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Case Study: January 2016
History
A 65 year old female presents with a tender spot in her temporal area.
Examination confirms the tender spot over the left temportal artery area. There is no history of visual loss or jaw claudication. Temporal arteritis is suspected and a temporal artery biopsy is carried out.
The patient has a history of bowel Non-Hodgkin’s lymphoma.
Questions
1. Describe what is seen in Figs 1, 2 and 3
2. What structure is seen in Fig 4-why is this relevent?
3. What immunohistochemical stain is seen in Fig 5?
4. Predict the immunohistochemical stain used in Fig 6.
5. What is the diagnosis?
Answers
1. Dense lymphocytic infiltrate in soft tissue around artery. Artery not involved.
2. Fig 4 shows perineural infiltration by the lymphocytic infiltrate. This will have caused the temporal pain.
3. This is a CD20
4. Cyclin D1.
5. This is mantle cell lymphoma (recurrent) involving the temporal artery. It is very rare for lymphoma to involve the temporal artery. The patient’s previous diagnosis was mantle cell lymphoma involving the gastrointestinal tract.
References
Masood I, While B, Mudhar HS.Perivascular mantle cell lymphoma affecting a temporal artery-A highly unusual cause of temporal headache. Cardiovasc Pathol. 2011 Jul-Aug;20(4):244-6
