Kojima M, Nakamura S, Shimizu K, Itoh H, Yoshida K, Hosomura Y, Yamane N, Ban S, Joshita T, Suchi T
Department of Pathology and Clinical Laboratories, Ashikaga Red Cross Hospital, Japan.
Pathol Res Pract. 1998;194(6):391-7. doi: 10.1016/S0344-0338(98)80029-0.
Florid reactive follicular hyperplasia (FRFH) of the enlarged lymph node in elderly patients requiring biopsy is a relatively uncommon phenomenon as compared with younger age groups. We experienced 23 patients, aged 60 years or more, from whom the biopsied lymph node specimens histologically showed inappropriate FRFH for their age, in the period between 1982 and 1996. These cases were morphologically subdivided into three groups, FRFH with interfollicular plasmacytosis, that with progressive transformation of germinal center, and FRFH without additional specific findings. FRFH with interfollicular plasmacytosis were observed in 11 cases, all of whom were accompanied with several immunological abnormalities (six with rheumatoid arthritis, three with multicentric Castleman's disease and one each with myoepithelial sialoadenitis and autoimmune hemolytic anemia). Three men with uncertain etiology exhibited an unusual histology of progressive transformed germinal centers which were clinically characterized by a bulky neck mass. Among the nine cases with nonspecific FRFH, only four had a specific etiology (one each with adult onset Still's disease, chronic sinusitis, Epstein-Barr virus infection and infectious lateral cervical cyst), while the other five with unknown etiology showed abnormal laboratory findings suggestive of an abnormal humoral immune response, i.e. hypergammaglobulinemia and seropositivities for some autoantibodies. None of our patients developed malignant lymphoma during the follow-up period. Of note, 16 (70%) of the 23 cases were found to be associated with various types of imbalances of the immune system, some of which appeared to be currently ill-defined as clinicopathological entities that were simply categorized as autoimmune disease.
在需要活检的老年患者中，肿大淋巴结的 florid 反应性滤泡增生（FRFH）与年轻人群相比是一种相对不常见的现象。在 1982 年至 1996 年期间，我们诊治了 23 例年龄在 60 岁及以上的患者，其活检淋巴结标本在组织学上显示出与其年龄不相称的 FRFH。这些病例在形态上分为三组：伴有滤泡间浆细胞增多的 FRFH、生发中心进行性转化的 FRFH 和无其他特定表现的 FRFH。伴有滤泡间浆细胞增多的 FRFH 有 11 例，所有患者均伴有多种免疫异常（6 例患有类风湿性关节炎，3 例患有多中心 Castleman 病，1 例分别患有肌上皮涎腺炎和自身免疫性溶血性贫血）。3 例病因不明的男性表现出不寻常的生发中心进行性转化组织学，临床上以颈部巨大肿块为特征。在 9 例非特异性 FRFH 病例中，只有 4 例有特定病因（1 例分别患有成人斯蒂尔病、慢性鼻窦炎、爱泼斯坦 - 巴尔病毒感染和感染性颈侧囊肿），而其他 5 例病因不明的患者实验室检查结果异常，提示体液免疫反应异常，即高球蛋白血症和某些自身抗体血清阳性。在随访期间，我们的患者均未发生恶性淋巴瘤。值得注意的是，23 例病例中有 16 例（70%）被发现与各种类型的免疫系统失衡有关，其中一些目前似乎作为临床病理实体定义不明确，仅被归类为自身免疫性疾病。
