A 14 yo male with h/o congenital heart disease s/p surgical repairment presented with cough, fevers and lymphadenopathy. Chest CT showed multiple enlarged noncalcified mediastinal lymph nodes with the largest one measuring 5 cm AP x 2 cm LR x 5.5 cm SI. A excisional biopsy of the right cervical lymph node was performed.
Nodal architecture completely effaced by diffuse lymphoid lesion composed of large atypical cells in the mixed inflammatory background composed of histiocytes, lymphocytes and granulocytes.