PMC6016151_01
H&E sections of the biopsy specimen demonstrating an involved lymph node. Images (a), (b), and (c) are at 2x, 10x, and 40x magnifications, respectively. The tumor cells are large, monomorphic, immunoblast-like with oval nuclei, prominent nucleoli, and abundant cytoplasm. The background shows residual small lymphocytes.
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fig1
The lymph node was mostly effaced by tumor cells, but the uninvolved areas appeared unremarkable and showed residual small mature lymphocytes (Figure 1).
Immunohistochemical stains of the tumor cells. The tumor cells express CD45 (a) and weak CD38 (f) but are negative for CD3 (b), CD20 (c), CD79a (d), and PAX5 (e). All images are at 20x magnification.
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fig2
An extensive immunohistochemical panel was performed to aid the diagnosis with appropriate reactive controls (Figures 2 and 3).
Additional immunohistochemical stains of tumor cells. The tumor cells also express CD138 (a), CD33 (b), and ALK (c). Higher magnification (100x, oil) of ALK in panel (d) demonstrates a cytoplasmic granular pattern highly suggestive of CLTC-ALK fusion protein expression. Images (a), (b), and (c) are all at 20x magnification.
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fig3
An extensive immunohistochemical panel was performed to aid the diagnosis with appropriate reactive controls (Figures 2 and 3).