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Virtual case of the month
Unusual pleomorphic cells in axillary lymph node
  1. Maria Lentini,
  2. Roberta Cardia
  1. Department of Human Pathology of adult and developmental age, School of Medicine, University of Messina, Messina, Italy
  1. Correspondence to Dr Maria Lentini, Department of Human Pathology of adult and developmental age, University Hospital "G. Martino", Pathology Unit, Messina 98125, Italy; lentini{at}unime.it

https://doi.org/10.1136/jclinpath-2020-206782

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    Clinical question

    A man in his 60s with a history of superficial gastric cancer and stage IIIB intestinal adenocarcinoma since 2 years, untreated due to systemic symptoms of myelofibrosis, on follow-up CT scan showed left pleural effusion and axillary adenopathy. Clinical diagnosis was gastrointestinal cancer metastasis versus lymphoma. Pleural fluid cytologic smears were negative for malignancy. Excisional biopsy of an axillary lymph node was performed.

    What is your diagnosis?

    1. Gastric or intestinal cancer metastasis.

    2. Lymph node granulomatous disease.

    3. Hodgkin’s lymphoma.

    4. Nodal extramedullary haematopoiesis (EMH).

    5. Lung cancer metastasis.

    Discussion

    EMH is the production of erythroid and myeloid progenitor cells outside of the bone marrow.1 It can occasionally occur in lymph nodes, frequently associated with underlying haematopoietic disorders or neoplasms.1 2 In very rare cases, it has been reported in patients treated with granulocyte colony-stimulation factor (G-CSF) during chemotherapy and radiotherapy for breast cancer and also in late-stage tumours. …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Contributors All the authors contribute to the conception of the work, the immunohistochemical analysis and its interpretation, the acquisition of the pictures, and the drafting the work.

    • 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.

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