42 yrs old male underwent mesenteric LN biopsy during surgery procedure.  
HISTORY: Clin. dgn.: "Acute mesenterial lymphadenitis". 5 days duration of right ileacal pain and urgent surgery with suspition of acute appendicitis.  
HISTO: Several I follicles, single II follicles, expanded paracortical T area with pleomorphic "immunoblasts" (HL like) in perifollicullar zone are present with background of small lymphos, some eos and scattered plasma cells. Some signs of hemophagocytosis are present too. Some large cells in T cell background.  
IH: Giant cells: CD30+ CD15-CD20/CD3- CD79a+ LCA+/-(?) CyclinD1/p53-(single +?) Bcl6+/- 20% EMA- Mum1+.  
 
WORKING DIAGNOSIS: Immunoblastic lymphadenopathy HL like vs ...  
 
Thank you beeing together.

Mueller-Hermelink 2007-12-19 14:47	I agree with your diagnosis : Reactive hyperplasia, mostly extrafollicular activation of B cells and plasmablasts. The increase of CD30 cells in this condition may be quite astonishing .CD30 + cell are loosely distributed around the follicles and do not show an "adequate" background of HD and RS cells. I have seen some eosinophils which we either interprete as sign of late inflammatory reaction or as hyperergic phenomenon in relationship to the other lymph node changes ,e.g. increase of vessels , activation of T cells etc. In this case I do not see alterations that would suggest a viral etiology.
ugnius 2007-12-19 14:53	Thank you. We are pleased with such urgent comment.
SergeyN 2007-12-19 15:05	I quite agree, it is most compatible with viral lymphadenitis.   Mesenteric lymphadenitis is much more common in adolescents and children, but 42 is not too old, eh? :)   Yersinia seems to be the most common cause, but adenoviruses, EBV and HIV could cause it, too. It would be nice to get a microbiological confirmation.
ugnius 2007-12-19 18:51	Thanx. But I hope, that after "simple appendectomy" the patient is at home and happy:)
tzankov 2007-12-20 08:48	reactive lymph node changes with parafollicular B-cell activation, I have nothing to add to Prof. Müller-Hermelink's comments. there is a nice paper published by him and Thomas Rüdiger some 2-3 years ago in Histopathology on that topic.
ugnius 2007-12-21 15:29	Thanx. Please find beautifull kappa lambda+ RS like cells. And some giant cells (in B cell environment) kappa/lambda-.
hurwitz 2007-12-27 16:27	I agree with Sergey's suggestion that Yersinia enterocolitica, should be considered as the causative agent in the first place, which would also explain the clinical symptoms.
hurwitz 2008-01-06 00:15	Let's conclude this case as:   Reactive lymphoid hyperplasia with prominent B-cell activation and CD30 expression.   Possible etiology: viral ? Yersinia enterocolica?   No evidence of malignancy.   Thanks for this interesting case and the discussion.
	» Add comment (Login)