C10010381 / invoice 10000

Reason: DischargeAppointment Notes: MMCMACROSCOPICRight popliteal LN: The specimen consists of a lymph node and fatmeasuring 28 x 20 x 18 mm. Sectioning shows a homogenous, glassy andbulging cream cut surface. 4RS 1A-1B. Submitted for overnight fixationprior to assessing.MICROSCOPICFour sections of lymph node are examined. Lymph node parenchyma ismarkedly expanded and effaced by proliferating round cells, whichlargely obscure follicular architecture. There are occasionalperipheralized lymphoid follicles. Proliferating cells consistprimarily of small to occasionally intermediate-sized lymphocytes withdense nuclei and sparse cytoplasm, interspersed with frequent, large,round to polygonal cells with paracentral nuclei with 1-2 prominentnucleoli. These large cells exhibit mild pleomorphism, and there arescattered mitotic figures (up to 4 per single high-powered field).Proliferating cells are interspersed with low numbers of plasma cellsand multifocally moderately increased Mott cells. Proliferating cellsinfiltrate the lymph node capsule and the surrounding connectivetissue.DIAGNOSISCONCERN FOR LYMPHOMA, SEE COMMENTCOMMENTNormal lymph node architecture is effaced by a proliferatingpopulation of round cells-the presence of both small and largeproliferating cells raises suspicion for lymphoid neoplasia.Immunohistochemistry is recommended for further evaluation of theproliferating cells, please contact the lab if you would like toproceed with this (block 1A, CD3 and PAX5 for lymphocytes, cost code =VMI x 2).Discussed with O above results. Advised next step for further differentiation as to what type of cell is affected, will need to perform an additional test (immunohistochemistry). O consented to test being run with QML. Recommended referral to oncology specialist and potential treatment options for him regarding chemotherapy if wanting to go down this path.    Vital Signs