Follicular hyperplasia
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Author:
Mikael Häggström [note 1]
Follicular hyperplasia is the most common pattern of reactive lymphadenopathy.[1] Reactive follicular hyperplasia is usually associated with varying degrees of paracortical and/or sinus hyperplasia. Older age, increased follicular density (especially back-to-back arrangement) and areas of diffuse nodal effacement leads to a suspicion of follicular lymphoma.[1]
Main differences:[1]
Feature | Follicular hyperplasia of a reactive lymph node | Follicular lymphoma |
---|---|---|
Density of follicles | Low | High |
Follicle distribution | Usually limited to subcortical region | Distributed evenly throughout parenchyma |
Follicles extending beyond capsule | Rarely | Often |
Follicle sizes and shapes | Uneven | Similar |
Cell types in germinal centers | Mixture of cells | Monomorphic or polymorphic |
Tingible-body macrophages | Present | Usually rare |
Mitotic rate | Usually moderate to high | Usually low to moderate |
Mantle zone | Usually distinct | Usually indistinct or absent |
Cell polarization | Often seen | Usually absent |
Interfollicular areas | Large | Compressed |
Areas of nodal effacement | Absent | Occasional |
If uncertain, perform the following studies:[1]
Feature | Reactive lymph node | Follicular lymphoma |
---|---|---|
Bcl-2 in B cells of germinal centers | Negative | Positive (90%) |
Light chain restriction on immunostains | Absent (rare exceptions) | Present (20% in paraffin) |
Light chain restriction on flow cytometry | Absent restriction (rare exceptions) | Restriction or absent, when gated correctly (95%) |
Ig rearrangements | Absent (rare exceptions) | Usually (80%) |
t(14;18) | Absent (rare exceptions) | Usually present (90%) |
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