Diagnostic Pathology Ashton.3rd Edition(2016) برای بزرگنمایی عکسها کلیک را روی ان نگه دارید..... ■■■【1】B-lymphoblastic lymphoma Figure 4.1 Low-power photograph of lymphoblastic lymphoma. Note preservation of much of the underlying nodal structure. Numerous 'starry-sky' macrophages are seen in this tumour Figure 4.2 Lymphoblastic lymphoma. The uniform tumour cells surround and partially invade a residual reactive follicle Figure 4.3 High-power view of lymphoblastic lymphoma. The tumour cells are relatively uniform in size, have fine nuclear chromatin and show one or more small nucleoli Figure 4.4 Plastic-embedded section of lymphoblastic lymphoma showing deep fissuring of the tumour cell nuclei, a feature seen in some but not all cases Figure 4.5 Imprint preparation of lymphoblastic lym- phoma showing uniform size of tumour cells, fine nuclear chromatin and multiple nucleoli. The cytoplasmic rim is narrow and inconspicuous on most cells Figure 4.6 B-lymphoblastic lymphoma stained for CD20. Reactive B-lymphocytes show positivity; the tumour cells are negative Figure 4.7 B-lymphoblastic lymphoma stained for CD79a. The tumour cells are positive. Note 'Indian file' arrangement of the cells outside the capsule Figure 4.8 Lymphoblastic lymphoma stained for terminal deoxynucleotidyl transferase (TdT). The lymphoma cells show nuclear positivity Figure 4.9 Lymphoblastic lymphoma stained for Ki67. The proliferation fraction in this tumour is in the region of 70 per cent ■■■【2】T-lymphoblastic lymphoma Figure 4.10 T-lymphoblastic lymphoma stained for CD3. The strong cytoplasmic positivity highlights nuclear clefts in this case Figure 4.11 T-lymphoblastic lymphoma stained for CD79a. Scattered non-neoplastic B-cells are strongly stained. The majority of the lymphoblastic cells show variable cytoplasmic staining ■■■【3】CLL Figure 5.1 B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma. Low-power view showing residual germinal centre surrounded by tumour cells Figure 5.2 B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma. Low-power view showing pale proliferation centres Figure 5.3 B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma showing a proliferation centre containing many prolymphocytes and paraimmunoblasts Figure 5.4 B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma. Paraimmunoblastic variant imprint preparation showing fine chromatin, visible nucleoli and cytoplasmic basophilia Figure 5.5 B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma paraimmunoblastic variant in which most of the cells resemble paraimmunoblasts Figure 5.6 Proliferation centre showing paraimmuno- blasts with small lymphocytes at the periphery Figure 5.7 B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma. Periodic acid-Schiff stain show- ing intranuclear inclusion of immunoglobulin M (IgM; Dutcher body) Figure 5.8 B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma showing transformation to high- grade lymphoma (Richter syndrome) Figure 5.9 Membrane staining of B-cells for CD23. Strongest staining seen on paraimmunoblasts Figure 5.10 Proliferation centre showing strong CD5 positivity of small T-lymphocytes with variable membrane staining of paraimmunoblasts Figure 5.11 Section of B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma (B-CLL/SLL) showing Hodgkin/Reed-Sternberg (H/RS) cells. There are scattered histiocytes but the stromal component is not sufficient to categorize this as Hodgkin lymphoma. It should be categorized as B-CLL/SLL containing RS cells Figure 5.12 Same case as that seen in Figure 5.11 stained for CD5. The B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma cells are positively stained. The more strongly staining cells are reactive T-cells. These were increased in number around the Hodgkin/Reed- Sternberg (H/RS) cells Figure 