Case of the Week #406
10x
40x
H&E
CD8
CD56
Chromogranin
Synaptophysin
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Acute lymphadenitis
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Progressively enlarging lymph node
Largest intra-abdominal adenopathy
Contributed by Jayalakshmi Balakrishna, M.D.
Lymph node replaced by adipose tissue
AFIP images
Lipomatosis
Contributed by Jayalakshmi Balakrishna, M.D.
Lymphoid tissue closely admixed with adipocytes
Lymph node with adipocytes within capsule
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Reported sites of involvement
Contributed by Keri Janowiak, M.D., M.Ed.
Screening mammography
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Nonneurologic disease manifestations
Left frontal lobe tumor
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Scalp lesion
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Breast APH lesion
Filum terminale
Contributed by Keri Janowiak, M.D., M.Ed., Ekene Okoye, M.D. and Aishwarya Ravindran, M.D.
Storiform and fascicular growth
Infiltrative growth
Histiocyte morphology
Touton giant cells
CD68
CD163
Factor XIIIa
ALK
Cyclin D1
SMA
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ALK FISH, breakapart probe
Contributed by Mark R. Wick, M.D.
Amyloidosis of lymph node
AFIP images
Amyloidosis of lymph node
Contributed by Mark R. Wick, M.D.
Amyloidosis of lymph node
Contributed by Nikhil Sangle, M.D.
Centroblasts
Centrocytes
AFIP images
Normal lymph node
Primary follicle
Lymph node
Secondary follicle
Secondary follicle
Paracortical T zone
Interdigitating dendritic cells
Smooth muscle proliferation in lymph node hilum
Sclerosis in an inguinal lymph node
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Plasma cells
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Mesenteric tumor with soft tissue parts
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Large smooth surfaced mass
AFIP images
Lymph node
AFIP images
Replacement by tan, firm tissue
Contributed by Patricia Tsang, M.D., M.B.A., Vincent A. Graffeo, M.D. and AFIP
Disarrayed vascular proliferation
Angiomyomatous proliferation
Smooth muscle proliferation
Thick walled vasculature
Abnormal blood vessels
Angiomyomatous proliferation
Thick walled vessels
Disarrayed smooth muscles
Angiomyomatous hamartoma of lymph node
Smooth muscle actin
CD31
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Apical lung lesion
Increased uptake in left upper lobe
FDG PET/CT scan shows
high-grade metabolic activity
in right hilar soft tissue lesion
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Abundant anthracotic pigment
AFIP images
B cell biomarker expression during development
T cell biomarker expression during development
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B cell development
B cell response to antigen
B cell biomarker expression during development
niches in the bone
marrow required for
B cell development
T cell activation
T cell development
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18F FDG PET / CT, HHV8 MCD
Contributed by Jayalakshmi Balakrishna, M.D., Amy Duffield, M.D., Ph.D., Tapan Bhavsar, M.D., Ph.D.,
Carlos Murga-Zamalloa, M.D. and Jackie D. Sublett II, M.D.
Hyaline vascular Castleman disease (HVCD)
Atretic follicles, interfollicular vascular proliferation
Atretic germinal center
Twinning of germinal center
Twinning of germinal center
Twinning of germinal center, thickened mantle zones
Lollipop follicle, thickened mantle zones
Twinning of
germinal centers,
sclerosed
vessels
Thickened mantle zones
Sclerosed vessels
Vascular proliferation
Lollipop follicle
Atretic follicle
Proliferation of T lymphoblasts
Onion skin pattern
Twinning of germinal center, CD23
Interfollicular areas rich in T cells, CD3
Follicles and atretic germinal centers, CD20
Proliferation of TdT+ cells
Vascular proliferation, CD34
Interfollicular areas rich in T cells, CD5
Follicular dendritic cell meshworks, CD21
Low proliferation rate in interfollicular areas
Germinal centers, BCL6+
Plasma cells, CD138
Plasma cell Castleman disease (PCCD)
Aggregates of plasma cells
T cells in interfollicular areas, CD3
Atretic follicles, CD20
Aggregates of plasma cells, CD138
Vascular proliferation, ERG
Human herpesvirus 8 associated multicentric Castleman disease (HHV8 MCD)
Aggregates of plasma cells
Atretic follicle, interfollicular plasma cell proliferation
Kaposi sarcoma in a case of HHV8 MCD
Kaposi sarcoma in a case of HHV8 MCD, HHV8
Kaposi sarcoma in a case of HHV8 MCD, MUM1
HHV8+ cells
Lambda light chain predominance in plasma cells
Increased proliferation in interfollicular areas, Ki67
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Algorithm for cat scratch disease diagnosis
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Retroauricular lymph node enlargement
Cervical lymphadenopathy and primary lesion
Contributed by Elizabeth Courville, M.D. and Mark R. Wick, M.D.
