FLORID REACTIVE FOLLICULAR HYPERPLASIA IN ELDERLY PATIENTS - A CLINICOPATHOLOGICAL STUDY OF 23 CASES

Florid reactive follicular hyperplasia (FRFH) of the enlarged lymph no de in elderly patients requiring biopsy is a relatively uncommon pheno menon as compared with younger age groups. We experienced 23 patients, aged 60 years or more, from whom the biopsied lymph node specimens hi stologically showed inappropriate FRFH for their age, in the period be tween 1982 and 1996. These cases were morphologically subdivided into three groups, FRFH with interfollicular plasmacy tosis, that with prog ressive transformation of germinal center, and FRFH without additional specific findings. FRFH with interfollicular plasmacytosis were obser ved in 11 cases, all of whom were accompanied with several immunologic al abnormalities (six with rheumatoid arthritis, three with multicentr ic Castleman's disease and one each with myoepithelial sialoadenitis a nd autoimmune hemolytic anemia). Three men with uncertain etiology exh ibited an unusual histology of progressive transformed germinal center s which were clinically characterized by a bulky neck mass. Among the nine cases with nonspecific FRFH, only four had a specific etiology to ne each with adult onset Still's disease, chronic sinusitis, Epstein-B arr virus infection and infectious lateral cervical cyst), while the o ther five with unknown etiology showed abnormal laboratory findings su ggestive of an abnormal humoral immune response, i.e, hypergammaglobul inemia and seropositivities for some autoantibodies. None of our patie nts developed malignant lymphoma during the follow-up period. Of note, 16 (70%) of the 23 cases were found to be associated with various typ es of imbalances of the immune system, some of which appeared to be cu rrently ill-defined as clinicopathological entities that were simply c ategorized as autoimmune disease.