5.13 Section stained for CD30 showing Hodgkin/ Reed-Sternberg (H/RS) cells in a monomorphic population of B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma cells Figure 5.14 Section stained for CD15 showing positive Hodgkin/Reed-Sternberg (H/RS) cells ■■■【4】Lymphoplasmacytic lymphoma Figure 5.15 Lymphoplasmacytic lymphoma showing amyloid deposition. Note the giant cell reaction to the amyloid Figure 5.16 Lymphoplasmacytic lymphoma showing a dilated sinus containing pink proteinaceous material. The adjacent cells are lymphocytes and plasma cells. The arrow indicates a Dutcher body Figure 5.17 High-power view of lymphoplasmacytic lymphoma showing parasinusoidal distribution of lymphocytes and plasma cells. Mast cells are present in the sinus (arrows) Figure 5.18 Lymphoplasmacytic lymphoma showing strong kappa positivity of plasma cells that accumulate around vessels and fibrous trabeculae Figure 5.19 Hairy cell leukaemia. Splenic hilar lymph node showing residual follicles pushed apart by pale-staining hairy cells Figure 5.20 Hairy cell leukaemia. High-power view showing the grooved bean-shaped nuclei of the hairy cells and their abundant pale cytoplasm Figure 5.21 Plasmacytoma, plasmablastic type showing prominent nucleoli and dark amphophilic cytoplasm Figure 5.22 Plasmacytoma, plasmablastic stained by methyl green pyronin to demonstrate cytoplasmic RNA Figure 5.23 Imprint preparation of plasmacytoma show- ing the appearance of mature plasma cells ■■■【5】Marginal zone lymphoma Figure 5.24 Nodal marginal zone lymphoma. The pale marginal zone cells follow the distribution of the lymph node sinuses Figure 5.25 Higher power view of nodal marginal zone lymphoma showing a reactive germinal centre surrounded by an attenuated mantle zone of small lymphocytes with an outer zone of marginal zone cells Figure 5.26 Nodal marginal zone lymphoma showing nodular growth pattern with reactive follicles at the centre of the nodules. Note the paler staining marginal zone cells around the follicles Figure 5.27 Nodal marginal zone lymphoma, low power. Showing residual reactive follicles and islands of marginal zone cells surrounded by epithelioid histiocytes Figure 5.28 Nodal marginal zone lymphoma. High-power view of marginal zone cells surrounded by epithelioid histiocytes Figure 5.29 Nodal marginal zone lymphoma showing plasmacytic differentiation Figure 5.30 Nodal marginal zone lymphoma with plasmacytic differentiation. Periodic acid-Schiff stain showing inclusions of immunoglobulin within the plasma cells Figure 5.31 Same case as Figure 5.30 stained for immunoglobulin M (IgM), demonstrating that the inclusions are IgM Figure 5.32 Low-power view of nodal marginal zone lymphoma stained for CD21, showing residual follicular dendritic cells ■■■【6】Follicuar lymphoma Figure 5.33 Grade 1 follicular lymphoma showing a single centroblast. The nucleus adjacent to the centroblast (arrow) is of a dendritic reticulum cell Figure 5.34 Follicular lymphoma. Relatively uniform follicles with attenuated mantles. No sinus structures seen Figure 5.35 Plastic-embedded section of follicular lymphoma showing centrocytes and three centroblasts Figure 5.36 Imprint cytology of a grade 1 follicular lymphoma showing centrocytes and a centroblast Figure 5.37 Follicular lymphoma. Giemsa stain showing basophilia of centroblast cytoplasm Figure 5.38 Follicular lymphoma showing extension into perinodal fat Figure 5.39 Follicular lymphoma involving axillary lymph node. Neoplastic follicles have invaded the fatty hilum and also extend outside the capsule Figure 5.40 Follicular lymphoma showing sclerosis around follicles Figure 5.41 Follicular lymphoma showing sclerosis of follicle centres (reticulin stain) Figure 5.42 Follicular lymphoma showing signet ring change. Many of the cells appear vacuolated