Pathology Quiz Case 1

Abstract

A 15-YEAR-OLDBOYPRESENTEDWITHA1-MONTH history of hoarseness, shortness of breath with exertion, and a globus sensation. He denied any dysphagia, odynophagia, or localized pain. He was otherwise healthy and had no family history of childhood cancers or anemia. Fiberoptic laryngoscopyrevealeda2-cm,nonulcerated, submucosalsoft-tissuemassepicenteredintheanterior left false vocal fold (Figure 1). The results of the physical examination were otherwise unremarkable, with no palpable lymphadenopathy.Combinedpositronemission tomographyandcomputedtomographyrevealeda2.2 1.6-cmsofttissuemass in the left supraglottic larynxthatpartiallyobliterated the left piriform sinus (Figure 2). The mass had a maximal standard uptake variable of 14.2. The patient was taken to the operating room for direct laryngoscopyandabiopsy.Microscopicexaminationshowed sheetsofmonotonous,discohesivemedium-sizedcellswith highnuclear tocytoplasmicratios,vesicularchromatin,and prominent nucleoli in the submucosa. Frequent apoptotic debris, tingiblebodymacrophages,andmitotic figureswere present (Figure3). Immunostains were diffusely positive for CD20 (Figure 4), CD10, and CD45 and weakly positive forBCL-2 .Thetumorcellswerenegative forCD3,TdT, and CD34. A Ki-67 study showed a proliferative index of approximately80%.Fluorescenceinsituhybridization(FISH) showednorearrangements involving c-myc, bcl-2, or bcl-6. What is your diagnosis?