Case 5
May 27, 2015
Case 5
• 15yrs boy treated for ALL 6yrs back.
• Regular follow-up
• B/L submandibular cervical lymphadenopathy 2x3cm.
• FNA of the lymphnode done.
List of Differentials
• Reactive lymphoid hyperplasia• Hemophagocytic lymphohisticytosis• Recurrent ALL• Secondary neoplasm : DLBCL• NHL
Reactive lymphoid hyperplasia
? Significant lymphadenopathy
? Clinical history Clinically : 2-3cm LN, soft to firm patient in remission PS : normal LDH : normal Toxoplasma : negative
Clinicians decided to do whole node biopsy to rule out relapse
IHC : to exclude focal involvement Tdt : Negative
Correlating clinical, serological and pathological findings
FINAL DIAGNOSIS
Progressive Transformation of Germinal Centre
Progressive Transformation of Germinal Centre
• Benign reaction pattern in lymph nodes• Florid or focal• 3.5% of non specific lymphadenitis• Pathogenesis premature arrest at an early
transition between primary and secondary follicles because of incomplete blastic transformation of B cells.
Progressive Transformation of Germinal Centre
Non hodgkins• Malignant lymphoma Hodgkins : NLPHL• Reactive lymphadenitis• Immunocompromised• IgG4 related lymphadenopathy
Thank you….