in this variant of follicular lymphoma Figure 5.43 Follicular lymphoma showing signet ring change. The nucleus of many of the tumour cells is com- pressed to form a small crescent Figure 5.44 Follicular lymphoma in which one neoplastic follicle displays a floret pattern Figure 5.45 Follicular lymphoma showing follicles out- lined by CD3+ T-cells Figure 5.46 Grade 1 follicular lymphoma showing CD10 staining of follicle centre cells Figure 5.47 Grade 1 follicular lymphoma labelled for Ki67 showing a relatively low proliferation fraction. Note that many of the follicles show most labelling at the periphery Figure 5.48 Follicular lymphoma stained for CD79a. The small dark cells are mantle cells that form attenuated mantles Figure 5.49 Follicular lymphoma stained for BCL-2 showing positivity of the follicle centres ■■■【7】Mantle cell lymphoma Figure 5.50 Mantle cell lymphoma showing a reactive follicle surrounded by tumour cells (lower left); a second follicle engulfed and infiltrated by tumour is visible at upper right Figure 5.51 Mantle cell lymphoma showing a nodular growth pattern Figure 5.52 Mantle cell lymphoma stained for reticulin. Note condensation of reticulin around blood vessel with short radiating spikes Figure 5.53 Mantle cell lymphoma showing characteristic perivascular hyaline material. Arrows indicate the nuclei of dispersed follicular dendritic cells Figure 5.54 Blastic variant of mantle cell lymphoma. The tumour cells contrast in size with those of the usual type, visible at upper right. The nuclear size, fine chromatin and visible (but small) nucleoli mimic the appearance of lymphoblastic lymphoma Figure 5.55 Mantle cell lymphoma showing characteristic cytomorphology. Note the characteristic histiocyte Figure 5.56 Blood film from a patient with mantle cell lymphoma. The circulating tumour cells show characteristic cleft nuclei with visible nucleoli and pale staining cytoplasm Figure 5.57 Nodular growth pattern of a mantle cell lymphoma highlighted by CD3+ T-cells Figure 5.58 CD5+ mantle cell lymphoma. The dark cells are reactive T-lymphocytes. The unstained islands are residual reactive germinal centres surrounded by lymphoma Figure 5.59 Mantle cell lymphoma stained for cyclin D1, same field as in Figure 5.58. Note that the staining is nuclear and varies in intensity Figure 5.60 Mantle cell lymphoma stained for CD20 showing a nodular growth pattern Figure 5.61 Mantle cell lymphoma stained for CD23 showing the characteristic expansion and dispersal of follicular dendritic cells Figure 5.62 Mantle cell lymphoma stained for Ki67, showing a low proliferation fraction. The areas of intense labelling are residual reactive germinal centres Figure 5.63 Blastoid mantle cell lymphoma showing numerous apoptotic bodies Figure 5.64 Same case as in Figure 5.63 stained for Ki67. A high proportion of the tumour cells can be seen to be in cycle ■■■【8】DLBCL Figure 5.65 Diffuse large B-cell lymphoma (centroblastic monomorphic) Figure 5.66 Diffuse large B-cell lymphoma (centroblastic monomorphic). Plastic-embedded section Figure 5.67 Diffuse large B-cell lymphoma (centroblastic). Imprint preparation showing moderate pleomorphism Figure 5.68 Diffuse large B-cell lymphoma (centroblastic centrocytoid). Plastic-embedded section showing large centrocytoid cells with prominent nucleoli Figure 5.69 Diffuse large B-cell lymphoma (centroblastic multilobated) Figure 5.70 Diffuse large B-cell lymphoma (centroblastic multilobated). Imprint preparation Figure 5.71 Diffuse large B-cell lymphoma (immunoblastic) Figure 5.72 Diffuse large B-cell lymphoma (immuno- blastic). Imprint preparation Figure 5.73 T-cell/histiocyte-rich B-cell lymphoma showing a tumour cell with centroblast morphology. The surrounding cells are predominantly T-cells and histiocytes Figure 5.74 