Cytologically Yours: CoW: 20140206

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Clinical Summary

The patient is a 12 year old female with a six month history of left shoulder pain. The patient had tried Aleve and had several chiropractic visits which were unsuccessful at relieving the pain.

Past Medical History

  • Previously heathy

Past Surgical History

  • No surgical history


  • AP/Lateral images show a destructive and aggressive appearing lesion in the left proximal huerus in the metaphysis extending 7.5cm distally in the diaphysis.

Clinical Plan

The differential diagnosis included osteosarcoma and Ewing sarcoma. MRI and CT guided biopsy are scheduled.



Resident Questions

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Final Diagnosis


  • Positive for malignancy, the differential diagnosis includes melanoma and Hodgkin lymphoma.


Biopsy Diagnosis

  • Classical Hodgkin lymphoma, favor mixed type.
    • CD15 Positive in tumor cells
    • CD30 Positive in tumor cells
    • PAX5 Weakly positive
    • CD20 Positive in background lymphocytes
    • CD3 Positive in background lymphocytes
    • S100 Negative
    • Mart1 Negative
    • HMB45 Negative


The features of Hodgkin lymphoma include atypical (Hodgkin cells) and Reed-Sternberg cells. The nucleus should be 3-4x the size of a small lymphocyte. In classic Hodgkin lymphoma, scattered eosinophils, plasma cells, histiocytes, and a predominately CD3+ lymphocyte population will be seen in the background. The immunophenotype of classic Hodgkin lymphoma shows CD15, CD30, MUM1, and weak PAX5 positivity. Histology is usually needed to subtype Hodgkin lymphoma.