Clinical Implication of Florid Reactive Follicular Hyperplasia in Japanese Patients 60 Years or Older: A Study of 46 Cases
Dokkyo University, Edo, Tōkyō, JapanInternational Journal of Surgical Pathology (Impact Factor: 0.95). 05/2005; 13(2):175-80. DOI: 10.1177/106689690501300208
Florid reactive follicular hyperplasia (FRFH) of the enlarged lymph node in middle-aged or elderly patients requiring biopsy is a relatively uncommon phenomenon as compared with that in younger age groups. Between 1984 and January 2004, we encountered 46 patients, aged 60 years or older, in whom histology of biopsied lymph node specimens showed inappropriate FRFH for the patient's age. An apparent cause of lymphadenopathy was initially identified in 17 cases (37%): 11 with autoimmune disease and related disorders, 3 with cancer-reactive lymphadenopathy, 2 with Epstein-Barr virus-associated lymph node lesion exhibiting transient autoimmune-disease-like clinical findings, and 1 with atypical mycobacterial infection. Among 29 patients without specific etiology, 16 patients (55%) exhibited histologic findings of progressive transformed germinal center (PTGC). Only 1 of our patients developed malignant lymphoma during the follow-up period. The present study indicates that PTGC is included in the etiology of FRFH in elderly Japanese patients as well as imbalance of the immune system such as autoimmune-disease-associated lymphadenopathy and idiopathic plasmacytic lymphadenopathy with polyclonal hyperimmunoglobulinemia. By in situ hybridization, Epstein-Barr virus genomes were demonstrated in only 6 (15%) of 39 cases examined.
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ABSTRACT: Among systemic rheumatic diseases (SRDs), lymphadenopathy is frequently found in patients with rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPDs) may occur in patients following methotrexate therapy for RA and dermatomyositis (DM). However, little is known about the distribution of EBV in reactive LPDs in patients with SRDs who had no history of methotrexate therapy. We analyzed 49 such patients (SLE=25, RA=23, DM=1) for the presence and distribution of EBV+ cells using Epstein-Barr virus (EBV)-encoded small RNA (EBER) specific in situ hybridization. A positive signal for EBERs was identified in 9 (SLE=5, RA=4) (18%) of 49 cases, and 3 main distribution patterns of EBER+cells could be delineated: pattern A, more than 500 EBER-positive cells were located in the germinal centers as well as interfollicular area (SLE=2); pattern B, EBER + cells were located in a few germinal centers (RA=2); and pattern C, up to 100 EBER+ cells were located in the interfollicular area (SLE=3, RA=2). Recent EBV infection may be a cause of lymph node lesion in only 2 cases of patients with pattern A. However, the pathognomonic significance of pattern B and pattern C EBER + cell distribution patterns still remains unclear. Our study indicates that the underlying immune deficits of patients with SRDs may also play an important role in the development of EBV-associated LPDs in SRDs, as previously suggested by several authors.
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ABSTRACT: The distinction between reactive and neoplastic lymphoid infiltrates is a common problem in clinical practice and can be problematic. The clinical implications for both the patient and the treating clinician are profound. In this article, we discuss six of the common entities that can present as atypical lymphoid hyperplasia and thus can mimic malignant lymphomas, with emphasis on morphologic features, immunophenotypic findings, and molecular correlates that help distinguish these disorders from neoplastic conditions. The six conditions to be discussed in detail include reactive follicular hyperplasia versus follicular lymphoma; progressive transformation of germinal centers versus nodular lymphocyte predominant Hodgkin lymphoma; immunoblastic proliferations versus diffuse large B-cell lymphomas; variant forms of Castleman disease that may mimic a number of lymphoid cancers; Kikuchi's disease versus large cell lymphomas; and finally, dermatopathic lymphadenopathy and its distinction from lymph nodes showing early involvement by cutaneous T-cell lymphoma (Mycosis fungoides).
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