T-cell/histiocyte-rich diffuse large B-cell lym- phoma with a tumour cell resembling a Reed-Sternberg cell Figure 5.75 Low-power view of T-cell/histiocyte-rich diffuse large B-cell lymphoma stained for CD20 showing the sparse tumour cells Figure 5.76 High-power view of T-cell/histiocyte-rich diffuse large B-cell lymphoma stained for CD20 showing strong membrane staining of the tumour cells Figure 5.77 Diffuse large B-cell lymphoma in an elderly man. The tumour cells show moderate pleomorphism and there is a background of small lymphocytes and histiocytes Figure 5.78 The same case as shown in Figure 5.77 stained to show Epstein-Barr virus-encoded RNAs (EBERS). All of the tumour cells appear to be positive, revealing the unstained background of small lymphocytes and histiocytes Figure 5.79 Lymph node containing ALK-positive large B-cell lymphoma showing characteristic sinus infiltration Figure 5.80 Higher-power view of ALK-positive large B-cell lymphoma showing the regular rounded immunoblastic cells with prominent single central nucleoli Figure 5.81 ALK-positive large B-cell lymphoma stained for CD10. The tumour cells show variable positivity. Note that this membrane antigen is showing a granular cytoplasmic distribution, possibly caused by altered clathrin function Figure 5.82 ALK-positive large B-cell lymphoma stained for CD79a. The tumour cells are focally positive and show granular cytoplasmic staining Figure 5.83 ALK-positive large B-cell lymphoma stained for CD138, showing strong positive staining of the tumour cells Figure 5.84 ALK-positive large B-cell lymphoma stained for ALK-1. Note the granular positivity characteristic of the ALK-1/clathrin gene translocation ■■■【9】Burkitt lymphoma Figure 5.85 Burkitt lymphoma showing a 'starry-sky' pattern Figure 5.86 High-power view of Burkitt lymphoma show- ing characteristic morphology of the tumour cells and apoptotic debris in a 'starry-sky' macrophage Figure 5.87 Endemic Burkitt lymphoma. Imprint showing characteristic tumour cells Figure 5.88 Sporadic Burkitt lymphoma with a florid granulomatous response Figure 5.89 Burkitt lymphoma, stained with Giemsa, show- ing lipid vacuoles in deeply basophilic cytoplasm (arrows) Figure 5.90 Sporadic Burkitt lymphoma. Imprint showing features similar to those of the endemic tumour Figure 5.91 Burkitt lymphoma stained for Ki67, showing labelling of 100 per cent of the tumour cells ■■■【10】Angioimmunoblastic lymphoma Figure 6.1 Angioimmunoblastic lymphoma. Even when the infiltrate extends beyond the capsule of the node into surrounding tissue, there is a tendency for the peripheral sinus to remain widely patent Figure 6.2 The typical polymorphous infiltrate in angioimmunoblastic lymphoma includes plasma cells, large blasts, eosinophils and clear cells Figure 6.3 The characteristic vascular proliferation in angioimmunoblastic lymphoma is caused by 'arborizing' high-endothelial venules Figure 6.4 Angioimmunoblastic lymphoma. The vessels are well seen in periodic acid-Schiff stains owing to staining of the basement membranes Figure 6.5 Clear cells. The neoplastic cells in angioimmu- noblastic lymphoma tend to cluster around vessels, and have clear cytoplasm with nuclei of intermediate size and variable pleomorphism Figure 6.6 Angioimmunoblastic T-cell lymphoma. The neoplastic T-cells express PD-1 with a membranous pattern of staining Figure 6.7 Angioimmunoblastic lymphoma stained with CD21. Both CD21 and CD23 can be used to demonstrate the complex network of follicular dendritic cells associ- ated with the vascular proliferation Figure 6.8 Angioimmunoblastic lymphoma stained with CD30. Scattered large blasts express B-cell markers and are frequently CD30+ Figure 6.9 Early or incomplete patterns of node involve- ment by angioimmunoblastic T-cell lymphoma. Follicles remain in parts