Progressive Transformation of Germinal Centers: A Clinicopathological Study of 42 Japanese Patients

Abstract

To clarify the clinicopathological features of progressive transformation of germinal center (PTGC) unrelated to nodular lymphocyte predominant Hodgkin's lymphoma in Japanese patients, we reviewed 42 cases and compared the results with those of the United States and Germany. Our results were similar to theirs, with male predominance (M/F ratio, 3:1) and the presentation of a solitary asymptomatic enlarged lymph node in the head and neck area as the common features. However, in Japan, PTGC occurs more frequently in elderly patients. In this study, 12 (29%) of the patients with PTGC were aged 60 years or more. Thirteen patients (31%) with lymphadenopathy in the neck and head area had developed localized chronic inflammation (chronic sialoadenitis=4, chronic tonsillitis=3, infectious epidermal cyst=2) or an autoimmune disorder (hyperthyroidism=2 and bronchial asthma=2). None of the patients developed a malignant lymphoma during the follow-up period of 5 to 238 months (median 27 months). Histologically, in a single longitudinal section of the lymph node, the PTGC occupied up to 5% of the total follicles in 22 patients, 5-10% in 10, 10-20% in 7, and more than 20% in 3. In 5 (12%) patients, an association with prominent marginal zone hyperplasia was also noted. This study also indicates that nodal involvement by various low-grade B-cell lymphomas exhibiting marginal zone distribution patterns should be considered as a differential diagnosis of PTGC. Moreover, in Japan, PTGC is thought to be involved in the etiology of florid reactive follicular hyperplasia in elderly patients.

Keywords

progressive transformed germinal center follicular hyperplasia lymph node marginal zone B-cells etiology

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References

1. Lennert K , Miiller-Hermelink HK . Lymphocyten und ihre Funktionsformen Morphologie, Organization und immunologische Bedeutung. Verh Anat Ges 69:19-62, 1975

2. Muiller-Hermelink HK , Lennert K . The cytologic, histologic, and functional bases for a modern classification of lymphomas. In Lennert K , Mohri N, Stein H , Kaiserling E , Muiller-Hermelink HK (eds): Malignant lymphomas other than Hodgkin's disease. Springer, Berlin, pp. 1-71, 1978

3. Poppema S , Kaiserling E , Lennert K . Nodular paragranuloma and progressive transformed germinal center. Ultrastrural and immunohistologic findings. Virchows Arch [B] 31:211-225, 1979

4. Poppema S , Kaiserling E , Lennert K . Hodgkin's disease with lymphocytic predominance, nodular type (nodular paragranuloma) and progressively transformed germinal centers-a cytohistological study. Histopathology 3:295-308, 1979

5. Burns BF , Colby TV , Dorfman RF . Differential diagnostic features of nodular L & H Hodgkin' disease including progressive transformation of germinal centers. Am J Surg Pathol 8:253-261, 1984

6. Osborne BM , Butler JJ . Clinical implications of progressive transformation of germinal centers. Am J Surg Pathol 8:725-733, 1984

7. Crossely B , Heryet A , Gatter KC . Does nodular lymphocyte predominant Hodgkin's disease arise from progressively transformed germinal centers? A case report with unusually prolonged history. Histopathology 11:621-630, 1987

8. Lennert K , Hansmann ML . Progressive transformation of germinal centers: Clinical significance and lymphocytic predominance Hodgkin's disease-the Kiel experience. Am J Surg Pathol 11:149-150, 1987

9. Hansmann ML , Fellbaum C , Hui PK , Moubayed P . Progressive transformation of germinal centers with and without association to Hodgkin's disease. Am J Clin Pathol 93:219-226, 1990

10.

10. Osborne BM , Butler JJ , Gresik MV . Progressive transformation of germinal centers: Comparison of 23 pediatric patients to the adult population. Mod Pathol 5:135-140, 1992

11.

11. Ferry JA , Zukerberg LR , Harrris NL . Florid progressive transformation of germinal centers. A syndrome affecting young men, without early progression to nodular lymphocyte predominance Hodgkin's disease. Am J Surg Pathol 16:252-258, 1992

12.

12. Nguyen PL , Ferry JA , Harris NL . Progressive transformation of germinal centers and nodular lymphocyte predominance Hodgkin's disease. A comparative immunohistochemical study. Am J Surg Pathol 23:27-33, 1999

13.

13. van den Oord JJ , de Wolf-Peeters C , Desmet VJ . Immunohistochemical analysis of progressively transformed follicular centers. Am J Clin Pathol 83:560-564, 1983

14.

14. Guettier C , Gatter KC , Heryet A , Mason DY . Dendritic reticulum cells in reactive lymph nodes and tonsils: An immunohistological study. Histopathology 10:15-24, 1986

15.

15. Cotran S , Kumar V , Collins T . Pathologic basis of disease. 2nd ed. WB Saunders, Philadelphia, pp. 188-259, 1998

16.

16. Stein H , Delsol G , Pileri S , Said J , Mann R , Poppema S , Swerdlow SH , Jaffe ES . Nodular lymphocyte predominant Hodgkin lymphoma. In Jaffe ES , Harris NL , Stein H , Vardiman JW (eds): Pathology and genetics of tumours of haematopoietic and lymphoid tissues. IARCPress, Lyon, pp. 240-243, 2001

17.

17. Kojima M , Nakamura S , Motoori T , Shimizu K , Ohno Y , Itoh H , Masawa N . Follicular hyperplasia presenting with a marginal zone pattern in a reactive lymph node lesion. A report of six cases. APMIS 110:325-331, 2002

18.

18. Schnitzer B . Reactive lymphoid hyperplasias. In Jaffe ES (ed): Surgical pathology of the lymph nodes and related organs, 2nd ed. WB Saunders, Philadelphia, pp. 98-132, 1995

19.

19. Osborne BM , Butler JJ . Follicular lymphoma mimicking progressive transformation of germinal centers. Am J Clin Pathol 88:264-269, 1987

20.

20. Goates JJ , Kamel OW , LeBrun DP , Benharroch D , Dorfman RF . Floral variant of follicular lymphoma. Immunological and molecular studies support a neoplastic process Am J Surg Pathol 18:37-47, 1994

21.

21. Campo E , Miquel R , Krenacs L , Sorbara L , Raffled M , Jaffe ES . Primary nodal marginal zone lymphomas of splenic and MALT type. Am J Surg Pathol 23:59-68, 1999

22.

22. Gupta D , Lim MS , Medeiros LJ , Elenitoba-Johnson KSJ . Small lymphocytic lymphoma with perifollicular, marginal zone, or interfollicular distribution. Mod Pathol 13:1161-1166, 2000

23.

23. Yatabe Y , Suzuki R , Matsuno Y , Tobinai K , Ichinohasama R , Tamaru J-I , Mizoguchi Y , Hashimoto Y , Yamaguchi M , Kojima M , Uike N , Okamoto M , Isoda K , Ichimura K , Morishima Y , Seto M , Suchi T , Nakamura S . Morphological spectrum of cyclin D1 positive mantle cell lymphoma: Study of 168 cases. Pathol Int 51:747-761, 2001

24.

24. Osborne BM , Butler JJ . Clinical implications of nodal reactive follicular hyperplasia in the elderly patient with enlarged lymph nodes. Mod Pathol 4:24-30, 1991

25.

25. Kojima M , Nakamura S , Shimizu K , Itoh H , Yoshida K , Hosomura Y , Yamane N , Ban S , Joshita T , Suchi T . Florid reactive follicular hyperplasia in elderly patients: A clinicopathological study of 23 cases. Pathol Res Pract 194:391-398, 1998