53yrs old woman. During the operation due to renal tumor the lymph node (pericholedochal) biopsy was performed. HISTO/IH: Some epitheliod histyocytes are clustering in expanded paracortex. The primary follicles and single solitary secondary follicles with some expansion of Bcl 2+ IgD+ mantle zone with compressed germinal centers. The strange paranoic feeling persists: that Bcl2 lympho's show some follicultropism. There are some "follicles" (similar to I follicles) inserted in paracortical zone (photo "clear zone"). There is more prominent population of CD20+CD23+ cells in mantle zones and in paracortical area. Single IgM perifollicular plasmacytes are present. The architecture is still intact, so- PROPROSED DIAGNOSIS: Reactive changes with reaction of epithelioid histyocytes (nonspecific)? Thank you for patience.

aorazi 2006-04-13 12:55	Agree: reactive lymphoid hyperplasia. The follicles shows a pleomorphic pattern with a Castleman-like picture (hyperplastic mantles and small "compressed" germinal centers -- see fig. 1)in a proportion of them. The paracortical/interfollical areas shows prominent "mottling" due to an increased number of macrophages with evidence of phagocytosis, which is also consistent with a reactive lymphoid hyperplasia.     These findings are not uncommonly seen in cases characterized by chronic immune response -- such as in patients with malignancy or autoimmune conditions.
ugnius 2006-04-13 18:19	Thank you, dr.Orazi.
ugnius 2006-04-13 18:29	A lot of appologies- I forgot to append the photo's of REAL epitheliod histyocytes:)
hurwitz 2006-04-23 18:15	I agree with Attilio comments. as Attilio said, clusters of epithelioid histiocytes can be seen in chronic immune responses and in regional lymphnodes draining areas with malignant tumors.
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