of the node but may be poorly defined with thin or incomplete mantle zones Figure 6.10 Some residual follicles in angioimmunoblastic T-cell lymphoma resemble those seen in Castleman disease, consisting largely of follicular dendritic cells Figure 6.11 Angioimmunoblastic T-cell lymphoma stained for CD21 showing some normal follicular dendritic cell networks, and others show irregular expansion and appear frayed Figure 6.12 Angioimmunoblastic T-cell lymphoma stained for CD20 showing abnormal follicles almost devoid of B-cells, leaving scattered larger B-cells centrally and small B-cells in the surrounding node ■■■【11】Anaplastic large T-cell lymphoma Figure 6.13 In the 'common' variant of anaplastic large cell lymphoma, cells show the features of large blasts, often with fairly abundant cytoplasm and forming cohe- sive sheets. Scattered hallmark cells are present (arrows) Figure 6.14 Anaplastic large cell lymphoma. Other examples show more marked pleomorphism with atypi- cal mitoses. Nuclei are open and lobated and include the hallmark cells, in which the lobes form horseshoe or ring shapes (arrows) Figure 6.15 Anaplastic large cell lymphoma-small cell variant. Nuclei are smaller and irregular and many lack prominent nucleoli. The cells have abundant pale-staining or clear cytoplasm Figure 6.16 Anaplastic large cell lymphoma- lymphohistiocytic variant. Neoplastic cells are obscured by numerous histiocytes, some of which show erythrophagocytosis Figure 6.17 Anaplastic large cell lymphoma-sarcomatoid variant. Many of the neoplastic cells have oval or spindle morphology and mimic a connective tissue sarcoma Figure 6.18 Anaplastic large cell lymphoma. A sinus pattern of spread is typical of early nodal involvement Figure 6.19 Anaplastic large cell lymphoma. CD30 staining typically shows membrane and Golgi positivity similar to that seen in Hodgkin lymphoma. CD30 is useful in identifying cells in the sinuses Figure 6.20 Anaplastic large cell lymphoma. Anaplastic lymphoma kinase (ALK) staining is both nuclear and cytoplasmic when the ALK/NPM (p80) translocation is present Figure 6.21 Expression of epithelial membrane antigen by anaplastic large cell lymphoma is variable and usually associated with anaplastic lymphoma kinase (ALK)-positive tumours. The staining pattern is similar to CD30 with membrane and Golgi positivity, but tends to be more granular ■■■【12】Peripheral T-cell lymphoma NOS Figure 6.22 The infiltrate in peripheral T-cell lymphoma not otherwise specified is frequently polymorphous with neoplastic cells of varying sizes with irregular nuclei. In this example, some have clear cytoplasm similar to those seen in angioimmunoblastic lymphoma Figure 6.23 The so-called Lennert lymphoma is a peripheral T-cell lymphoma not otherwise specified in which cohesive clusters of epithelioid histiocytes are prominent Figure 6.24 Peripheral T-cell lymphoma not otherwise specified: intermediate cell morphology. The tumour cells have irregular, small to medium-sized, uniformly hyperchromatic nuclei Figure 6.25 Peripheral T-cell lymphoma not otherwise specified: intermediate cell morphology. In this example, the cells have rounded, fairly uniform nuclei, most with a single prominent nucleolus Figure 6.26 Peripheral T-cell lymphoma not otherwise specified: large cell morphology. In this example, cells have large, open, irregular, folded nuclei, one or more nucleoli and abundant pale or clear cytoplasm ■■■【13】Adult T-cell lymphoma Figure 6.27 Adult T-cell leukaemia/lymphoma. Circulating neoplastic cells typically show complex lobation of the nuclei givingrise to the term 'flower cells' Figure 6.28 Adult T-cell leukaemia/lymphoma. In a typical case, the infiltrate is pleomorphic and many cells show nuclear folding and lobation Figure 6.29 Adult T-cell leukaemia/lymphoma. In