Florid follicular lymphoid hyperplasia of the palate: review of the literature and report of an illustrative case.

OBJECTIVE: The aim of this report was to review oral follicular lymphoid hyperplasia, with emphasis on palatal lesions. METHOD AND MATERIALS: A comprehensive search was performed on PubMed for case reports and case series of palatal follicular lymphoid hyperplasia published in the English language literature. Relevant data from collated articles was sought, including patient demographics, clinical manifestations, imaging modalities and findings, comorbidities, etiopathogenesis, lesional management, and lesional outcome. A new palatal case has also been provided to illustrate several features of this lesion. RESULTS: In total, 32 cases were assembled to establish clinicopathologic correlations, representing the largest aggregation of published cases. Most of the affected patients were at least 60 years old and with a decisive female predilection. The majority of lesions were ≤ 3 cm, appearing as normal color, purple-red or red, and varied from soft to firm. Notably, 32% of palatal follicular lymphoid hyperplasias were associated with denture wear, and lesional recurrence was recorded in 16% of cases. To date, none of the reported cases of palatal follicular lymphoid hyperplasia has undergone malignant transformation. CONCLUSIONS: Palatal follicular lymphoid hyperplasias often arise as a reactive process. Critical histopathologic and histochemical assessments are necessary to establish benignity. Postoperatively, clinicians should follow patients for at least 5 years for recurrence and remain vigilant for neoplastic change as several published accounts of non-oral follicular lymphoid hyperplasias have undergone malignant transformation, usually to lymphoma.

B-cell Follicular Lymphoid Hyperplasia (Pseudolymphoma) of the Oral Cavity: A Diagnostic Quandary.

Pseudolymphoma is a reactive process involving lymphadenopathy, polyclonal proliferation of B or T-cells, simulating oral lymphoma. With its incidence being very rare, only four cases have been reported in oral cavity with the detailed immunocytochemical examination, which can be due to this entity's unawareness, underdiagnosis or overdiagnosis. It is prerogative to perform immunocytochemical investigations to prevent overdiagnosis as lymphoma, which can be debilitating to the patient. Wherein the treatment of pseudolymphoma initially includes topical or intralesional corticosteroid, antibiotics to surgical and radiotherapy based on its etiology. Herein, we discuss B-cell follicular lymphoid hyperplasia previously diagnosed as small round cell tumor.

[Dasatinib-induced follicular lymphoid hyperplasia, an entity to know]. / Hyperplasie lymphoïde folliculaire induite par la prise de dasatinib, une entité à connaître.

Follicular lymphoid hyperplasia induced by dasatinib is an entity recently described. It is sometimes difficult to rule out the diagnostic of small B-cell lymphoma. Usually, the node is swollen, with follicular architecture conserved, composed by germinal centers with variable size and shape, with a hight number of mitoses and tingible bodies macrophages inside. Follicular lymphoid hyperplasia is isolated or associated with multiple reactive patterns. The immunohistochemical profil of germinal centers is CD20+, CD10+, BCL6+, BCL2-. Swollen node disappears in a short time after dasatinib discontinuation. Clinicians and pathologists need to be aware of this entity, so as not to avoid mistakenly suspect lymphoma when lymphadenopathy occurs in a patient with chronic myeloid leukemia treated with dasatinib.

Oral follicular lymphoid hyperplasia: clinicopathologic of a case series / Hiperplasia linfoide folicular oral: clinicopatológico de uma série de casos

