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Mesenteric Lymph Node (385137)
Mesenteric Lymph Nodenew
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munafdesai 		2011-09-26 16:59
INCTR - EBMWG Hematopathology Online
M/17 months, septicemia, WBC count 2500/cumm, HB 9.9 gm%, platelet 110,000/cumm, clinical/hematologic findings are suspicious of hempphagocytic syndrome,  
 
Acute abdomen, rt hemicolectomy done, sent for HPE. Images from mesenteric lymph nodes are submitted.  Ileum and colon  showed acute nonspecific necroinflammatory process
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tzankov
2011-09-28 10:41
What I see is a reactive lymph node with a paracortical expansion with immunoblasts and cells with nuclear inclusions (LN-04). In the PAS stain there are some histiocytoid cells with morule-like inclusions too. I susupect viral infection. In order to narrow the differential I would suggest performing immunosstaining at least for CMV and EBV and ask for the serology.
munafdesai
2011-09-28 15:43
I have added two more images showing erythrophagocytosis (LN30 - LN31).
tzankov
2011-09-28 17:38
nice, the hemophagocytosis strenghtens the assumption of a viral etiology. EBV should be tested by EBER. clinically ALPS and familial hemophagocytosis (I admit that the histology is rather not suggestive of the latter) should be excluded as well as familial anamnesis should be carefully analyzed.
Last modified: 2011-09-28 15:40:06