other examples, the infiltrate is more monomorphic and more closely resembles other forms of large cell lymphoma Figure 6.30 T-cell prolymphocytic leukaemia. Leukaemic cells show nuclear irregularity and cytoplasmic blebs Figure 6.31 T-cell prolymphocytic leukaemia. A low- power view of the node shows occasional spared follicles and high endothelial venules within the infiltrate Figure 6.32 T-cell prolymphocytic leukaemia. Cells are slightly larger than lymphocytes with slightly irregular nuclei and a single nucleolus ■■■【14】Mycosis fungoides Figure 6.33 Mycosis fungoides/Sézary syndrome. In touch preparations, the cells show marked complex nuclear folding or convolutions Figure 6.34 Mycosis fungoides/Sézary syndrome In grade 3 involvement, the infiltrating cells include large blasts and show considerable variation in size. Many have irregular folded nuclei Figure 6.35 Enteropathy-associated T-cell lymphoma (EATL). In mesenteric nodes involved by EATL, the infiltrate is similar to that seen in the bowel wall. In this example of early involvement, the sinuses contain an infiltrate of pleomorphic cells ■■■【15】 Immundeficient lymphoma Figure 7.1 Polymorphic post-transplant lymphoprolifera- tive disorder. The B-cell proliferation includes immunoblasts, plasma cells and many showing intermediate differentiation Figure 7.2 Methotrexate-associated malignant lym- phoma. Although some cells closely resemble Hodgkin/ Reed-Sternberg cells, the background cell population is not typical of classical Hodgkin lymphoma Figure 7.3 Methotrexate-associated malignant lymphoma stained for CD30. The larger cells are positive for CD30 with a typical pattern of membrane and Golgi staining Figure 7.4 Methotrexate-associated malignant lymphoma stained for LMP1. Many of the cells express LMP1, indicat- ing latent Epstein-Barr virus infection ■■■【16】Hodjkin lymphoma Figure 8.1 Nodular lymphocyte-predominant Hodgkin lymphoma. Low-power view, showing nodular growth pattern Figure 8.2 Section of nodular lymphocyte-predominant Hodgkin lymphoma, stained for reticulin, showing the characteristic nodular growth pattern Figure 8.3 Nodular lymphocyte-predominant Hodgkin lymphoma showing the centre of a nodule stained for CD3. Note the T-cell rosetting of the LP cells (arrows) Figure 8.4 Nodular lymphocyte-predominant Hodgkin lymphoma, stained for CD20, showing nodular prolifera- tion composed predominantly of B-cells Figure 8.5 Section of nodular lymphocyte-predominant Hodgkin lymphoma, stained for CD20, showing a strongly labelled multinucleated LP cell surrounded by unstained T-lymphocytes. Cytoplasmic spikes from the LP cell extend between the T-cells Figure 8.6 Giemsa-stained section of classical Hodgkin lymphoma showing a Reed-Sternberg cell and a mono- nuclear Hodgkin cell. Both cells show deep cytoplasmic basophilia Figure 8.7 Classical Hodgkin lymphoma stained for CD3. T-cells are the predominant cell type and show tight rosetting of a Reed-Sternberg cell Figure 8.8 Classical Hodgkin lymphoma stained for CD30. Note the strong positive staining of the cell membrane and Golgi region of Hodgkin/Reed-Sternberg cells Figure 8.9 Classical Hodgkin lymphoma stained for CD15. Note the membrane and cytoplasmic staining with Golgi zone accentuation of Hodgkin/Reed-Sternberg (H/RS) cells. Large numbers of granulocytes show strong staining. These can obscure the positive staining of H/RS cells Figure 8.10 Classical Hodgkin lymphoma stained for Ki67. All Hodgkin/Reed-Sternberg cells are in cycle and show positive nuclear staining. The nuclei of these cells are recognizable by their large size Figure 8.11 Immunohistochemical staining for beta- 2-microglobulin (B2M) in two representative cases of classical Hodgkin lymphoma. (a) B2M staining in a case with mutated B2M and a corresponding absence of B2M