Secondary bone lymphoma

Discussion:

The patient proceeded to a PET-CT (not shown), which demonstrated avid FDG uptake in both iliac bones along with avid uptake in enlarged cervical lymph nodes. The patient proceeded to lymph node biopsy. 

Histopathology

MACROSCOPIC DESCRIPTION: "Cervical lymph node": A lymph node 12x12x11m with a nodular grey cut surface and rubbery texture. A3. (YS)

MICROSCOPIC DESCRIPTION: Sections show a lymph node with surrounding fibroadipose tissue. There is extensive areas of central lymph node necrosis. No granulomas are seen. The nodal architecture is effaced by a population of malignant medium to large lymphoid cells. Tumor cells contain amphophilic cytoplasm, oval nuclei with coarse granular chromatin and small nucleoli. Frequent apoptotic bodies are present, imparting a "starry sky" appearance. Immunohistochemical results show tumor cells stain: POSITIVE: CD20, CD79a, BCL-6, MUM1, CMYC (50%). NEGATIVE: CD3, CD5, CD10, BCL-2, CyclinD1, EBER-CISH, Tdt. The Ki67 proliferation index is approximately 80-90%. 

DIAGNOSIS: Cervical lymph node, excisional biopsy: Diffuse large B-cell lymphoma, activated B-cell phenotype.

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