Case 3--Histologic Changes

A piece of tissue, 8 x 5.5 x 2.5 cm, had multiple, firm, white nodules, up to 0.8 cm in diameter. A level 6 lymph node was also received.

A representative nodule contains homogeneous, pink material, which involves vessel walls (arrow). There is a moderate interstitial infiltrate of lymphoid cells, some in aggregates. The lymphoid infiltrate also spreads into adjacent alveolar walls. Note that there has been some destruction of alveolar walls next to the nodule.

At higher power, a vessel wall has been destroyed by pink material abutted by two multinucleated giant cells (arrow). Looser, cellular intimal proliferation has narrowed the vessel lumen and also occupies the area at the lower right.

In the loose connective tissue were typical lymphocytes and plasma cells (upper left). A multinucleated giant cell lies next to some extracellular pink material at the lower right. What special stain would help to make a diagnosis? Answer

The submitted lymph node was normal.

Clinical summary Case 3 continued

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Answer: A Congo red stain was performed, but it was negative. Another stain for amyloid--the crystal violet stain--was also negative. Nevertheless, you are convinced that this material resembles the amyloid seen in the previous two cases. For further tests, see the next page.

Clinical summary Case 3 continued

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