Abstract
Non Hodgkin lymphoma with infarction at initial presentation is rare and can be confused with an acute inflammatory process. A 47 year-old-man presented with complaint of swelling in the left parotid region for 2 weeks which increased in size with severe, continuous and throbbing pain in the last 2-3 days. A clinical diagnosis of parotid abscess was made. Incision and drainage did not yield any pus. Fine needle aspiration cytology showed a highly cellular tumor comprising of somewhat uniform round cells with granular nuclear chromatin. Ghost outline of cytoplasm was noted. A diagnosis of infarcted neoplasm of the parotid gland, probably acinic cell carcinoma was suggested. Histopathologically, it was reported as non-Hodgkin lymphoma with infarction which was confirmed by immunohistochemistry. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10319 Journal of Pathology of Nepal (2014) Vol. 4, 591-593
Highlights
Lymph node infarction is associated with concurrent or subsequent malignant lymphoma.[1]
Lymph node infarction refers to a syndrome of spontaneous coagulative necrosis of lymph node that is frequently associated with concurrent or subsequent malignant lymphomas
It is important for the pathologists to be aware of lymphomas presenting initially with pain and swelling due to infarction mimicking clinically an acute inflammatory process
Summary
Lymph node infarction is associated with concurrent or subsequent malignant lymphoma.[1] It may occur following fine needle aspiration biopsy. Fine needle aspiration (FNA) has become an initial diagnostic modality in the evaluation of both non-neoplastic and neoplastic processes involving the lymph nodes.[2] Here, we report a case of non-Hodgkin lymphoma (NHL) with infarction of a large deep seated lymph node in the parotid region clinically masquerading as an abscess. Granular cytoplasm and dark mildly pleomorphic nuclei in Pap stained smears (fig.1a). In air dried Leishman stained smears, the ghost outline of cytoplasm was seen and nuclei appeared finely granular. The mass represented a lymph node almost entirely replaced by an infarcted tumor (fig.2a). A diagnosis of non-Hodgkin lymphoma diffuse, large B cell type was confirmed
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