Case 350: A 20-year-old man with an enlarged cervical lymph nodes

H & P

• enlarged lymph node in his posterior neck. It is 3x3cm, firm, nontender, freely moveable nodule

• no fever, no icterus and the thyroid gland is normal, the trachea is not deviated and there are no signs of hypothyroidism

• No other noticeable lymphadenopathy , no organomegaly

• no physical complaints other than feeling weak and tired

Reactive hyperplasia

Gross photo of the excised node

Low power of lymph node-- note effacement of architecture

mid power--

High power

Labs

• Hemoglobin: 12.5g/dL,• Hct: 38%, • RBC'S: 4.5 x106uL • MCV: 84 um3 • WBC count: 6.2x 103/uL• Differential: Normal• Platelet count: 186x103/uL• Peripheral smear: normal

TSH: 3 µU/m

• AST: 31 IU/L

• BUN: 18 mg/dL

• ALT: 28 IU/L

• Creatinine: 1.1 mg/dL

• Alkaline Phosphatse: 64 IU/L

• Serum Calcium: 9 mg/dL

• Urinalysis: Sp. Gravity: 1.025, Negative-Sugar, Bile, Protein, Blood Micro-sediment: Occasional WBC's, no casts.

• Immunology:

• VDRL:Non-reactive

• ANA: Negative

• Monospot: Negative

• EB virus ab Positive

Low power view of Nodular Sclerosis HD-- note the broad band offibrosis