expression in Hodgkin/Reed-Sternberg (H/RS) cells and (b) B2M staining in a case with wild-type B2M showing Golgi and membrane staining in H/RS cells Figure 8.12 Low-power view of a section of nodular sclerosis classical Hodgkin lymphoma showing nodular growth pattern and banded sclerosis Figure 8.13 Nodular sclerosis classical Hodgkin lymphoma showing characteristic lacunar cells. Note collagen fibres at top of picture and the absence of classic Reed- Sternberg cells Figure 8.14 Nodular sclerosis classical Hodgkin lym- phoma, fibrohistiocytic variant. Degenerate Hodgkin/ Reed-Sternberg cells are seen in a background of spindle- shaped histiocytes and scattered eosinophils with few small lymphocytes Figure 8.15 Imprint preparation of nodular sclerosis classical Hodgkin lymphoma showing a lacunar Hodgkin/ Reed-Sternberg cell. Note the abundant pale-staining cytoplasm, multilobed nucleus and small nucleoli. Rosetting lymphocytes can be seen adhering to the cell membrane Figure 8.16 Plastic-embedded section of nodular sclerosis classical Hodgkin lymphoma showing a lacunar Hodgkin/Reed-Sternberg cell. The cytoplasm of this cell is relatively abundant and contains few organelles Figure 8.17 Nodular sclerosis classical Hodgkin lymphoma showing atypical Hodgkin/Reed-Sternberg cells Figure 8.18 Nodular sclerosis classical Hodgkin lymphoma showing sheets of Hodgkin/Reed-Sternberg cells with an area of necrosis (so-called 'syncytial Hodgkin lymphoma') Figure 8.19 Lymphocyte-rich classical Hodgkin lymphoma showing scattered Hodgkin/Reed-Sternberg cells in the mantle/marginal zone of a follicle. Note the absence of inflammatory cells apart from small lymphocytes Figure 8.20 Lymphocyte-rich classical Hodgkin lymphoma showing numerous CD30+ Hodgkin/Reed-Sternberg cells in the mantle/marginal zone of a follicle with occasional positive cells at the periphery of the follicle centre Figure 8.21 Mixed cellularity classical Hodgkin lymphoma showing a classical Reed-Sternberg cell together with H/RS cells in a background of small lymphocytes, eosinophils and histiocytes Figure 8.22 Mixed cellularity classical Hodgkin lymphoma stained to show Epstein-Barr virus-encoded RNAs(EBERS). All Hodgkin/Reed-Sternberg cells present show nuclear positivity Figure 8.23 Lymphocyte-depleted classical Hodgkin lymphoma showing Hodgkin/Reed-Sternberg cells in a paucicellular background of amorphous eosinophilic material (previously called diffuse fibrosis) Figure 8.24 Lymphocyte-depleted classical Hodgkin lymphoma showing sheets of atypical Hodgkin/Reed- Sternberg cells and areas of necrosis without banded sclerosis (previously called Hodgkin sarcoma) ■■■【17】Histiocytic sarcoma Figure 9.1 Histiocytic sarcoma showing tumour cells with reniform and indented/grooved nuclei and abundant eosinophilic cytoplasm Figure 9.2 Histiocytic sarcoma immunostained for CD4. Note the membrane staining of the tumour cells. The darkly staining lymphocytes are helper T-cells Figure 9.3 Langerhans cell histiocytosis of lymph node showing distension of the sinuses by Langerhans cells and giant cells Figure 9.4 Langerhans cell histiocytosis of lymph node showing a sinus distended by Langerhans cells with elongated grooved nuclei and abundant pale eosinophilic cytoplasm. Eosinophils form a 'microabscess' in one area Figure 9.5 Langerhans histiocytosis of lymph node immu- nostained for S100 protein. The Langerhans cells, which have a sinusoidal distribution, are strongly stained Figure 9.6 Imprint preparation of Langerhans cell histiocytosis of a lymph node. The Langerhans cells have grooved or folded nuclei and abundant pale-staining cytoplasm Figure 9.7 Langerhans cell sarcoma showing multinucle- ated cells and atypical mitoses with a background of more typical Langerhans cells Figure 9.8 Langerhans cell sarcoma