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Benign Lymph Node Lesions
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Several diseases manifest a follicular hyperplasia in lymph nodes that causes changes which are suggestive of the disorders. These disorders include toxoplasmic lymphadenopathy, rheumatoid lymphadenopathy, luetic adenopathy, AIDS-associated adenopathy, measles, and Castleman’s disease.
Immunopathology of Myasthenia Gravis
Published in Marc H. De Baets, Hans J.G.H. Oosterhuis, Myasthenia Gravis, 2019
Follicular hyperplasia is characterized by lymphoid follicles in the thymic medullary area. These follicles “blow up” the medulla so that the medulla/cortex ratio, which normally is 1:2 to 1:1, increases up to 4:1. In fact these lymphoid follicles are not situated in the medullary parenchyma but in the perivascular spaces in the medulla and at the cortico-medullary junction232 and it is the expansion of this compartment that gives the thymus a hyperplastic aspect (Figure 9a and 9b). Also in a nonneoplastic and nonhyperplastic thymus of MG patients (even in those seronegative for anti-AChR) abnormalities can be found, as there are “lymph node-type T cell areas”232 with deposits of fibronectin,220,221 diffuse B cell infiltration in the medulla,215,222 enlarged perivascular space222 with high endothelial venules223 and abnormal dispersion of dendritic cells.222,224 So apparently a common abnormality, regardless of follicular hyperplasia, underlies the thymus in MG. The microenvironment in the MG-thymus is schematically represented in Figure 10.
Pharyngitis
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The differential diagnosis is usually from other glandular fever-type syndromes. A dye test for the serological diagnosis of toxoplasmosis was described in 1948. This test, in modified form, remains the gold standard although for diagnostic purposes it is restricted on grounds of cost to reference laboratories. Several tests for specific antibody classes have been developed and used for diagnostic as well as epidemiological purposes. Lymph node biopsy, which reveals follicular hyperplasia and typical epithelioid cells, is sometimes carried out to confirm the diagnosis.
Paediatric-type follicular lymphoma arising in conjunction with pregnancy
Published in Acta Oncologica, 2021
Stefano Fratoni, Pasquale Niscola
The case of PTNFL was observed by us in a young female. This particularly rare lymphoma typically presents with isolated lymphadenopathy in the head and neck. Despite the ‘blastoid’ features on histological examination, PTNFL has an extremely indolent clinical behaviour, being surgical excision alone virtually curative [5–6]. Nonetheless, exceptional cases of transformation in high-grade B-cell lymphoma may occur [7]. The differential diagnosis of PTNFL may be quite troublesome. The recognition of this particularly rare lymphoma is important for hematopathologist, given that overlap with florid reactive follicular hyperplasia (RFH) may be a practical problem. Reliable criteria for its diagnosis have been previously illustrated [8]. In this setting the immunohistochemical expression of forehead box protein P1 FOXP-1 may be a useful tool to distinguish PTNFL from RFH [9]. Nonetheless, establish clonality by B-cell receptor studies is mandatory in the diagnostic work up. On the other hand, purely follicular large B-cell lymphoma with IRF4 rearrangement may mimic PTNFL. The strong nuclear expression of IRF4/MUM1 along with rearrangement of IRF4 with an IGH locus, usually allows the distinction between the two [10].
Clinical and biochemical characteristics of patients having general symptoms with increased serum IgG4
Published in Modern Rheumatology, 2020
Kou Hasegawa, Yoshihisa Hanayama, Mikako Obika, Tomoko Miyoshi, Hiroko Ogawa, Eisei Kondo, Hitomi Kataoka, Yasuharu Sato, Fumio Otsuka
In the present study, four of the 11 cases of lymph node biopsy satisfied the consensus statement on the pathology of IgG4-RD in addition to items (1) and (2) of the comprehensive diagnostic criteria 2011. As for the pathology for diagnosing IgG4-related lymphadenopathy [15,16], distinguishing hyper IL-6 syndromes such as multicentric Castleman’s disease (MCD) and rheumatic diseases is critical. Given that the pathological findings of MCD and IgG4-related lymphadenopathy are similar, a diagnosis solely based on the pathology is often difficult [15,16]. Therefore, a comprehensive diagnosis based on clinical, serological or radiological evidence is necessary [5]. In this study, no fibrotic changes were detected in four biopsied cases of lymph nodes, while histological type II (reactive follicular hyperplasia-like) and type III (interfollicular expansion and immunoblastosis) were observed in two cases each [16]. According to the consensus statement on the pathology of IgG4-related lymphadenopathy, we diagnosed these cases by a comprehensive approach.
Infectious mononucleosis-related tonsillar hyperplasia mimicking T-cell lymphoma on histopathology: A rare case and review
Published in Acta Oto-Laryngologica Case Reports, 2020
Usman Asad, Irfan Warraich, Winslo Idicula
Histopathologic examination of the tonsils showed mildly distorted architecture but complete effacement of the tonsillar architecture was not seen. Findings were consistent with follicular hyperplasia and an expanded interfollicular area (Figure 2(C,E)). Atypical large cells were seen in the expanded interfollicular area. The majority of these cells stained positive for CD3 (Figure 2(C)) with only scattered CD20 cells, raising concern for T-cell lymphoma. CD20, which normally stains for B-cells, did not show many positively staining cells, further suggesting the possibility of a T-cell-related malignancy (Figure 2(D)). These findings alarmed the general pathologist and he informed the otolaryngologist of his concern and a forwarded the case to a hematopathologist. The hematopathologist ordered additional immunostaining markers to further assess these concerns and cautioned the clinician against rushing to a diagnosis of T-cell lymphoma. The hematopathologist conducted additional immunostaining with PAX-5, a more sensitive and specific B-cell marker. It highlighted a significantly larger number of B-cells in the follicles and the interfollicular area. Figure 2(E) exhibits a polymorphous infiltrate of lymphoid cells, including small lymphocytes, intermediate-sized lymphoid cells, and immunoblasts.