50yrs old male with veryfied hairy cell leukaemia (DBA44+CD20+ CD5/CD23/Cyclin(-) infiltration in BM 90%). Suprclavicular lymph node was biopsied.  
HISTO/DIAGNOSIS: Architecture diffuselly obscured. Necrotic lymphadenitis with leucocytoclasia. Lymphoplasmacytic and eosinophilic capsular infiltration. Some epithelioid macrophages in clusters. some perinecrotic histyocytic reaction (granuloma like). some necrotic areas "sinus like", Grocott, Ziehl Neelsen, PAS stains are negative.  
IH: Ki67 high; Ig kappa/lambda~ 2/1; EBV ratio 2/1; LMP1+ CMV+ elements are absent; T zones are predominant; CD68/MPO+ crescentic histiocytes are absent; CD4/CD. CD138+ plsmacytes, esp. in pericapsular/perisinusoidal location. HCL (DBA44) (-).  
 
QUESTION: Origin of this necrotic lymphadenitis (virus? oth.?).  
Thank you for participation.

Mueller-Hermelink 2007-10-24 17:19	This is very difficult and the information is still incomplete . How is the distribution of T cells ( CD4 vs. CD8)Are they proliferating or is it predominantly a proliferation of plasma cell precursors. Is it a vascular pattern or subtotal necrosis ina post -inflammatory lymph node with scarring of the capsule ? And than , the question of hairy cell leukemia : Is there infiltration or not ( CD 44 ?) Could it be a hyperimmunisatory reaction after Gamma -Interferon treatment .Iam sorry,I cannot give more help It looks ,however, more reactive than neoplastic)
ugnius 2007-10-24 18:18	Thank you a lot. DBA44 is complettelly negative. CD4/CD8 was not done due to "reactive" pattern. I will proceed with add IH stains.
Went 2007-10-25 08:53	without wanting to give doubts on the diagnosis of hcl, i just would like to remember that hcl usually is cyclin D1+ and can be TRAP-; still, we know that the morphology is usually very characteristic, therefore the dx should not be difficult. concerning the shown lesion, i also would like to see more immunostainings of this interesting case.
kunze 2007-10-25 21:38	With regard to the clinical history a drug induced hyperimmune lymphadenopathy seems to me most likely.
ugnius 2007-10-26 08:44	NOTE: Interferon was not administered in biopsy time.
ugnius 2007-10-26 17:07	Some new data appended. CMV and histoch stains for microorganisms are negative.
ugnius 2007-10-26 17:08	CD4/CD8~2/1. CMV/EBV LMP1(-). PAS/Grocott/Ziehl Neelsen(-).
Mueller-Hermelink 2007-10-28 11:15	Looking at these new immunostains it seems to me clearly a reactive , hyperimmunisatory reaction . The distibution of necrotic areas suggests vascular or ischemic reasons, which might be caused by this enormous perinodal fibrosis.Local reactions to any drugs or infectious agents should be excluded.
ugnius 2007-10-28 11:22	Thank you for continuous support and help.
hurwitz 2007-12-14 17:27	I will just do the formal job to conclude the case. Please regard Prof.Müller-Hermelinks last comment, as the final diagnosis.   Thanks for submitting this very interesting case.
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