| Paper # 001 | Versión en Español |
Marcial Garcia-Rojo, Jesús González, Ana Morillo, Jesús Martín
[Title] [Introduction] [Materials and Methods] [Pictures] [Discussion] [Bibliography]
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Axillary Lymph Node
The pathological examination of the axillary lymph node biopsy
showed macroscopically a 2.5 x 2.5 x 1.5 cm lymph node with an
smooth and homogeneous cut surface. The histological examination
revealed an almost complete effacement of the architecture of the
lymph node, only sparing some marginal zones. This effacement was
due to a neoplastic diffuse proliferation of small lymphocytes
with eccentric nuclei with visible nucleoli and a moderate amount
of cytoplasm, which showed frequent PAS positivity. Immunohistochemically, neoplastic cells
were found to be positive with the Common Leukocyte Antigen (CLA)
(CD54A), L-26 (CD-20) and Kappa light chains immunohistochemical
markers. They were negative for Kappa light chains and UCHL-1
(CD45RO), although there were frequent accompanying
non-neoplastic small UCHL-1 positive lymphocytes. The neoplasm
was diagnosed as a low grade B-cell non Hodgkin lymphoma type
lymphoplasmacytoid (immunocytoma).
Stomach
The pathological examination of the gastrectomy specimen showed
an infiltrated aspect of the gastric mucosa and muscular layer in
both the fundic area and the antrum, with a more extensive
involvement of the lesser curvature. Histologically the neoplasm
was diffuse and composed of malignant individual cells and small
groups with abundant intracytoplasmic mucin., often producing a
signet-ring aspect. In about a 10 % of the tumor, there were
lakes of extracellular mucin con scarce amount of cells often
arranged in small sheet. These mucinous areas affected mainly the
muscular layer of the stomach. The neoplastic cells reached the
serous surface and infiltrated the fundic area and part of the
antrum and cardiac zones, but spared the proximal and distal
resection margins. There were metastases from this tumor in four
of seven lymph nodes isolated in the lesser curvature and also in
nine of thirteen lymph nodes isolated from the greater curvature
and omentum.
Collision of lymphoma and
adenocarcinoma in lymph nodes
Interestingly, all the lymph nodes isolated in the
surgical specimen were affected by a low grade non Hodgkin
lymphoma type immunocytoma, with the same characteristics of the
one diagnosed six months earlier. So, in thirteen lymph nodes we
could observe a collision of the lymphoma and the metastasis of
the adenocarcinoma. The lymphoma in these nodes only spared the
marginal sinus, were a great amount of metastatic signet ring
adenocarcinoma cells were located, frequently extending to the
surrounding perinodal adipose tissue. The differentiation of
adenocarcinoma cells from lymphoid cells were accentuated by the
PAS and Colloidal Iron Stains, that stained strongly signet ring
adenocarcinoma cells.
The immunohistochemical study of
these two neoplasms revealed that the lymphoid tumor had the same
characteristics as the lymphoma diagnosed six months earlier.
Meanwhile, the adenocarcinoma cells were strongly positive with
cytokeratins 8, 18 and 19 and CEA, and negative with LCA and the
rest of lymphoid markers previously mentioned.
Spleen
The splenectomy specimen was 11 x 8 x 6.5 cm and weighed 282 g.
At the cut surface a market whitish diffuse dotting cold be
observed. No metastases were found neither in the spleen nor in
the ten lymph nodes of the hilus, but all of these and the
splenic white pulp were affected by a low grade non Hodgkin
lymphoma type immunocytoma.
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