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Case 27

Hematopathology Case

Clinical Information


A 58-year-old male had a past medical history of ulcerative colitis and Cohn's disease with ileostomy placement. Recently he presented to the clinic with weight loss, diffuse lymphadenopathy, and pain in bilateral hips and arms. He also had a 3 month history of nodules and a swollen left arm.  The first nodule to appear was below his left axilla and then more appeared on his left chest, right axilla, right jaw, right groin area, above his right eye and in his scalp in the left temporal region.  Usually the nodules would start out red and purple and then they have all been progressively getting larger. He had worsening lymphadenopathy involving his left axilla and a mass on his left temple over the the past 3 months. CT scan showed involvement of numerous lymph nodes, significant tumor replacement of the liver, and bony involvement. His LDH was 2609. His alkaline phosphatase was 434. He was hypercalcemic as well.


An axillary lymph node and a skin lesion from his left chest were biopsied.







Axillary lymph node. HE, 2

Axillary lymph node. HE, 4



Axillary lymph node. HE, 10

Axillary lymph node. HE, 10



Axillary lymph node. HE, 20

Axillary lymph node. HE, 40



Axillary lymph node. HE, 40

Axillary lymph node. HE, 40



Skin lesion. HE, 4

Skin lesion. HE, 10



Skin lesion, HE. 20

Skin lesion. HE, 40



Lymph node. Touch imprint, HE, 40

Lymph node. Tough imprint, HE, 40





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Source: Department of Pathology, Creighton University Medical Center, Omaha, NE