case_images: PMC7352137_01
case_images: (a) PET scan shows increased uptake in the right cervical lymph node (white arrow). (b) Gross picture of the lymph node cross-section showing tan-yellow nodular areas with focal necrosis.
case_images: CRIPA2020-4674103.001.jpg
case_images: PMC7352137_01_CRIPA2020-4674103.001.jpg
case_images: fig1
case_images: The patient's right cervical lymphadenopathy persisted, and a repeat PET/CT scan performed 6 months later revealed increasing standardized uptake value (SUV) from 3 to 5.4 and 18F-fluorodeoxyglucose (FDG) avidity (Figure 1(a)) concerning for residual/refractory disease. The cut surface showed tan-yellow nodular surface (Figure 1(b)).
case_images: H&E staining (a) shows a diffuse cellular infiltrate with areas of necrosis (black arrow). Higher power at 200x (b) shows the infiltrate composed of numerous foamy macrophages with abundant pink cytoplasm, scattered lymphocytes, (c) multinucleated giant cells (red arrows), and (d) cholesterol clefts (dashed arrows).
case_images: CRIPA2020-4674103.002.jpg
case_images: PMC7352137_01_CRIPA2020-4674103.002.jpg
case_images: fig2
case_images: Histologic sections revealed fibroadipose tissue with an intense foamy histiocytic infiltrate with numerous giant cells, cholesterol clefts, hyalinizing necrosis, dystrophic calcification, and scattered small lymphocytes (Figures 2(a)-2(d)), morphologically consistent with xanthogranuloma.
case_images: Immunohistochemical stains reveal scattered CD3-positive T-cells (a), rare CD20-positive B-cells (b), and majority of the cells staining positive for CD68 (c). Pancytokeratin stain is negative (d).
case_images: CRIPA2020-4674103.003.jpg
case_images: PMC7352137_01_CRIPA2020-4674103.003.jpg
case_images: fig3
case_images: CD68 immunohistochemical stain confirmed the morphologic findings and marked the diffuse histiocytic infiltrate (Figures 3(a)-3(d)).