RESUMEN La hiperplasia folicular linfoide (HFL) es una proliferación linfoide reactiva que puede simular linfomas, tanto clínica como histológicamente. El objetivo de este estudio fue investigar las características clínicas, morfológicas e inmunohistoquímicas de una serie de casos de HFL en la cavidad oral y discutir importantes aspectos diagnósticos y diagnósticos diferenciales en relación con los linfomas foliculares. Un análisis retrospectivo de los registros de una base de datos de 38 años reveló nueve casos diagnosticados como HFL de la cavidad oral. La edad de los pacientes osciló entre 8 y 44 años. La mayoría de las lesiones se localizaron en la mucosa oral y la presencia de un nódulo indoloro fue el hallazgo clínico más común. El análisis histopatológico reveló proliferación de células linfoides dispuestas en patrón folicular, presentando folículos primarios y secundarios con centro germinal y zona del manto, con evidencia de macrófagos que contenían cuerpos apoptóticos en su interior, así como evidencia de figuras de mitosis típicas. Observamos el área interfolicular, los linfocitos, los macrófagos e las islas epimioepiteliales. El análisis inmunohistoquímico reveló positividad de folículos linfoides para CD20, CD68, CD3 y linfoma de células B2 (Bcl-2). La presentación clínica de HFL y las evidencias histopatológicas de folículos linfáticos que muestran centros germinales indistintos con una zona del manto mal definida pueden ser un problema debido a la similitud con el linfoma folicular.

Follicular lymphoid hyperplasia of the posterior maxillary site presenting as uncommon entity: a case report and review of the literature.

BACKGROUND: Follicular lymphoid hyperplasia (FLH) is characterized by an increased number and size of lymphoid follicles. In some cases, the etiology of FLH is unclear. FLH in the oral and maxillofacial region is an uncommon benign entity which may resemble malignant lymphoma clinically and histologically. CASE PRESENTATION: We report the case of a 51-year-old woman who presented with an asymptomatic firm mass in the left posterior maxillary site. Computed tomography scan of her head and neck showed a clear circumscribed solid mass measuring 28 × 23 mm in size. There was no evidence of bone involvement. Incisional biopsy demonstrated benign lymphoid tissue. The patient underwent complete surgical resection. Histologically, the resected specimen showed scattered lymphoid follicles with germinal centers and predominant small lymphocytes in the interfollicular areas. Immunohistochemically, the lymphoid follicles were positive for CD20, CD79a, CD10, CD21, and Bcl6. The germinal centers were negative for Bcl2. Based on these findings, a diagnosis of benign FLH was made. There was no recurrence at 1 year postoperatively. CONCLUSIONS: We diagnosed an extremely rare case of FLH arising from an unusual site and whose onset of entity is unknown. Careful clinical and histopathological evaluations are essential in making a differential diagnosis from a neoplastic lymphoid proliferation with a nodular growth pattern.

Alteraciones inmunológicas en la Enfermedad de Castleman / Immunological disorders in Castleman's disease

La enfermedad de Castleman es una entidad poco frecuente, caracterizada por hiperplasia linfoide angiofolicular. Tiene dos tipos histológicos principales: el hialino vascular y el de células plasmáticas; y dos formas clínicas: la localizada y la multicéntrica. Se presenta el caso de una paciente femenina de 19 años de edad con diagnóstico de enfermedad de Castleman tipo hialino vascular, con tres adenopatías localizadas en la región cervical y antecedentes de cuadros infecciosos a repetición previos al diagnóstico. En el estudio inmunohistoquímico se observó CD 20, CD 3 patrón normal y Ki 67 positivo en los folículos linfoides. El estudio inmunológico de sangre periférica arrojó una disminución marcada de los linfocitos CD3+, fundamentalmente a expensas de los CD4+, con conservación de la inmunidad humoral y presencia de anticuerpos antinucleares. Se detectaron anticuerpos IgG anticitomegalovirus y antivirus de Epstein Barr y no se detectaron anticuerpos anti-VIH1,2. Las manifestaciones clínicas sugestivas de inmunodeficiencia antes del diagnóstico de la enfermedad de Casttleman y los resultados de laboratorio obtenidos, permiten sugerir la influencia de la desregulación del sistema inmune en la patogenia de la enfermedad proliferativa. El estado de inmunodeficiencia, además, favorece las infecciones por gérmenes oportunistas, que a su vez potencian los desórdenes inmunes y linfoproliferativos. Se obtuvo una respuesta clínica favorable con tratamiento inmunoestimulante(AU)

