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Case 350: A 20-year-old man with an enlarged cervical lymph nodes
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H & P
• enlarged lymph node in his posterior neck. It is 3x3cm, firm, nontender, freely moveable nodule
• no fever, no icterus and the thyroid gland is normal, the trachea is not deviated and there are no signs of hypothyroidism
• No other noticeable lymphadenopathy , no organomegaly
• no physical complaints other than feeling weak and tired
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Reactive hyperplasia
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Gross photo of the excised node
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Low power of lymph node-- note effacement of architecture
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mid power--
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High power
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Labs
• Hemoglobin: 12.5g/dL,• Hct: 38%, • RBC'S: 4.5 x106uL • MCV: 84 um3 • WBC count: 6.2x 103/uL• Differential: Normal• Platelet count: 186x103/uL• Peripheral smear: normal
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TSH: 3 µU/m
• AST: 31 IU/L
• BUN: 18 mg/dL
• ALT: 28 IU/L
• Creatinine: 1.1 mg/dL
• Alkaline Phosphatse: 64 IU/L
• Serum Calcium: 9 mg/dL
• Urinalysis: Sp. Gravity: 1.025, Negative-Sugar, Bile, Protein, Blood Micro-sediment: Occasional WBC's, no casts.
• Immunology:
• VDRL:Non-reactive
• ANA: Negative
• Monospot: Negative
• EB virus ab Positive
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Low power view of Nodular Sclerosis HD-- note the broad band offibrosis