PMC4903025_01
1A: Patient with enlargement of multiple lymph nodes (arrows) in the cervical and submandibular chains. 1B: Enlarged inguinal lymph nodes (arrows) on examination
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F1
One month prior to presentation the patient developed recurrent night sweats with worsening cervical lymphadenopathy and new inguinal lymphadenopathy as well as fatigue and malaise (figure 1).
FIGURE 2A: Light microscopy of lymph node. 40x Formalin architecture" (Formalin fixation; 40x magnification): Sections demonstrate interfollicular expansion by polymorphous lymphocytes including clusters of "monocytoid B-cells" (paler areas). The background shows increased vascularity.. FIGURE 2B "100X B5 mottled areas" (B5 Fixation; 100X magnificiation): Sections demonstrate increased T-zone histiocytes, imparting a "mottled" appearance to the nodal architecture.
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F2
The specimen contained a single lymph node measuring 4.0 x 1.8 x 1.4 cm that was sectioned for microscopy with immunohistochemistry (figures 2, 3) and flow cytometry (figure 4).
FIGURE 3A: CMV stain. "CMV inset" (B5 Fixation; 400X magnificaition): Sections demonstrate enlarged histiocytes with characteristics of CMV infected cells embedded in a background of monocytoid B-cells. Inset demonstrates the CMV immuohistochemical stain showing positivity in these large cells.. FIGURE 3B: EBV stain
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F3
The specimen contained a single lymph node measuring 4.0 x 1.8 x 1.4 cm that was sectioned for microscopy with immunohistochemistry (figures 2, 3) and flow cytometry (figure 4). Immunohistochemistry demonstrated positive CMV within scattered large cells and focal EBV staining (figure 3).
Flow cytometry results. The lymphocyte gate comprised 82% of total cells and consists of T-cells (50%) and polytypic B-cells (32%). T-cells show no discrete phenotypic aberrancies. No monotypic B-cell population detected.
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F4
The specimen contained a single lymph node measuring 4.0 x 1.8 x 1.4 cm that was sectioned for microscopy with immunohistochemistry (figures 2, 3) and flow cytometry (figure 4).