Macroscopic Evaluation: material fixed in formalin – 2 pieces of material of size 4´1.5´2 cm and 2´1´1 cm. The areas of necrosis and hemorrhage were revealed at section.

Histological Evaluation:  localization of pathologic process in T-zone is observed: proliferation of post-capillary venules (PAS+), diffuse infiltration by lymphoid cells with minimal cytologic atypia, large amounts of eosinophiles, histiocytes (CD68+) are revealed. The quantity of dendrite follicular cells (CNA42+) is increased especially around of blood vessels. Immune phenotype of atypical lymphocytes is: CD3(+), CD43(+), CD30(-), EMA(-). In some areas B-zones (CD20+) in appearance of regressive follicles are preserved. Necrosis of big area surrounded with macrophages (CD68+) and granulomatous inflammation with giant cells here and there are revealed. Infiltrate is spread in capsular and pericapsular tissue.

Conclusion: Angioimmunoblastic T-lymphoma with accompanied granulomatous inflammation.

Remark: Disease is known as angioimmunoblastic lymphadenopathy (Lukes-Collins classification) and lymphogranulomatosis X (Kiel classification). In accordance with REAL classification disease is considered as the sub-type of peripheral T-lymphoma, which is taking out as separate category – angioimmunoblastic T-lymphoma.

Clinical findings: At the beginning stage low temperature (37-37.4°C) and increasing of peripheral lymph nodes in every projection area and skin rash of maculopapular appearance were observed. Eosinophilia (70%) was revealed in peripheral blood. As a result of cytological, histological and immunomorphological investigations angioimmunolastic T-lymphoma, IV stage (high level of malignancy) was diagnosed. Patient complaints upon pain in bones, abdomen area and perspire.

Comments:  Please, write Your opinion and the suggestions about the further treatment strategy of this case to Eka Kldiashvili, Ph.D. kldiashvili@georgia.telepathology.org, Georgian Telemedicine Union (Association), Tbilisi, Georgia.