case_images: PMC2913787_01
case_images: MRI of the neck showing an enlarged lymph node (long arrow) and a bulge in the right tonsillar fossa (short arrow) suspicious for primary tumour.
case_images: IJOL2010-302656.001.jpg
case_images: PMC2913787_01_IJOL2010-302656.001.jpg
case_images: fig1
case_images: Due to a possible vascular relation to the mass, an MRI of the neck was done, showing a sharply defined ovoid 3 x 3 x 4.5 cm nonspecific soft tissue mass with heterogeneous enhancement, likely a lymph node, with a mass-like bulge in the right tonsillar fossa suspicious for a primary tumour (Figure 1).
case_images: Lymph node with diffuse infiltrate of plasma cells including atypical binucleated and multinucleated forms (black arrows) (H & E stain, x40).
case_images: IJOL2010-302656.002.jpg
case_images: PMC2913787_01_IJOL2010-302656.002.jpg
case_images: fig2
case_images: Binucleate and multinucleate forms were also present (Figure 2).
case_images: Tonsillar tissue with intact surface squamous epithelium (arrow) and underlying diffuse infiltrate of neoplastic plasma cells (H & E stain, x10).
case_images: IJOL2010-302656.003.jpg
case_images: PMC2913787_01_IJOL2010-302656.003.jpg
case_images: fig3
case_images: The tonsillar lesion was fairly circumscribed and the epithelium was not infiltrated (Figure 3).
case_images: CD138 immunostain was positive, confirming plasma cells (x40).
case_images: IJOL2010-302656.004.jpg
case_images: PMC2913787_01_IJOL2010-302656.004.jpg
case_images: fig4
case_images: Further immunohistochemical analysis on the specimens showed CD138 plasma cell marker positivity (Figure 4), while CD20 and CD3 were negative, with kappa light chain restriction.