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Clinical Problem Solving: Pathology
April 2007

Pathology Quiz Case 3

Author Affiliations

Rouen University Hospital, Rouen, France




Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(4):413. doi:10.1001/archotol.133.4.413

A 7½-year-old boy presented with a 2-month history of progressive enlargement of a left cervical lymph node. He also complained of general lethargy. Physical examination showed an enlarged cervical left posterior lymph node with multiple bilateral smaller tender lymph nodes. There were no other enlarged lymph nodes, and no hepatosplenomegaly was observed. His medical history was unremarkable, and the results of the rest of physical examination were normal.

Laboratory evaluation revealed a white blood cell count of 5.2×103/μL, with a granulocyte count of 2.24×103/μL. The erythrocyte sedimentation rate was 11 mm/h. Liver function tests revealed no abnormalities. Serologic tests were negative for infectious disease (ie, mononucleosis, toxoplasmosis, and brucellosis), and the results of a human immunodeficiency virus antibody test were also negative. No significant increase was observed in viral antibody titers (ie, varicella zoster, herpesvirus hominis, and cytomegalovirus). An ultrasound scan revealed enlarged lymph nodes in areas I, II, and III in both the right and the left sides; the largest lymph node (1.0 × 1.5 cm), which had a necrotic center, was observed in area V on the left side. A chest x-ray film showed no abnormalities. The patient then underwent excision biopsy of a lymph node from the left posterior triangle, and the specimen was sent for histologic examination.

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