• Also called angiofollicular lymphoid hyperplasia, giant lymph node hyperplasia

• Primarily affects mediastinal lymph nodes, occasionally affects thymus

• Associated with fever, weight loss, anemia

• Poor prognosis if multifocal disease

• Excision is curative if localized

• Enlarged, distorted lymph nodes

• 19 year old woman with posterior mediastinum disease (Kyobu Geka 2002;55:519)
• 39 year old man with progressive dyspnea and cough for six months (Rare Tumors 2010;2:e11)
• 41 year old man with central necrotic or cystic change in mass (Kyobu Geka 2005;58:845)

Mediastinal mass

• Follicular aggregates of small, mature lymphocytes with compression of sinuses
• Increased number of small-caliber vessels, surrounded by fibrohyaline eosinophilic material or mature plasma cells
• Follicles also surrounded by “onion-skin” arrays of lymphocytes

Onion-like appearance

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