Treatment

Under local anesthesia, an incisional biopsy was performed and the tissue submitted for histologic evaluation.

Incisional and excisional biopsy

Histologic examination of the H & E sections showed sheets of monotonous, nodular, atypical lymphoid infiltrate.  The atypical cells were predominantly small, with round to irregular nuclear contours, clumped chromatin and inconspicuous nucleoli.  Scattered large cells with vesicular chromatin and one or more nucleoli morphologically consistent with centroblasts were identified.  Using the Mann-Berard criteria counting 15 fields yielded an average of 7 centroblasts per field. 

The immunohistochemical stains were positive for CD10, CD20 and BCL-2.  

Figure 3 Low power (x40) H & E histology demonstrates a piece of mucosa infiltrated by sheets of monotonous, nodular, atypical lymphoid cells. They were predominantly small, with round to irregular nuclear contours, clumped chromatin and inconspicuous nucleoli. Scattered large cells consistent with centroblasts were also identified.

Figure 4 Higher power (x100) H & E histology demonstrates closer look at the atypical lymphoid cells arranged in lobules of predominantly small cells with round to irregular nuclear contours, clumped chromatin and inconspicuous nucleoli. Scattered large cells consistent with centroblasts were identified.

Figure 5Low power (x40) Immunohistochemistry stain demonstrate that the atypical lymphoid cells are uniformly positive with BCL-2.

Figure 6Low power (x40) Immunohistochemistry stain demonstrate that the atypical lymphoid cells are uniformly positive with CD-10. The CD10 positive B cells are noted not only within neoplastic follicles but are also increased within the interfollicular areas

Figure 7 Low power (x40) Immunohistochemistry stain demonstrate that the atypical lymphoid cells are uniformly positive with CD-20.