CD23, and CD35 (Figures 2E,F), and negative for ALK, CD3, CD20, CD30, CD45, cytokeratin, S-100, HMB45, desmin, and EBER.