Contributed by Laurentia Nodit, MD and Fiona Craig, MD
Published on line in November 2002
The patient was a 17 year-old female with a 2cm, left upper neck, mobile, not painful mass for 2 months. During this time the patient felt tired, but otherwise normal. There was no fever, sweats or chills. There was no history of mononucleosis and the mononucleosis serologic tests were negative. Systemic antibiotic therapy was administered with no improvement. Consequently, the mass was surgically removed and sent for pathological examination.
Received was a 2 x 1.5 x 1 cm lymph node with a pink-tan, granular cut surface and no gross abnormalities.
Histological sections demonstrated an enlarged lymph node with numerous regressively transformed follicles (Fig. 1) replacing the usual lymph node architecture. The follicles were composed of prominent central hyalinized vessels, surrounded by concentric layers of follicular center cells (onion-like appearance) (Fig. 2). Penetrating hyalinized small vessels frequently gave some of the abnormal follicles a lollipop-like appearance (Fig. 3). Interfollicular areas were composed of small lymphocytes, few scattered plasma cells and proliferation of the small blood vessels (Fig. 4). The sinuses were obliterated.