Permanent pathology and flow cytometry immunophenotyping analysis identified the tumor as a high-grade B-cell lymphoma with Burkitt morphology composed of intermediate-size malignant cells in a diffuse pattern with numerous tingible bodies creating a "starry sky" appearance (figure 2).
It is characterized histologically by a diffuse proliferation of intermediate-size neoplastic cells, a high mitotic rate, and numerous large macrophages with clear cytoplasm and phagocytized cellular debris (tingible bodies).
However, in histology sections the kinetoplasts are not visible, and the organisms can be easily mistaken for tingible bodies
, fungal elements, toxoplasmosis, histoplasmosis, or artifacts.
The number of histiocytes containing tingible bodies
was felt not to be a reliable feature for distinguishing reactive from neoplastic follicular proliferations in both adults and children.