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Abstract Background Subcutaneous vaccination or desensitization may induce persistent nodules at the injection sites. Without the knowledge of prior injection, histopathological work‐up may be challenging. Objective Aim of this study was to contribute to the histopathological work‐up of unclear subcutaneous nodules, especially their differentiation from cutaneous lymphoma. Methods We retrospectively reviewed clinical data and histopathological slides of four patients with subcutaneous nodules, which were suspected to suffer from cutaneous T‐ or B‐cell lymphoma. Sections of these cases and 12 negative controls were stained with hematoxylin and eosin and a standardized immunohistochemical panel of B‐ and T‐cell markers including EBER in situ hybridization as well as electron microscopy. Results In all cases, large histiocytes with granular cytoplasm compatible with intracellular aluminum hydroxide were present. EBER in situ hybridization revealed positive staining of these granular histiocytes while staining was absent in negative controls. Limitations Post hoc completion of medical history revealed that vaccination or specific immunotherapy had been applied before at the biopsy site in only three out of four patients; one patient was lost to follow‐up. Conclusion EBER in situ hybridization is an adjunctive tool to differentiate aluminum‐induced granuloma/lymphoid hyperplasia from other forms of pseudolymphoma and cutaneous B‐ or T‐cell lymphomas.Keywords:
Lymphoid hyperplasia
Pseudolymphoma
Follicular hyperplasia
Cutaneous lymphoma
Follicular lymphoid hyperplasia is a rare reactive benign lesion of the oral mucosa. This is also known as pseudolymphoma as the features mimic the malignant counterpart Follicular lymphoma. In present case, a 34 year old male patient came with a nodular swelling in the posterior-lateral left side of tongue. Medical or dental history was non contributory. Swelling was painless, well demarcated, and about peanut sized. The swelling was provisionally diagnosed as either neurilemmoma, mucocele, or traumatic fibroma. Complete excision was performed, and tissue was sent to a private laboratory. Histopathological findings seen were germinal centers having a core of monotonous cells of the same size and demarcated mantle area mimicking the lymphoma. Immunophenotyping revealed diffused positivity for kappa and lambda expressions. CD10 was diffusely positive in germinal centers and BCl 2 was positive in the mantle area while negative in germinal centers. The final diagnosis given was follicular lymphoid hyperplasia. The entity mentioned in the present paper is an unusual variant of the benign lymphoproliferative lesion and very few cases are reported in the tongue area. Thus, it is important to understand the nature of this benign lesion in all aspects to avoid diagnostic dilemmas due to its malignant mirroring characteristics.
Pseudolymphoma
Lymphoid hyperplasia
Follicular hyperplasia
Follicular lymphoma
Immunophenotyping
Mantle zone
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Pseudolymphoma
Cutaneous lymphoma
Lymphoid hyperplasia
Folliculitis
Gene rearrangement
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Citations (98)
Abstract Background Subcutaneous vaccination or desensitization may induce persistent nodules at the injection sites. Without the knowledge of prior injection, histopathological work‐up may be challenging. Objective Aim of this study was to contribute to the histopathological work‐up of unclear subcutaneous nodules, especially their differentiation from cutaneous lymphoma. Methods We retrospectively reviewed clinical data and histopathological slides of four patients with subcutaneous nodules, which were suspected to suffer from cutaneous T‐ or B‐cell lymphoma. Sections of these cases and 12 negative controls were stained with hematoxylin and eosin and a standardized immunohistochemical panel of B‐ and T‐cell markers including EBER in situ hybridization as well as electron microscopy. Results In all cases, large histiocytes with granular cytoplasm compatible with intracellular aluminum hydroxide were present. EBER in situ hybridization revealed positive staining of these granular histiocytes while staining was absent in negative controls. Limitations Post hoc completion of medical history revealed that vaccination or specific immunotherapy had been applied before at the biopsy site in only three out of four patients; one patient was lost to follow‐up. Conclusion EBER in situ hybridization is an adjunctive tool to differentiate aluminum‐induced granuloma/lymphoid hyperplasia from other forms of pseudolymphoma and cutaneous B‐ or T‐cell lymphomas.
