We present a new case of the enlarge left supraclavicular lymph node in a 22-year-old Bosnian girl.  
Six months ago she also got the biopsy of the lymph node. The diagnosis was a reactive lymph node.  
Now, lymph node got a preserved architecture with both primary and secondary follicles and with proliferation and polarization of its marginal zone. Focally, reduction of germ centers is present. Interfollicular areas (red blood cells, eosinophils, erytroblasts, plasma cells) are increased along with proliferation of blood vessels.  
IHQ: CD20(+), CD45RA(+), CD5(+), Bcl-2 (+/-), Kappa(+), Lambda(+), IgM(+), IgD(+) and CD43 (stains T-lymphocytes).  
Question: Is this again only reactive lymph node or malignant alteration is going to occur?  
Thanks in advance for your opinion!

hurwitz 2007-09-05 19:51	I agree with your description. There is indeed marked hyperplasia of the interfollicular areas with vascular proliferation. I cannot see any evidence for a lymphoproliferative process.   Is there any clinical finding to explain these changes, such as a skin affection in the draining area, viral infection or drug reaction ?   What was the site of the previously biopsied lymphnode? Did it show similar findings?
anpo 2007-09-08 23:16	I agree with Nina, there are no signs of any malignant proliferation. It rather looks like a lymph node where there previously was a reactive follicular hyperplasia and now it is in regress.
kremer 2007-09-09 14:23	Yes, no signs of a lymphoma (reactive)
Mueller-Hermelink 2007-09-15 17:12	The overall picture of these follicles reminds me of early Castleman's disease. Is that a focal tumoral lesion?
diane.c.farhi 2007-09-19 18:16	Please allow me to contribute, as a new member of the group. I agree with the other pathologists. The germinal centers are, for the most part, small and compact and show onion-skinning, but without penetrating small vessels. A PAS stain might bring out this feature, if present. The interfollicular area seems to contain transformation of germinal centers in one slide. This seems to me to a reactive lymphoid hyperplasia with features of giant lymph node hyperplasia (Castleman's disease) of the hyaline-variant type. If it is a large, solitary mass, it is more consistent with this diagnosis. Either way (just reactive or GLNH) it is benign and not pre-malignant. Thank you for permitting me to join your group.
SergeyN 2007-09-20 15:46	Castleman should definitely be excluded. There have been data that CD5 is underexpressed in mantle zones in hyaline-vascular variant, it seems to be the case here.     It would be nice to see simple CD20, Ki67 and CD21 to see if the germinal centres are really burnt-out. Clinical presentation, including other sites, HIV status and general symptoms could be helpful.
hurwitz 2007-09-30 16:17	We can conclude this case as reactive lymphadenopathy DD early Castleman
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