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Case 129 - Discussion

Hematopathology Case

 

 

CD30 CD30
 
CD30  

INFECTIOUS MONONUCLEOSIS

 

  • Kids or teenager, fever, pharyngitis, lymphadenopathy or tonsilar enlargement, splenomagely

  • Histology:

    • Partially architectural effacement; large areas of necrosis may be present

    • Prominent paracortical expansion with a mottled pattern: heterogeneous population of cells, including small and large lymphocytes, immunoblasts, plasma cells, histiocytes, and eosinophils

    • Interfollicular immunoblasts may be scattered (mimicking Hodgkin lymphoma) or in sheets (mimicking DLBCL)

    • Variable follicular hyperplasia and sinus histiocytosis

    • Marked capillary proliferation with hyperplastic endothelial cells

    • Capsular or extracapsular infiltration

  • IPX:

    • Immunoblasts CD30+

    • EBV positive in all stages of B-cells

  • DDX:

    • HD: fibrosis, eosinophils, typical RS cells with giant red nucleoli

    • ALCL: large, pleomorphic, T-cells

    • DLBCL: older age, uniform population, CD30-

Reference: Ioachim's Lymph Node Pathology, 4th edition