Lymphoid hyperplasia
Pseudolymphoma
Follicular hyperplasia
Cutaneous lymphoma
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Diagnosis of palatal swellings is a challenge. Benign and malignant tumors may be misinterpreted as lesions of inflammatory origin. We present a case of B-cell non-Hodgkin lymphoma on the palate of a 40-year-old male. A number of factors can make the diagnosis of oral lymphoma difficult. Many lymphomas are extranodal, there is usually a prominent superimposed nonspecific inflammatory response and thus they mimic benign lymphoid hyperplasia. It is important for the pathologist to be familiar with features that distinguish benign from malignant lymphoid proliferations.
Pseudolymphoma
Lymphoid hyperplasia
Hard palate
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B-cell cutaneous lymphoid hyperplasia (B-cell pseudolymphoma) represents a heterogeneous group of benign reactivelymphoproliferative diseases caused by polyclonal B-cell rich lymphocytic infiltrates, simulating the appearance of acutaneous B-cell lymphopma clinically and/or histologically. A histopathologic differentiation of cutaneous lymphoidhyperplasia with follicular growth pattern from follicle center cell lymphoma is important. However, the differentiationbetween cutaneous lymphoid hyperplasia and cutaneous lymphoma is somewhat difficult and close long-term follow-upmay be necessary. Herein, we present two cases of B-cell cutaneous lymphoid hyperplasia with a clinico-pathologicreview of the literature.
Lymphoid hyperplasia
Pseudolymphoma
Follicular hyperplasia
Cutaneous lymphoma
B-cell lymphoma
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Lymphoid hyperplasia
Pseudolymphoma
Follicular hyperplasia
Infiltration (HVAC)
Sjögren syndrome
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A case of a 53-year-old female patient with reactive lymphoid hyperplasia (RLH), clinically designated as pseudolymphoma of the liver is described in this article.The patient was admitted to our hospital for further evaluation of hepatic tumors incidentally discovered at another hospital.Various diagnostic methods, including ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI) and hepatic angiography displayed three small lesions in the liver with outstanding findings consistent with hepatocellular carcinoma (HCC).Surgical resection was performed and the three lesions were microscopically diagnosed as RLH of the liver.The lesions comprised a massive infiltration of lymphoid cells with follicles and hyalinized interfollicular spaces.Immunohistochemical examination revealed that infiltrating lymphocytes had no prominent nuclear atypia and polyclonality.RLH of the liver is a very rare condition and only twelve cases have been reported in the English literature.Majority of the reported cases were middle-aged women and about half of them had some immunologic abnormalities such as autoimmune thyroiditis, Sjogren's syndrome, primary immunodeficiency, primary biliary cirrhosis.Since they are often clinically misdiagnosed as HCC, surgery is the choice of treatment for these patients.Although their pathology resembles malignant lymphoma, the clinical course is completely benign.The authors propose that RLH of the liver can be discriminated from HCC by its clinical features.
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Pseudolymphoma
Follicular hyperplasia
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On the basis of an initial case, we hypothesized that IgG4-positive plasma cells may be increased in pulmonary nodular lymphoid hyperplasia (PNLH) compared with other lymphoid proliferations of the lung. Six cases of PNLH, 9 cases of low-grade B-cell lymphoma of the bronchus-associated lymphoid tissue (BALT), 8 cases of intraparenchymal lymph nodes, 8 cases of either primary or secondary follicular bronchiolitis, and 4 cases of lymphocytic interstitial pneumonitis were stained by immunohistochemical analysis for IgG4 and IgG. The mean number of IgG4-positive and IgG-positive plasma cells and the IgG4/IgG ratio were determined from a manual count of images from 3 separate high-power fields (hpf) of areas showing the highest numbers of stained cells, respectively. The mean number of IgG4-positive plasma cells and the IgG4/IgG ratio were significantly increased in PNLH (IgG4=78/hpf, IgG4/IgG=0.35) compared to low-grade lymphoma of BALT (IgG4=4/hpf, P=0.02; IgG4/IgG=0.03, P=0.005), intraparenchymal lymph nodes (IgG4=7/hpf, P=0.03; IgG4/IgG=0.06, P=0.007), follicular bronchiolitis (IgG4=0/hpf, P=0.02; IgG4/IgG=0, P=0.004), and lymphocytic interstitial pneumonitis (IgG4=2/hpf, P=0.02; IgG4/IgG=0.06, P=0.007). These findings support our current understanding of PNLH as a distinct form of reactive lymphoid proliferation, potentially aid in its distinction from low-grade B-cell lymphoma of BALT, and raise the possibility that PNLH may belong within the family of IgG4-related sclerosing diseases.
