History and physical examination:

1. The patient is a 24-year-old woman presenting with shortness of breath (of uncertain duration). She reports episodes of chills but denies fevers, night sweats, and weight loss.
2. Physical exam is unremarkable.
3. Past medical history is remarkable for an episode of thrombocytopenia in the setting of sepsis.

Radiographic studies:

1. Chest CT demonstrates an anterior mediastinal mass measuring 9.2 x 6.8 x 5.7 cm.
2. Additional abdomen and pelvis CT was negative for lymphadenopathy or organomegaly.

CBC data:

CBC value	Normal range
WBC: 5.8x103/microliter	4.3-10
RBC: 3.89x 106/microliter	3.80- 5.00
hemoglobin: 11.9 g/dL	11.5-15.5
hematocrit: 34%	36-45
MCV: 88 fL	81-98
MCH: 30.6 pg	27.3-33.6
MCHC: 34.7 g/dL	32.2-36.5
platelet count: 279x103/microliter	150-400

 

 

 

 

 

 

 

Peripheral blood differential:

Cell type	% from WBC	Absolute number (103/microliter)	Reference range (Absolute #)
Neutrophils	69	4.06	1.80-7.00
Lymphocytes	17	1.00	1.00-4.80
Monocytes	10	0.59	0.00-0.80
Eosinophils	3	0.18	0.00-0.50
Basophils	1	0.06	0.00-0.20
Immature granulocytes	0	0	0.00-0.05

 

 

 

 

 

 

Work-up and evaluation:

1. The anterior mediastinal mass is biopsied.
2. Flow cytometric immunophenotyping was performed on this sample.  An additional tube is added after reviewing the initial data.

Flow cytometry tubes:
Data acquisition was performed on a modified LSRII flow cytometer. 
Data analysis was performed using Woodlist software (in-house software written by Brent L Wood)
Standard immunophenotyping tubes for lymphoma (B and T cell tubes).  After
Evaluation of the T cells, a tube for classical Hodgkin lymphoma (CHL) was run.

Tube	Pac B	FITC	PE	ECD	PE-Cy5.5	PE-Cy7	A594	APC	APC-A700	APC-H7
B cell	CD20*	Κ	λ	-	CD5	CD19	CD38	CD10	-	CD45
T cell	CD8^	CD2	CD5	CD34	CD56#	CD3	CD4	CD7	CD30	CD45
Hodgkin	CD95	CD64	CD30	CD5	CD40	CD20	-	CD15	CD71	CD45

 

 

 

*CD20 run using V450; ^CD8 run using BV; #CD56 run using PeCy5

 

VIEW CASE (PPT)

Jonathan Fromm, MD, PhD
University of Washington
Seattle, WA USA