Suppurative granulomas
Palisading histiocytes
Lymph node biopsy
Steiner stain
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Lymphadenopathy
AFIP images
Deciduosis
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Moderately enlarged inguinal lymphadenopathy
18FDG avid lymphadenopathy
18FDG PET / CT, transaxial PET / CT
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Cervical lymphadenopathy on examination
Contributed by Ingrid Tam, M.D., M.Sc., Emina Emilia Torlakovic, M.D., Ph.D. and Nikhil Sangle, M.D. (Case #396)
Vaguely nodular pattern
Polymorphous paracortical population
Cytological features, cytoplasmic pigment
Mild dermatopathic lymphadenitis
Paracortical expansion
Melanin pigment
Low Ki67 proliferative index
CD1a positive Langerhans cells
S100 positive dendritic cells
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Liver mass on MRI
Contributed by Elaine S. Jaffe, M.D.
Splenic mass
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Solitary splenic nodule
Pancreatic nodule
Contributed by Elaine S. Jaffe, M.D., Shunyou Gong, M.D., Ph.D. and João Víctor Alves de Castro, M.D.
Spindle cells in an inflammatory background
Cytologic features and background
Fibrinoid necrosis
Colonic lesion
Interface between spleen and tumor
Vascular damage and granulomas
Inflammatory background obscuring neoplastic cells
SMA IHC
Double staining for SMA / EBER
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Syncytial group of tumor cells
Contributed by João Víctor Alves de Castro, M.D. and Elaine S. Jaffe, M.D.
EBER ISH
EBER positive spindle cells
AFIP images
inclusion in axillary
lymph node
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Wright stain
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Small bowel and liver tumor
Cystic neck lesion
Liver mass
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Neck swelling
Paraneoplastic pemphigus
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Mesentery tumor
Small bowel and liver tumor
Well circumscribed neck tumor
Liver tumor
Contributed by Aishwarya Ravindran, M.D. and Karen L. Rech, M.D.
Storiform growth
Ovoid cells mixed with lymphocytes
CD21
CD35
Clusterin
CXCL13
CD3
TdT
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Normal lymph node
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Lymphadenopathy
Contributed by Mariah Ferrier, M.S., PA (ASCP)
Tan-pink homogenous surface
Contributed by Jack Reid, M.D. and Sherif A. Rezk, M.D.
Hyperplastic lymphoid follicles
Polarization of germinal centers
Hyperplastic lymphoid follicles
HIV positive individual
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Polymorphous lymphocytes
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Analysis of CD38
Histopathology lymph node: follicular hyperplasia
Contributed by Ryan Hickey, PA (ASCP)
Inguinal lymph node with necrotizing granuloma
Contributed by Simon A. Backer, M.D.
Necrotizing granuloma in a cervical lymph node
Infectious (suppurative) granulomatous lymphadenitis
Sarcoid granuloma
Sarcoid granuloma with asteroid body
Necrotizing granuloma with palisading histiocytes
GMS with fungal forms in necrotizing granuloma
Contributed by Simon A. Backer, M.D.
Epithelioid granuloma
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Heterogenous enhancing splenic lesion on CT
Color Doppler showing dotted blood flow signals in mass
T1 and T2 weighted MRI of splenic mass
Isointense mass
Contributed by Nadine S. Aguilera, M.D. and Emily Gardner, M.D.
Solitary well circumscribed mass
Hamartoma with similar texture and color as the spleen
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Nodule of increased stiffness
Resected spleen
Contributed by Nadine S. Aguilera, M.D.