immunostained for S100 protein ■■■【18】Dendritic cell sarcoma Figure 9.9 Interdigitating dendritic cell sarcoma in a lymph node involved by B-cell chronic lymphocytic leukaemia in transformation Figure 9.10 Interdigitating dendritic cell sarcoma in a lymph node involved by B-cell chronic lymphocytic leukaemia in transformation, high-power view of the spindle cell neoplasm Figure 9.11 Interdigitating dendritic cell sarcoma in a lymph node involved by B-cell chronic lymphocytic leukaemia in transformation; S100 staining in the interdigitating dendritic cell sarcoma Figure 9.12 Interdigitating dendritic cell sarcoma in a lymph node involved by B-cell chronic lymphocytic leukaemia in transformation; the B-cell chronic lymphocytic leukaemia cells express CD5 Figure 9.13 Follicular dendritic cell sarcoma of lymph node showing a storiform pattern of interlacing spindle cells Figure 9.14 Follicular dendritic cell sarcoma of lymph node. In this area, the neoplastic spindle cells are inter- spersed with large numbers of lymphocytes Figure 9.15 Follicular dendritic cell sarcoma immunostained for CD21, showing strong positivity of the spindle cells, which were also positive for CD23 and CD35 Figure 9.16 Follicular dendritic cell sarcoma complicating hyaline vascular Castleman disease. Castleman follicles are surrounded by the spindle cell neoplasm Figure 9.17 Follicular dendritic cell sarcoma complicating hyaline vascular Castleman disease showing spindle cell areas of follicular dendritic cell sarcoma Figure 9.18 Follicular dendritic cell sarcoma complicating hyaline vascular Castleman disease. CD21 staining shows the dendritic cell network Figure 9.19 Blastic plasmacytoid dendritic cell neoplasm. The cells are small to intermediate in size with round or irregular nuclei, fine chromatin and small nucleoli Figure 9.20 Systemic mastocytosis involving a lymph node and showing interfollicular spread of the mast cell infiltrate Figure 9.21 High-power view of systemic mastocytosis stained by toluidine blue. The mast cells have character- istic spindle cell morphology and show metachromatic granules ■■■【19】Myeloid sarcoma Figure 9.22 Myeloid neoplasm with PDGFRA gene mutation showing blasts admixed with numerous eosinophils Figure 9.23 Myeloid sarcoma involving a lymph node showing a residual reactive follicle surrounded by a uniform infiltrate of blast cells Figure 9.24 High-power view of myeloid sarcoma. The neoplastic cells have rounded nuclei with fine nuclear chromatin. Three cells in this photograph show eosinophilic cytoplasmic granules (arrows) Figure 9.25 Myeloid sarcoma of lymph node immuno- stained for CD68 (PG-M1) showing positivity of many of the myeloid cells surrounding a reactive follicle Figure 9.26 Myeloid sarcoma immunostained for neutrophil elastase. Many of the cells show granulocytic differentiation ■■■【20】 Non hematolymphoid tumors Figure 10.1 Poorly differentiated tumour in a lymph node. The tumour is composed of a diffuse infiltrate of large discohesive cells. Fine needle aspiration cytology had suggested this was a high-grade lymphoma Figure 10.2 The tumour cells were negative for all lymphoid markers and showed expression of cytokeratin, confirming a poorly differentiated carcinoma Figure 10.3 Lymph node showing an intranodal palisaded myofibroblastoma with palisaded spindle cells and amianthoid fibres Figure 10.4 Low-power view of Kaposi sarcoma showing a vascular proliferation with fascicles of spindle cells Figure 10.5 High-power view of Kaposi sarcoma demon- strating the atypical spindle cells and red cells in clefts between the spindle cells Figure 10.6 Pelvic lymph node showing benign müllerian inclusions within the capsule Figure 10.7 Lymph node showing a benign subcap- sular inclusion of naevus cells. Note the bland nuclear morphology (arrow)
