Table of Contents
Definition / general | Diagrams / tables | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Negative stains | Molecular / cytogenetics description | Differential diagnosisCite this page: DePond W. Follicular hyperplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesfollicularhyperplasia.html. Accessed September 21st, 2023.
Definition / general
- May be due to bacteria, rheumatoid arthritis, lupus (Pathol Int 2000;50:304), viruses (HIV) or associated with Castleman disease or progressive transformation of germinal centers (Int J Surg Pathol 2005;13:175)
- Lack of light chain expression: usually is associated with lymphoma but rarely is associated with hyperplasia, often in HIV+ patients (Am J Clin Pathol 2005;124:143)
- May have skewing of light chain ratios in germinal center cells compared to mantle cells (Am J Clin Pathol 2003;119:130)
- In elderly, cases with interfollicular plasmacytosis are associated with immunologic abnormalities (Pathol Res Pract 1998;194:391)
- HLA-DO may distinguish florid follicular hyperplasia from follicular lymphoma by flow cytometry (Am J Clin Pathol 2003;119:842)
Diagrams / tables
Images hosted on other servers:
Various patterns
Gross description
- Usually less than 1 cm
- Pink homogenous cut surface
- May resemble fat
Microscopic (histologic) description
- Nodal architecture is preserved
- Usually no / minor infiltration of capsule and perinodal adipose tissue
- Follicles are markedly variable in size and shape
- Margins are sharply defined and surrounded by a mantle layer of IgD+ small lymphocytes, often with an onion skin pattern and sometimes primarily on one pole of the follicle
- Follicles are composed of centrocytes (small) and centroblasts (large)
- Interfollicular lymphocytes differ from follicular lymphocytes
- Tingible body macrophages (with nuclear debris) and mitotic figures are common
- Large number of dendritic cells with intact dendritic meshwork by CD21 / CD35 staining
Microscopic (histologic) images
Contributed by Dr. Mark R. Wick and AFIP images
Cortical and paracortical hyperplasia
Reactive follicular hyperplasia
Hyperplastic
lymphoid follicle
contrasted with
neoplastic follicles
Cellular composition of hyperplastic follicle
Hyperplastic follicle
contrasted with
neoplastic follicle
Immunostaining BCL2 protein
Reactive follicular hyperplasia contrasted with follicular lymphoma
Reactive follicular
hyperplasia with
monocytoid B cell
reaction
Florid reactive follicular hyperplasia with deficient mantles
AIDS related
lymphadenopathy
with florid follicular
hyperplasia
Nonspecific paracortical hyperplasia
Plasmacytoid monocytes in in reactive lymph node
Follicular hyperplasia with follicle lysis in HIV infection
Images hosted on other servers:
Various images
Tingible body macrophages
Cytology description
- Tingible body macrophages, no lymphoid aggregates, no two nuclei-like cleaved cells, no / rare prominent nucleoli (Diagn Cytopathol 2006;34:11)
Negative stains
- BCL2 (Am J Clin Pathol 2000;114:258), CD10 (Appl Immunohistochem Mol Morphol 2000;8:263)
- No immunoglobulin heavy chains
- No light chain restriction
Molecular / cytogenetics description
- Usually no clonality but rarely is clonal by flow cytometry and molecular methods with no clinical evidence of lymphoma - these cases occurred in normal young males and an HIV+ young woman (Am J Clin Pathol 2004;121:464)
Differential diagnosis
- Castleman disease
- Follicular lymphoma: diffuse effacement of nodal architecture, follicles are similar in size and shape and uniformly distributed throughout the node, no tingible body macrophages, cells are similar within and between the follicles, BCL2+ (Am J Clin Pathol 2003;119:145), clonal, t(14;18), light chain restriction, presence of immunoglobulin heavy chains
- HIV+ explosive follicular hyperplasia
- Kimura disease
- Progressive transformation of germinal centers
- Rheumatoid lymphadenopathy
- Syphilitic lymphadenitis