Splenic hamartoma and uninvolved spleen
Red pulp
CD8 stain
CD34 stain
CD21 stain
CD68 stain
AFIP images
Hemangioma
Capillary / cavernous hemangioma
Epithelioid hemangioma
Lobular capillary hemangioma
Cellular hemangioma
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Giant splenic hemangioma
Cavernous splenic hemangioma
Splenomegaly and hemangiomas
Contributed by David Danielson, M.D., John Schmieg, M.D., Ph.D., Aaron Auerbach, M.D., M.P.H. and @Andrew_Fltv on Twitter
Architectural effacement by a vascular neoplasm
Typical proliferation of blood vessels
Cavernous hemangioma
Hemangioma with extramedullary hematopoiesis
Hemangioma
CD31 positive
CD34 positive
CD8
CD68 negative
D2-40 negative
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Scatter diagram of CBC
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Small spherocytes
Contributed by Zenggang Pan, M.D., Ph.D.
Nodal histiocytic sarcoma
AFIP images
True histiocytic lymphoma
True histiocytic lymphoma with prominent erythrophagocytosis
CD45RB and CD68
S100
Contributed by Barina Aqil, M.D.
Florid follicular hyperplasia
Monocytoid cell hyperplasia
Follicular hyperplasia, EBV+ in HIV setting
Florid follicular hyperplasia in CMV lymphadenitis
Monocytoid cell hyperplasia in CMV lymphadenitis
Paracortical hyperplasia in CMV lymphadenitis
CMV lymphadenitis
Mycobacterium avium intracellulare (MAI)
Kaposi sarcoma
Kaposi sarcoma
Burkitt lymphoma, EBV+ in HIV setting
Burkitt lymphoma, EBV+ in HIV setting
Burkitt lymphoma, EBV+ in HIV setting
Burkitt lymphoma, EBV+ in HIV setting
Classic Hodgkin lymphoma, EBV+ in HIV setting
Classic Hodgkin lymphoma, EBV+ in HIV setting
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Petechiae or small bruise-like markings
Contributed by Julia Geyer, M.D.
Focal germinal centers, hyperplastic marginal zones
Histiocytes, immunoblasts, neutrophils, macrophages
Expanded red pulp, atrophic white pulp
Cordal macrophages, phagocytosing platelets
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Erythematous papules on face and neck
Ill defined, erythematous subcutaneous nodule
Contributed by Ryanne A. Brown, M.D., M.B.A.
Dermal histiocytoid cells
Histiocytoid cells
CD68
CD1a
S100
Langerin
BRAF V600E
Contributed by Ryanne A. Brown, M.D., M.B.A.
No Birbeck granules
Contributed by Kunwar Singh, M.D. and Robert S. Ohgami, M.D., Ph.D.
Castleman disease
Follicular dendritic cell tumor
CD1a
CD3
CD4
CD8
CD99
TdT
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Grossly enlarged with haematoma
Contributed by Aishwarya Ravindran, M.D. and Karen L. Rech, M.D.
Epithelioid tumor cells with indistinct cell borders
CD68
CD163
CD14
S100
Cyclin D1
OCT2
AFIP images
Various images from lymph node
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Axillary lymph node transformation from CLL / SLL
Contributed by Elizabeth Courville, M.D. and Amy Beckman, M.D.
Lymph node from a 38 year old woman:
Distorted lymph node architecture
Pale staining areas
Karyorrhectic debris
Histiocytes and lymphocytes
CD3, CD4, CD8, CD20
CD3, CD4, CD8, CD68
CD30, CD123, MPO, EBV ISH
Cervical lymph node from a 40 year old woman:
Pale staining areas
Necrosis with mononuclear infiltrate
Karyorrhectic debris
Histiocytes
Lymph node
CD68
CD123
CD3
CD20
CD30
AFIP images
Kikuchi necrotizing lymphadenitis
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Histiocytes with myelin figures
#2 with tubuloreticular structures
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Ultrasound findings
CT and MRI findings
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Lesion on buttock
Contributed by Aishwarya Ravindran, M.B.B.S. and Julie Teruya-Feldstein, M.D.
Excisional biopsy of lymph node
Eosinophilic infiltrates
Eosinophilic infiltrates
Inflammatory milieu
Polykaryocytes of Warthin-Finkeldey type
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Eosinophils in a reactive background
Contributed by Vignesh Shanmugam, M.D.
Misguided myeloid / dendritic cell model
Contributed by Vignesh Shanmugam, M.D.
