PMC6211252_01
MRI of the upper arm showing a spindle shaped contrast enhancing mass in the median nerve course. (a) coronar view (b) axial view.
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Its diameter was about 11 x 4 centimeters (Figure 1(a,b)).
Intraoperative views of tumour dissection and removal. (a) Opening the capsule of the tumour and electric stimulation of fascicle-like structures. (b) Exposed tumour with a smooth surface in its middle part. (c) Exposed tumour, infiltrative growing in its proximal ending (arrow). (d) Tumorbed after removal of the median part, rest tumour embedding a nerve branch (arrow).
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In its middle part the exposed tumour had a smooth capsule which was opened (Figure 2(a)). In its equator the surface had a good boundary to the surrounding tissue (Figure 2(b)). In its distal and especially in its proximal ending the tumour showed a more infiltrative growth (Figure 2(c)). But with the intention to set no damage at the main nerve trunk approximately twenty percent residual tumour was left (Figure 2(d)).
Histological stain sections. (a) Immunhistochemical staining for T-cells within the interfollicular zone. (b) In 10x HE stain section areas with high endothelial venules are demonstrated. (c) Immunhistochemical expression of CD20 demonstrating regressed germinal centers. (d) Immunhistochemical expression of CD23 shows extended network of follicular dendritic cells.
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The final histological examination of the tumour showed typical criteria of the Castleman disease with an effaced architecture of a lymph node with regressed germinal centers and typical high endothelial venules (Figure 3(a,b)). Immunohistochemistry demonstrated regressed atrophic germinal centers (Figure 3(c)) and aberrant network of follicular dendritic cells (Figure 3(d)).