Case 771 - A 49-Year-Old Female with Nausea and Vomiting

Hematopathology

Contributed by Sarika Jain, MD and Steven H Swerdlow, MD

Clinical History

A 49 year old female presented to the hospital with nausea and vomiting. CT scan of the abdomen demonstrated gastric and duodenal masses and retroperitoneal lymphadenopathy. She underwent retroperitoneal lymph node, gastric body, gastric antrum and duodenal biopsies.

Microscopic Description

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Figure 1
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Figure 2

 

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Figure 3

 Histologic sections of the duodenum and the gastric body demonstrate dense infiltration of the lamina propria by intermediate to mostly large cells with dispersed chromatin and prominent nucleoli along with a moderate number of mitotic figures (Figures 1 and 2). The histologic sections from the retroperitoneal lymph node demonstrate multiple needle cores of fibroadipose tissue with possible lymph node showing a diffuse proliferation of similar cells with many mitotic figures and a focal starry sky appearance with tingible body macrophages (Figure 3).

Immunohistochemical Stains

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Figure 4
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Figure 7

 

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Figure 8
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Figure 9

 

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Figure 11

 

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Figure 12
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Figure 13

 

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Figure 15

No phenotypic aberrancy was identified using stains for CD5, CD7, CD2, CD4 and CD8. Infiltrate was negative with immunohistochemical stains for Bcl-6, cyclin D1, myeloperoxidase, lysozyme, CD117, and CD68/PGM-1.

Peripheral blood/ Bone marrow: Negative for Blasts.

FINAL DIAGNOSIS