Sagittal view
Coronal view
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LCH
Contributed by Vignesh Shanmugam, M.D.
Preservation of follicle centers
Sinusoidal infiltration
Infiltrate of subcapsular sinus
Frequent admixed eosinophils
Prominent nuclear grooves
Admixed multinucleated giant cells
Langerin
CD1a
S100
Cyclin D1
Contributed by Catherine Hagen, M.D.
Langerhans cell histiocytosis
CD1a positive LCH
S100 positive LCH
AFIP images
With Hodgkin lymphoma
Involving spleen
Malignant
S100
Nuclear and cytoplasmic staining S100
Case #314
Diffuse involvement
Sinusoidal and pericapsular involvement
Pericapsular involvement
Admixed eosinophils
Nuclear grooves
Mitotic activity
CD1a
CD5
CD20
CD23
Langerin
S100
Contributed by Vignesh Shanmugam, M.D.
Prominent nuclear grooves and admixed eosinophils
Scattered multinucleated giant cells
AFIP images
Birbeck granules
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Birbeck granules
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PAS
Black granules - Orcein
L: expansion of medullary sinuses; R: Long Ziehl-Neelsen stain
Contributed by Patricia Tsang, M.D., M.B.A.
Tortuous vascular channels
Anastomosing vascular channels
Vascular channels appear papillary
CD31
CD34
CD68
Contributed by Genevieve M. Crane, M.D., Ph.D.
Thickened capsule
Thickened fibrotic capsule
Inflammatory cells in capsule
T. pallidum organisms
Plasma cells in capsule
T. pallidum organisms
Ki67
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Spiral shaped bacteria
AFIP images
Lymph node
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Diagnostic criteria
Contributed by Anna Sarah Erem, M.D. and Gulisa Turashvili, M.D., Ph.D. (Case #522), @katcollmd on Twitter and AFIP
Extrapulmonary lymphangioleiomyomatosis
Lymphangiomyomatosis
Lymphangiomyomatosis
Lymph node
Involving pelvic lymph node
Contributed by Kristin Dittmar, M.D.
Enlarged lymph node due to mesothelial inclusion
Contributed by Debra L. Zynger, M.D.
Core biopsy
High power
CK7
CK5 / 6
Calretinin
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F-FDG PET images of splenic metastasis
CT images of splenic metastasis
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Parotid gland: carcinoma ex pleomorphic adenoma
AFIP images
Metastatic Merkel cell carcinoma from skin
Metastatic Merkel cell carcinoma
Metastatic neuroblastoma
Metastatic seminoma
Metastatic carcinoma
simulating Hodgkin
lymphoma
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Submandibular lymphadenopathy
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Central caseation
in node involved
by M. avium
intracellulare
Contributed by Ahmed Alrajjal, M.D.
Sheets of foamy histiocytes
Nonnecrotizing granuloma
Reactive histiocytes
Sheets of histiocytes
Lymph node, AFB stain
Contributed by Ahmed Alrajjal, M.D.
Touch imprint, lymph node granuloma
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Mycobacterium avium complex (MAC), Ziehl-Neelsen stain
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PCR for 7 different strains
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Splenic peliosis
AFIP images
Plasmacytoma
Plasmacytoma
With crystalloids
With amyloid deposition
With blood lakes
With myxoid stroma
Plasmablastic plasmacytoma of nasopharynx
Anaplastic plasmacytoma
Immunohistochemistry
Contributed by Roaa Aljuaid, M.B.B.S.
Follicular hyperplasia
Nodules at different stages
Macronodules
Expansile lymphoid follicles
Reactive follicles
Ingrowth of mantle zone B cells
IgD in PTGC
BCL2 in PTGC nodules
BCL6 in PTGC nodules
CD10 in PTGC nodules
Atypical lymphocytes versus immunoblasts
CD15
EMA
PAX5
Contributed by Roberto N. Miranda, M.D. and Roman Segura-Rivera, M.D.
