Case 70

A 53-year-old woman presented with a bulky neck mass. She had a history of night sweats, but denied fever and weight loss. Physical examination revealed left cervical lymphadenopathy, measuring about 3 × 5 cm. The spleen tip was palpable but the liver was not enlarged. Laboratory studies were unremarkable except for an elevated erythrocyte sedimentation rate (ESR) of 50 mm/h, but the lactate dehydrogenase was within normal limits (145 U/l). CT scan showed a cluster of matted lymph nodes at the base of the left neck, and slightly enlarged left axillary lymph node. No lymphadenopathy was identified in the mediastinum and abdomen. Mild hepatosplenomegaly was demonstrated by abdominal CT scan. A biopsy was performed on the left cervical lymph node, which showed diagnostic lesions (Figs. 70.1 and 70.2). A subsequent bone marrow biopsy revealed no pathological findings.