SPECIMEN:    MEDIASTINAL LYMPH NODE LEFT RIB 7TH
DATE OF SURGERY: 12/20/2001
HISTORY: Tumor, chest wall and rib.

GROSS DESCRIPTION:

#1, "Mediastinal lymph node" consists of a single fragment of tan-white soft tissue, 1 x 1 x 0.5 cm.  Bisected and entirely in A.

#2, "Left seventh rib with tumor" consists of a segment of rib measuring 13 cm in length.  Attached to the rib is a tan-red firm mass measuring 4 x 5 x 2 cm which surrounds the bone.  The deep margin is inked black.  Sectioning of the tumor reveals a variable tan-yellow cut surface with areas of possible necrosis and probable destruction of bone.  Representative portions are decalcified and submitted in B through E with rib margins in F.

MICROSCOPIC:

Sections from the tumor show a proliferation of fibroblasts and inflammatory cells with prominent neutrophils, eosinophils, and plasma cells.  These areas are separated by broad fibrous bands.  Occasional larger cells with mild nuclear atypia are present along with many classic Reed-Sternberg cells.  The rib marrow away from the tumor shows normal cellularity and mixed hematopoiesis.  The mediastinal lymph node shows a fibrotic lymph node with many eosinophils and other mixed inflammatory cells.  There are still some well preserved germinal centers, but other areas show Reed-Sternberg cells and variant Hodgkin's cells.

DIAGNOSIS:

1.    Mediastinal lymph node, excision: Hodgkin's disease, nodular sclerosis type.

2.    Left seventh rib tumor excision: Hodgkin's disease, nodular sclerosis type.