Reactive follicular hyperplasia
Polarized Ki67
Follicular lymphoma
Nonpolarized Ki67
Nodal marginal zone lymphoma
Monocytoid cytology
Mantle cell lymphoma (MCL) with mantle zone pattern
Cyclin D1 (mantle pattern) in MCL
Progressive transformation of germinal centers
CD20 in PTGC
NLPHL
LP cells
Rosetting CD3+ lymphocytes
Castleman disease, hyaline vascular variant
Germinal center in HVCD
Interfollicular expansion
Immunoblasts
Infectious mononucleosis, EBER
EBV positive diffuse large B cell lymphoma
EBER positivity in EBV positive diffuse large B cell lymphoma
Mixed cellularity classic Hodgkin lymphoma (MCCHL)
EBER positivity in MCCHL
Contributed by Kathy Smith, PA
Enlarged lymph node
Tan, homogenous appearance
Contributed by Jayalakshmi Balakrishna, M.D.
Follicular hyperplasia
Follicular hyperplasia
Interfollicular area
Germinal center dark zone
Sinus histiocytosis
Granulomatous lymphadenitis
Necrosis
Chronic lymphadenitis
Primary follicle
Primary follicle
Primary follicle
CD20
Germinal center
CD3
Plasma cells
Plasma cells
Immunoblasts
Polarization of germinal center
Reactive germinal center
Contributed by Jayalakshmi Balakrishna, M.D.
Lymphocytosis
Neutrophilic leukocytosis
Contributed by Jayalakshmi Balakrishna, M.D.
B cells
T cells
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Reactive lymphoid hyperplasia
AFIP images
Reactive lymphadenopathy of rheumatoid arthritis
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Follicular hyperplasia
with eosinophilic
material in
interfollicular areas
Extensive replacement
by focally calcified
eosinophilic material
Rounded, well
separated follicles
with expanded
paracortex
Follicular center composed
primarily of centrocytes,
with no / rare tingible body
macrophages or mitotic figures
Interdigitating dendritic
cells (CD1+) are associated
with small lymphocytes
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Imaging findings in RDD
Contributed by Aishwarya Ravindran, M.B.B.S. and Karen L. Rech, M.D.
Excisional biopsy of
subcutaneous mass
CD163
S100
OCT2
Cyclin D1
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CT findings
Expansible low density mass
5 cm tumor in hilus
Hypointensity of tumor
Splenic lesion at medial aspect
Lesion in lower spleen
Hypoenhancing mass
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Macroscopic findings
Laparoscopic view
Contributed by Shafinaz Hussein, M.D. and Huifei Liu, M.D., Ph.D. (Case #364)
Circumscribed, bosselated, firm, tan colored mass
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Well demarcated, unencapsulated lesion
Splenic resection
Well defined, nonencapsulated lesion
Red-brown, multinodular lesions
Contributed by Valentina Sangiorgio, M.D., Shafinaz Hussein, M.D. and Huifei Liu, M.D., Ph.D. (Case #364)
Multiple vascular nodules
Predominantly small capillaries
Bland endothelial cells
CD8
CD31
CD34
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Rupture of implant
Various images
Contributed by Dr. Mark R. Wick
Silicone in axillary lymph node
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Material consistent with silicone
Liquid silicone droplets
Various images
Subcapsular sinus diffusely expanded
Vacuoles which contain refractile material
Foreign body granuloma
Germinal centers surrounded by sinuses
Silicone leakage
Silicone particles in cystic spaces
Case #309
Splenic gonadal fusion
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Necrotizing lymphadenopathy
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Life cycle
Contributed by Tayler A. van den Akker, M.D.
Histologic triad
Follicular hyperplasia
Reactive follicles, monocytoid cells
Epithelioid histiocytes
Epithelioid histiocytes, monocytoid B cells
Toxoplasma special stain
AFIP images
Toxoplasmic lymphadenitis
Monocytoid B cells
Contributed by Bobbi Pritt, M.D.
Tachyzoites of Toxoplasma gondii
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Toxoplasma tissue cyst within an intact neurone
Classic histomorphology of toxoplasma lymphadenitis
Great teaching case of cerebral toxoplasmosis
Case #405
AFIP images
Vascular transformation of sinuses
Intra-abdominal lymph node
Nodular spindle cell vascular transformation
Ashton-Key: 2016
Auerbach: 2022
Crane: 2021
Duffield: 2020
Hsi: 2017
Hudnall: 2019
Jaffe: 2016
Jiang: 2023
King: 2023
Medeiros: 2017
Medeiros: 2021
Medeiros: 2023
Naeim: 2018
Wang: 2020
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