PMC6794960_01
Low-power view of the left inguinal lymph node biopsy demonstrating complete effacement of normal lymph node architecture.
CRIHEM2019-7834728.001.jpg
PMC6794960_01_CRIHEM2019-7834728.001.jpg
fig1
She had an excisional left inguinal lymph node biopsy which revealed an enlarged lymph node with effaced architecture due to diffuse proliferation of neoplastic spindle cells (Figures 1-6). Positive tumor markers included CD4, CD30, CD45, CD43, CD68, and CD163, with a 37% MIB-1 proliferative index, consistent with HS (Figures 1-6).
Effaced inguinal lymph node with spindled and epithelioid cells with eosinophilic cytoplasm. Large pleomorphic nuclei with abundant nucleoli.
CRIHEM2019-7834728.002.jpg
PMC6794960_01_CRIHEM2019-7834728.002.jpg
fig2
She had an excisional left inguinal lymph node biopsy which revealed an enlarged lymph node with effaced architecture due to diffuse proliferation of neoplastic spindle cells (Figures 1-6). Positive tumor markers included CD4, CD30, CD45, CD43, CD68, and CD163, with a 37% MIB-1 proliferative index, consistent with HS (Figures 1-6). She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).
Effaced inguinal lymph node with frequent mitoses and apoptosis.
CRIHEM2019-7834728.003.jpg
PMC6794960_01_CRIHEM2019-7834728.003.jpg
fig3
She had an excisional left inguinal lymph node biopsy which revealed an enlarged lymph node with effaced architecture due to diffuse proliferation of neoplastic spindle cells (Figures 1-6). Positive tumor markers included CD4, CD30, CD45, CD43, CD68, and CD163, with a 37% MIB-1 proliferative index, consistent with HS (Figures 1-6). She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).
Inguinal lymph node CD30+ stain.
CRIHEM2019-7834728.004.jpg
PMC6794960_01_CRIHEM2019-7834728.004.jpg
fig4
She had an excisional left inguinal lymph node biopsy which revealed an enlarged lymph node with effaced architecture due to diffuse proliferation of neoplastic spindle cells (Figures 1-6). Positive tumor markers included CD4, CD30, CD45, CD43, CD68, and CD163, with a 37% MIB-1 proliferative index, consistent with HS (Figures 1-6). She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).
Inguinal lymph node CD4+ stain.
CRIHEM2019-7834728.005.jpg
PMC6794960_01_CRIHEM2019-7834728.005.jpg
fig5
She had an excisional left inguinal lymph node biopsy which revealed an enlarged lymph node with effaced architecture due to diffuse proliferation of neoplastic spindle cells (Figures 1-6). Positive tumor markers included CD4, CD30, CD45, CD43, CD68, and CD163, with a 37% MIB-1 proliferative index, consistent with HS (Figures 1-6). She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).
Inguinal lymph node CD163+ stain.
CRIHEM2019-7834728.006.jpg
PMC6794960_01_CRIHEM2019-7834728.006.jpg
fig6
She had an excisional left inguinal lymph node biopsy which revealed an enlarged lymph node with effaced architecture due to diffuse proliferation of neoplastic spindle cells (Figures 1-6). Positive tumor markers included CD4, CD30, CD45, CD43, CD68, and CD163, with a 37% MIB-1 proliferative index, consistent with HS (Figures 1-6). She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).
Positron emission tomography (PET) scan assessment of tumor burden before CHOEP chemotherapy initiation. Increased uptake in the bilateral supraclavicular (SUV 10.9), paratracheal (SUV 12.1), hilar (SUV 12.9), periportal (SUV 10.3), left inguinal (SUV 16.9) lymph nodes, pulmonary nodule (SUV 6.1), and right hepatic lobe (SUV 4.7). CHOEP: cyclophosphamide, Adriamycin, vincristine, etoposide, and prednisone.
CRIHEM2019-7834728.007.jpg
PMC6794960_01_CRIHEM2019-7834728.007.jpg
fig7
Positron emission tomography (PET) imaging indicated widely metastatic disease, with increased uptake in numerous lymph nodes, pulmonary nodules, and the liver (Figure 7). She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).
Follow-up PET after the 3rd cycle of CHOEP. Interval resolution of supraclavicular, hilar, and axillary uptake. Increased uptake in the right hepatic lobe (SUV 5.8). New uptake in L1 (SUV 8.8). PET: positron emission tomography; CHOEP: cyclophosphamide, Adriamycin, vincristine, etoposide, and prednisone.
CRIHEM2019-7834728.008.jpg
PMC6794960_01_CRIHEM2019-7834728.008.jpg
fig8
The patient had a repeat PET scan after completion of her third cycle of CHOEP that demonstrated a new lesion in the first lumbar vertebrae and increased uptake in her liver concerning for disease progression (Figure 8). She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).
Liver parenchyma infiltrated with large spindle cells with abundant foamy clear to eosinophilic cytoplasm and large pleomorphic nuclei with abundant nucleoli. Mixed inflammatory infiltrates, consisting of neutrophils, eosinophils, lymphocytes, and plasma cells.
CRIHEM2019-7834728.009.jpg
PMC6794960_01_CRIHEM2019-7834728.009.jpg
fig9
She had a biopsy of the liver mass lesion which was identical to the HS noted on the previous excisional lymph node biopsy (Figures 2-9).