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Clinical Problem Solving: Pathology
April 2006

Pathology Quiz Case

Author Affiliations

Vanderbilt Medical Center, Nashville, Tenn



Arch Otolaryngol Head Neck Surg. 2006;132(4):455. doi:10.1001/archotol.132.4.455

A 25-year-old Nigerian man presented with painless neck nodules that had been present for as long as he could remember, at least as far back as early childhood. He reported that the nodules had been stable in size for the past decade. He had no other significant personal or family medical history and no ear pain, weight loss, night sweats, fever, difficulty in breathing, signs of infection, or other systemic symptoms.

Physical examination revealed bilateral cervical lymphadenopathy with multiple mobile 5- to 6-cm lymph nodes (Figure 1). There were no cranial nerve deficits. Fine-needle aspiration demonstrated large histiocytes with distinct cell membranes containing an abundance of cytoplasm (Figure 2). The histiocytes also contained intact lymphocytes and plasma cells (Figure 2). Histologic examination revealed sheets of lymphocytes in the lymph nodes (Figure 3). The results of S100 protein staining were positive (Figure 4), and those of a screening test for human immunodeficiency virus were negative.