Case 5

• 15yrs boy treated for ALL 6yrs back.

• Regular follow-up

• B/L submandibular cervical lymphadenopathy 2x3cm.

• FNA of the lymphnode done.

List of Differentials

• Reactive lymphoid hyperplasia• Hemophagocytic lymphohisticytosis• Recurrent ALL• Secondary neoplasm : DLBCL• NHL

Reactive lymphoid hyperplasia

? Significant lymphadenopathy

? Clinical history Clinically : 2-3cm LN, soft to firm patient in remission PS : normal LDH : normal Toxoplasma : negative

Clinicians decided to do whole node biopsy to rule out relapse

IHC : to exclude focal involvement Tdt : Negative

Correlating clinical, serological and pathological findings

FINAL DIAGNOSIS

Progressive Transformation of Germinal Centre

Progressive Transformation of Germinal Centre

• Benign reaction pattern in lymph nodes• Florid or focal• 3.5% of non specific lymphadenitis• Pathogenesis premature arrest at an early

transition between primary and secondary follicles because of incomplete blastic transformation of B cells.

Progressive Transformation of Germinal Centre

Non hodgkins• Malignant lymphoma Hodgkins : NLPHL• Reactive lymphadenitis• Immunocompromised• IgG4 related lymphadenopathy

Thank you….