PATIENT: 60-year-old woman with many concomitant diseases (coronary heart disease, hypertension, hypertensive cardiomyopathy, congestive heart failure, pulmonary hypertension, type 2 diabetes, dyslipidemia).  
 
CLINICAL HISTORY: Three years ago, due to the suspition of cardiac amyloidosis, the patient underwent bone marrow aspiration and trephine biopsy, which showed reactive changes (mixed lymphoid hyperplasia) and normal polyclonal plasma cells. Peripheral blood showed mild leukocytosis (10,54 *109/L, normal range beeing up to 9,8 *109/L) with mild lymphocytosis (4,1 *109/L, normal range beeing up to 4,0). Although immunofixation showed no monoclonal protein, there was a significantly increase in Ig kappa chains (up to 367 mg/L, normal range beeing 6,7-22,4) and mild increase in Ig lambda chains (up to 36,50 mg/L , normal range beeing 8,3-27,0). Also increased was beta2 microglobuline 5,74 mg/L (normal range 0,97-2,64). Abdominal fat aspiration biopsy was negative for amyloid.  
One year ago the patient suffered a stroke.  
Recently the patient experienced weight loss (10 kg per 7 months).  
PET-CT scan shows multiregional lymphadenopathy with low metabolic activity.  
 
CORE NEEDLE BIOPSY OF A RIGHT AXILLA LYMPH NODE (Fig.1-21): primary and secondary lymphoid follicles without FDCs expansion, paracortex with monotonous small-to-medium CD3/CD2/CD5/CD7+, CD4+ >> CD8+ T cells and scattered larger CD30+/EBER(-) cells with conspicuous nucleoli. Increased vascularity and focally open subcapsular sinus. Clonality evaluation by PCR showed clonal IG profile (IGH FR1-3) and no TCR clonality.  
 
THE SUBSEQUENT BONE MARROW TREPHINE BIOPSY (Fig.22-28) showed nonspecific reactive lymphoid hyperplasia.  
 
EXCISIONAL LEFT AXILLARY LYMPH NODE BIOPSY (Fig.29-67): retained architecture with Castleman-like secondary lymphoid follicles with vessels penetrating fibrosed (IgM positive??) germinal centers (”lollipop”) . Increased vascularity of paracortex. Clonality evaluation by PCR revealed (the same as previously seen in another lymph node) clonal IG profile (IGH FR1-3) and no TCR clonality.  
 
PROPOSED DIAGNOSIS:  
- Reactive paracortical hyperplasia? (B clonal??)  
- AITL?  
- Other lymphoproliferative disorder?  
 
Thanks so much for Your valuable insights!!