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Virtual case of the month
Enigmatic intranodal spindle cell lesion
  1. Alessandro Pietro Aldera1,2,
  2. Dhirendra Govender1,3
  1. 1 Division of Anatomical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  2. 2 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
  3. 3 PathCare Claremont, Cape Town, South Africa
  1. Correspondence to Dr Alessandro Pietro Aldera, Division of Anatomical Pathology, University of Cape Town, Cape Town 7925, South Africa; aldale001{at}myuct.ac.za

http://dx.doi.org/10.1136/jclinpath-2020-206586

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    Clinical question

    A middle-aged woman without prior medical history presented with multiple enlarged lymph nodes in the right anterior cervical chain. Excisional biopsy of the affected nodes was performed. Two adherent lymph nodes were received measuring 3×3 cm together. The sample was bisected and submitted for histopathological evaluation. Review the high quality, interactive digital Aperio slide at http://virtualacp.com/JCPCases/jclinpath-2020-206586/ and consider your diagnosis.

    What is your diagnosis?

    1. Fibroblastic reticular cell sarcoma.

    2. Follicular dendritic cell sarcoma.

    3. Inflammatory myofibroblastic tumour.

    4. Interdigitating dendritic cell sarcoma.

    5. Intranodal palisaded myofibroblastoma.

    The correct answer is after the discussion.

    Discussion

    The nodal architecture is effaced (figure 1A) by a proliferation of spindle cells which are arranged in a vaguely whorled pattern (figure 1B) and in loose fascicles with conspicuous admixed small lymphocytes and few plasma cells. The neoplastic cells have indistinct cell borders and elongated ovoid nuclei with vesicular chromatin and small central eosinophilic …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • APA and DG contributed equally.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.