Case of the Month June 2011

A 36 year old female with history of incidental lung neoplasm

Zoe Kinkade, M.D., Sabine Pargman, M.D., Jeffrey A Vos, M.D.


Gross and Microscopic Description:
A gross description was not received with the pathology report; however, histologic sections from the right pneumonectomy and mediastinal lymph nodes were received. All of the parts of this case showed similar pathology, consisting of an atypical lymphoid infiltrate involving the peribronchial and interstitial areas of the lung as well as effacement of many of the submitted lymph nodes.

H&E: 400x, subcarinal lymph node. The lymph node is effaced by a diffuse proliferation of large, pleomorphic lymphoid cells.

H&E: 500x, subcarinal lymph node. Mitotic activity was readily discernible, with occasional atypical mitotic figures.

H&E: 1000x, subcarinal lymph node. Scattered highly atypical cells with wreathe-like nuclei were identified.  An inflammatory background of eosinophils, neutrophils and histiocytes is noted.

CD30: 400x, subcarinal lymph node.  The large atypical cells are immunoreactive for CD30 with a characteristic staining pattern showing golgi accentuation.

CD7: 400x, subcarinal lymph node. Although negative for most T-cell associated antigens, the atypical lymphoid cells were positive for CD7.

CD43: 400x, subcarinal lymph node.  Although not a specific marker, CD43 staining further supports T-cell lineage in this context.

TIA-1: 400x, subcarinal lymph node. TIA-1, a cytotoxic T-cell stain, demonstrated granular cytoplasmic positivity within the malignant cells.

ALK-1: 400x, right upper lobectomy. No immunoreactivity for ALK-1 was detected.

Other markers performed: 
Negative: CD2, CD3, CD4, CD5, CD8, CD15, CD20, CD79a, Myeloperoxidase, EMA, pancytokeratin, EBER (by in-situ hybridization)
Weakly positive: CD45