Tamiolakis D

Primary gastric Hodgkin's lymphoma: A case report and review of the literature

Primary gastric Hodgkins lymphoma is a rarely encountered lesion. Most cases are observed in the course of systemic disease. Other cases have been reclassified in retrospective studies as non-Hodgkins lymphomas, after the employment of immunohistochemistry. Some Hodgkins lymphomas may masquerade non-Hodgkins lymphomas, and vice versa. Therefore, an accurate diagnosis is important, as treatment and outcome differ significantly for these entities. We report a case of primary Hodgkins lymphoma arising in the stomach of a 46-year-old male, and discuss the diagnostic approach as well as the differentials of Hodgkins disease in this anatomic site.

Neutrophil-rich Anaplastic Large Cell Lymphoma (NR-ALCL) Mimicking Lymphadenitis: A Study by Fine-Needle Aspiration Biopsy

A 45-year-old man presented to his practitioner with a 25day history of a painful tender nodule, measuring up to 2.5 cm in greatest dimension, in the right inguinal region. He had occasional complaints of pain down the anterior and lateral aspects of his right leg. No other palpable masses, skin lesions, or hepatosplenomegaly was identified. He was given a broad-spectrum antibiotic therapy, but the tenderness of the nodule did not resolve. Fifteen days later, the patient reported increased fatigue, but no fever, or recent weight loss. The patient was admitted for further analysis. Amongst the others, the laboratory tests for isolation of Chlamydia trachomatis (Frei test, complement-fixing antibodies, and microimmunofluorescence test for Chlamydia), were negative. Imaging studies did not show pelvic or elsewhere lymphadenopathy. A FNA biopsy on the inguinal nodule, using standard techniques with a 25-gauge needle, was performed. Airdried smears were stained with hemacolor and ethanolfixed smears were stained with Papanicolaou stain. The remaining fluid was centrifuged and cytospin preparations were made. A paraffin-embedded cell block was also prepared. The cytospin preparations and the direct smears were highly cellular consisting of small mature to large pleomorphic lymphoid cells intimately admixed with large numbers of neutrophils, representing up to 75% of all cells in some microscopic fields. Findings were suggestive of lymphadenitis, due to the intense presence of neutrophils. The cell block preparations showed an effacement of the architecture of the lymph node, with areas of suppurative necrosis surrounded by a cellular rim consisting of large-sized atypical lymphoid cells (Fig. 1). Higher magnification showed many of the atypical cells to have nuclei with a vesicular chromatin pattern and one or more prominent nucleoli. The surrounding cytoplasm was sometimes vacuolated. Numerous mitotic figures were identified. Classic Reed – Sternberg cells were scanty or absent. Immunocytochemical analysis performed on the cell block preparations revealed a CD30 and AKLpositive ALCL, T-cell type. Nuclear and cytoplasmic ALK-1 expression was seen in all tumor cells (Fig. 2), while CD30 showed a strong membranous staining with a paranuclear dot (Fig. 3). The atypical cells stained with antibodies for CD4/Leu-3a, CD43/Leu-22 (Bectin-Dickinson, San Jose, CA, USA), CD45/LCA, CD45RO/ UCHL-1, CD30/Ber-H2, and ALK protein/ALK-1 (Dako). Additional stains for CD3, CD15, CD20/L26, EMA/E29, kappa and Lambda polyclonal light chains (Dako) were negative. Most of the tumor cells showed nuclear p53 (Dako) staining and a high proliferative rate, confirmed by MIB-1/Ki67 staining of greater than 85%. The negative staining results with antibodies for S-100, Melan A/Klon A103, HMB-45/melanosome, cytokeratin coctail, myeloperoxidase and CD34 (Dako) effectively ruled out epithelial metastatic carcinoma, melanoma and granulocytic sarcoma respectively. Neutrophils were stained with CD15 but, as already stated, there was no staining of tumor cells with this antibody. The in situ hybridization for EBV, which was performed using a

Fine-needle aspiration cytology of a para-aortical solitary plasma-cell tumor

Extramedullary plasma-cell tumor (EMP) is a very rare disease and mainly arises in the head and neck area. An EMP arising in the paraaortical space was diagnosed by fine needle aspiration cytology and immunocytochemistry, in a 48-year-old male. Smears were cellular and showed dissociated monomorphic plasma cells. Immunocytochemistry demonstrated monoclonal expression of kappa-light immunoglobulin chain and CD38 positivity. Cytomorphology and immunocytochemical profile allowed a definitive diagnosis of plasmacytoma.Extramedullary plasma-cell tumor (EMP) is a very rare disease and mainly arises in the head and neck area. An EMP arising in the paraaortical space was diagnosed by fine needle aspiration cytology and immunocytochemistry, in a 48-year-old male. Smears were cellular and showed dissociated monomorphic plasma cells. Immunocytochemistry demonstrated monoclonal expression of kappa-light immunoglobulin chain and CD38 positivity. Cytomorphology and immunocytochemical profile allowed a definitive diagnosis of plasmacytoma.