Lymphoid hyperplasia
Pseudolymphoma
Follicular hyperplasia
IgG4-Related Disease
Follicular lymphoma
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Benign hyperplastic lymphoid infiltrates of the skin (pseudolymphoma, older term) simulate lymphoma clinically and histologically. They can be divided into B-cell predominant (typical cutaneous lymphoid hyperplasia (CLH), angiolymphoid hyperplasia, Kimura's disease, and Castleman's disease) and T-cell predominant (T-cell CLH, lymphomatoid contact dermatitis, and lymphomatoid drug eruption). Both types may represent exaggerated reactions to diverse external antigens (insect bite, tattoo, zoster, trauma, among others). A composite assessment of clinical presentation and behavior, routine histology, immunophenotyping, and molecular studies is essential for the diagnosis of benign cutaneous lymphoid infiltrates. Treatment includes antibiotics, intralesional and systemic corticosteroids, excision, radiotherapy, and immunosuppressants. Treatment depends on the assessment and biologic behavior, which is usually benign. Molecular biologic analysis has shown that a significant proportion of cases harbor occult B- or T-cell clones (clonal CLH). Progression to overt cutaneous lymphoma has been observed in a minority of cases. Patients with clonal populations of B or T cells and persistent lesions should be closely observed for emergence of a lymphoma.
Pseudolymphoma
Cutaneous lymphoma
Lymphoid hyperplasia
Occult
Immunophenotyping
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IgG4-related disease is a reactive lymphoproliferative-sclerosing lesion that can involve various organ systems of the body, with autoimmune pancreatitis being the prototype. This review article focuses on the various lymphoproliferative lesions that can occur in this disease. The first is IgG4-related lymphadenopathy, which can accompany typical IgG4-related disease or occur ab initio. The morphologic spectrum of the affected lymph nodes ranges from multicentric Castleman disease-like, to follicular hyperplasia, marked interfollicular expansion mimicking peripheral T-cell lymphoma, progressive transformation of germinal center-like, and nodal inflammatory pseudotumor-like. The diagnosis can be confirmed by demonstration of an increase in IgG4+ plasma cells. The second is the development of lymphoma in patients with IgG4-related disease. The lymphoma can occur in the sites affected by IgG4-related disease, where the most common type is extranodal marginal zone lymphoma; or in other nodal and extranodal sites, where the most common type is diffuse large B-cell lymphoma. The third is florid lymphoid hyperplasia as the dominant morphologic feature of IgG4-related disease in various extranodal sites, mimicking malignant lymphoma. Such findings appear to be particularly common in the salivary gland, lacrimal gland, skin and breast, probably attributable to early discovery of mass lesions involving these sites, before the sclerosing process has time to take over. Keywords: IgG4-related disease, IgG4-related sclerosing disease, lymphoproliferative lesion, pseudolymphoma, lymph node pathology, lymphadenopathy, lymphoma, florid lymphoid hyperplasia, follicular hyperplasia, Castleman disease-like
Pseudolymphoma
Follicular hyperplasia
Lymphoid hyperplasia
IgG4-Related Disease
Follicular lymphoma
Lymphoproliferative Disorders
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