Reactive follicular hyperplasia

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Reactive follicular hyperplasia is a benign lymph node change.

General

  • Many causes - including: bacteria, viruses, chemicals, drugs, allergens.
    • In only approximately 10% can definitive cause be identified.[1]

Microscopic

Features:[2]

  • Enlarged follicles, follicle size variation - key feature with:
    • Large germinal centers (pale on H&E).
      • Mitoses common.
      • Variable lymphocyte morphology.
      • Tingible-body macrophage (large, pale cells with junk in the cytoplasm).
      • Germinal centers (GCs) have a crisp/sharp edge.
      • Normal dark/light variation of GCs; superficial aspect light, deeper aspect darker.
    • Rim of small (inactive) lymphocytes.

DDx:

Image: Normal lymph node (umdnj.edu).

IHC

Screening panel:

Others:

  • BCL2 -ve.
    • Germinal centers negative.

Images

 
BCL2 negative immunostaining in the germinal centers of reactive follicular hyperplasia. BCL2 immunostain.

See also

References

  1. Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 174. ISBN 978-0781775960.
  2. Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 179. ISBN 978-0781775960.