Ferry J A, Zukerberg L R, Harris N L
James Homer Wright Pathology Laboratory, Massachusetts General Hospital 02114.
Am J Surg Pathol. 1992 Mar;16(3):252-8.
Progressive transformation of germinal centers (PTGC) occurs focally in reactive lymph nodes, and has been reported with increased frequency in patients with nodular lymphocyte predominance Hodgkin's disease (NLPHD). It has been suggested that patients with lymph node biopsy samples showing PTGC are at increased risk for the development of NLPHD, and that Hodgkin's disease may evolve from PTGC. We report five young men (ages 14-24 years, mean 18) with prominent lymphadenopathy and florid PTGC, in whom careful examination and follow-up showed no progression to Hodgkin's disease. Three patients developed adenopathy that involved several node groups and two had localized adenopathy. Cervical (2), inguinal (2) and axillary (1) nodes ranging from 3 to 4 cm were excised. The number of progressively transformed germinal centers (PTGCs) ranged from 10 to 123 per specimen (mean 67); single sections contained nine to 29 PTGCs (mean 19). In three cases the nodal architecture was significantly distorted, suggestive of NLPHD, but Reed-Sternberg cells were absent. Follow-up is available for all patients (all untreated): three patients had persistent adenopathy 1 year 4 months to 10 years after diagnosis. Results of repeat biopsy in two patients (2 and 3 years after diagnosis) showed florid PTGC with no evidence of Hodgkin's disease. One of these patients had one subsequent biopsy 8 years after presentation; results showed only rare PTGCs. The fourth and fifth patients, who had presented with isolated adenopathy, were free of recurrent adenopathy at 2 and 5 years. These cases suggest a syndrome of lymphoid hyperplasia with florid PTGC in adolescent boys and young men. Although adenopathy can persist, there has been no progression to Hodgkin's disease. Recognition of this syndrome is important to avoid overdiagnosis of LPHD. Close follow-up of these patients will be necessary to evaluate the relationship of this disorder to NLPHD.
生发中心进行性转化（PTGC）局灶性发生于反应性淋巴结，据报道在结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHD）患者中其发生率增加。有人提出，淋巴结活检显示PTGC的患者发生NLPHD的风险增加，且霍奇金淋巴瘤可能由PTGC演变而来。我们报告了5名年轻男性（年龄14 - 24岁，平均18岁），他们有明显的淋巴结病和显著的PTGC，经仔细检查和随访未发现进展为霍奇金淋巴瘤。3例患者出现累及多个淋巴结组的淋巴结病，2例有局限性淋巴结病。切除了2个颈部、2个腹股沟和1个腋窝的淋巴结，大小为3至4厘米。每个标本中进行性转化的生发中心（PTGC）数量为10至123个（平均67个）；单切片包含9至29个PTGC（平均19个）。3例患者的淋巴结结构明显扭曲，提示NLPHD，但无里德 - 斯腾伯格细胞。所有患者（均未治疗）均有随访：3例患者在诊断后1年4个月至10年持续存在淋巴结病。2例患者（诊断后2年和3年）重复活检结果显示为显著的PTGC，无霍奇金淋巴瘤证据。其中1例患者在就诊8年后进行了1次后续活检；结果仅显示罕见的PTGC。第4和第5例患者最初表现为孤立性淋巴结病，在2年和5年时无复发性淋巴结病。这些病例提示青春期男孩和年轻男性中存在一种伴有显著PTGC的淋巴样增生综合征。虽然淋巴结病可能持续存在，但未进展为霍奇金淋巴瘤。认识到这种综合征对于避免NLPHD的过度诊断很重要。对这些患者进行密切随访对于评估这种疾病与NLPHD的关系是必要的。
