STORY: 71 yrs old female with right sided lateral lymphadenopathy (4x6x7 cm confluent immobile nodes for 1 year). CRB elevated. Slight monocytosis is present.
CLIN DIAGNOSIS: "Lymphoma?".
HISTO: Confluent hypercellular and pleomorphic"epithelioid" granulomas with acellular necrosis ("caseating") with TBC like appearance.
IH: A lot of Langerhans cells within granulomas: CD1a+; CD68+; S100+ with admixture of histiocytes, multinucleated cells...
PROPOSED DIAGNOSIS: TBC granulomatous lymphadenitis (enriched LC) vs Langerhans cell histiocytosis: "granulomatous, TBC like pattern".
PROBLEMATIC ASPECTS: 1. The absense of Eos? 2. The theorethical possibility of association with other LPL (not present there?)?