陈国章教授的反馈信息：

Dear Dr. Zhou,

This is a most puzzling LYMPH NODE for which I cannot reach a clear-cut
diagnosis.

The node shows patchy fibrous bands. There are abnormal large cells located
in the sinuses. These cells have round or oval nuclei, distinct nucleoli,
and pale or retracted cytoplasm. Nuclear atypia/pleomorphism is mild to
moderate. The background lymph node parenchyma is rich in plasma cells.
Certainly there is some resemblance to Rosai-Dorfman disease, but the
cytoplasm is not as abundant. I in fact favor an interpretation of a
malignant neoplasm. Since the cells are apparently cohesive in areas (but
may be due to packing within the sinuses rather than genuine cellular
cohesion), carcinoma is seriously considered.

We have performed panels and panels of immunostains to cater for various
possibiltiies ranging from carcinoma to melanoma, large cell lymphoma of B
or T cell lineage, Hodgkin lymphoma, histiocytic and dendritic cell
neoplasms and germ cell tumor, but unfortunately nothing stains. I even
ventured the possibility of a sinus-lining cell tumor by staining for
Langerin.

(1) Eptihelial markers - cytokeratin CAM5.2, cytokeratin AE1/AE3, BerEP4
(2) Melanoma markers - S100
(3) Histiocytic and dendrtic cell markers - CD68, CD163. S100
(4) Sinus lining cell - Langerin
(5) Hodgkin lymphoma - CD30
(6) B cell lymphoma, including ALK+ large B cell lymphoma - CD20, Oct-2,
ALK1
(7) T cell lymphoma - CD3, CD2, CD7
(8) Germ cell tumor - Oct3/4

Since LCA/CD45 is negative, I cannot even be sure whether this is a
hematolymphoid neoplasm.

In summary, I am not sure what it is, but would consider this an
UNDIFFERENTIATED MALIGNANT NEOPLASM (sinusoidal large cell malignancy).

Many thanks for sharing this most difficult case with me.



Best personal regards,


John