Castleman'sdisease is a rare disorder characterized by angiofollicularlymphoid hyperplasia. There are two main histological patterns of the disease: the hyaline vascular type and the plasma cell type; andtwo clinical forms: localized and multicentric. We report a case of a 19-year-old female patient with hyaline vascular type Castleman's disease with cervical lymphadenopathies and medical history of repetitive infectious diseases before diagnosis. The inmunohistochemical study reported CD 20, normal pattern of CD3 and Ki 67 positive only in lymphoidfollicles. The immunological study showed low levels of CD3+ CD4+ lymphocytes, slightly low levels of CD3+ CD8+ lymphocytes, and the presence of antinuclear antibodies (ANA). The humoral immunity was not affected.Other findings were IgG antibodies against CMV and EBV positive, and VIH 1,2 antibodies negative. Clinical history suggesting Immunodeficiency and laboratory findings support the hypothesis that deregulation of the immune system could lead to the pathogenesis of the proliferative disease. Also, the immunodeficiency state promotes the onset of opportunistic infections which may increase immune and proliferative disorders. A favorable response to immunostimulant treatment was observed(AU)

Alteraciones inmunológicas en la Enfermedad de Castleman / Immunological disorders in Castleman's disease

La enfermedad de Castleman es una entidad poco frecuente, caracterizada por hiperplasia linfoide angiofolicular. Tiene dos tipos histológicos principales: el hialino vascular y el de células plasmáticas; y dos formas clínicas: la localizada y la multicéntrica. Se presenta el caso de una paciente femenina de 19 años de edad con diagnóstico de enfermedad de Castleman tipo hialino vascular, con tres adenopatías localizadas en la región cervical y antecedentes de cuadros infecciosos a repetición previos al diagnóstico. En el estudio inmunohistoquímico se observó CD 20, CD 3 patrón normal y Ki 67 positivo en los folículos linfoides. El estudio inmunológico de sangre periférica arrojó una disminución marcada de los linfocitos CD3+, fundamentalmente a expensas de los CD4+, con conservación de la inmunidad humoral y presencia de anticuerpos antinucleares. Se detectaron anticuerpos IgG anticitomegalovirus y antivirus de Epstein Barr y no se detectaron anticuerpos anti-VIH1,2. Las manifestaciones clínicas sugestivas de inmunodeficiencia antes del diagnóstico de la enfermedad de Casttleman y los resultados de laboratorio obtenidos, permiten sugerir la influencia de la desregulación del sistema inmune en la patogenia de la enfermedad proliferativa. El estado de inmunodeficiencia, además, favorece las infecciones por gérmenes oportunistas, que a su vez potencian los desórdenes inmunes y linfoproliferativos. Se obtuvo una respuesta clínica favorable con tratamiento inmunoestimulante

Castleman'sdisease is a rare disorder characterized by angiofollicularlymphoid hyperplasia. There are two main histological patterns of the disease: the hyaline vascular type and the plasma cell type; andtwo clinical forms: localized and multicentric. We report a case of a 19-year-old female patient with hyaline vascular type Castleman's disease with cervical lymphadenopathies and medical history of repetitive infectious diseases before diagnosis. The inmunohistochemical study reported CD 20, normal pattern of CD3 and Ki 67 positive only in lymphoidfollicles. The immunological study showed low levels of CD3+ CD4+ lymphocytes, slightly low levels of CD3+ CD8+ lymphocytes, and the presence of antinuclear antibodies (ANA). The humoral immunity was not affected.Other findings were IgG antibodies against CMV and EBV positive, and VIH 1,2 antibodies negative. Clinical history suggesting Immunodeficiency and laboratory findings support the hypothesis that deregulation of the immune system could lead to the pathogenesis of the proliferative disease. Also, the immunodeficiency state promotes the onset of opportunistic infections which may increase immune and proliferative disorders. A favorable response to immunostimulant treatment was observed