PMC7352137_01
(a) PET scan shows increased uptake in the right cervical lymph node (white arrow). (b) Gross picture of the lymph node cross-section showing tan-yellow nodular areas with focal necrosis.
CRIPA2020-4674103.001.jpg
PMC7352137_01_CRIPA2020-4674103.001.jpg
fig1
The patient's right cervical lymphadenopathy persisted, and a repeat PET/CT scan performed 6 months later revealed increasing standardized uptake value (SUV) from 3 to 5.4 and 18F-fluorodeoxyglucose (FDG) avidity (Figure 1(a)) concerning for residual/refractory disease. The cut surface showed tan-yellow nodular surface (Figure 1(b)).
H&E staining (a) shows a diffuse cellular infiltrate with areas of necrosis (black arrow). Higher power at 200x (b) shows the infiltrate composed of numerous foamy macrophages with abundant pink cytoplasm, scattered lymphocytes, (c) multinucleated giant cells (red arrows), and (d) cholesterol clefts (dashed arrows).
CRIPA2020-4674103.002.jpg
PMC7352137_01_CRIPA2020-4674103.002.jpg
fig2
Histologic sections revealed fibroadipose tissue with an intense foamy histiocytic infiltrate with numerous giant cells, cholesterol clefts, hyalinizing necrosis, dystrophic calcification, and scattered small lymphocytes (Figures 2(a)-2(d)), morphologically consistent with xanthogranuloma.
Immunohistochemical stains reveal scattered CD3-positive T-cells (a), rare CD20-positive B-cells (b), and majority of the cells staining positive for CD68 (c). Pancytokeratin stain is negative (d).
CRIPA2020-4674103.003.jpg
PMC7352137_01_CRIPA2020-4674103.003.jpg
fig3
CD68 immunohistochemical stain confirmed the morphologic findings and marked the diffuse histiocytic infiltrate (Figures 3(a)-3(d)).