GIANT FOLLICLE HYPERPLASIA: A STUDY OF ITS INCIDENCE, HISTOPATHOLOGIC VARIABILITY, AND THE FREQUENCY OF SARCOMA AND SECONDARY HYPERSPLENIC COMPLICATIONS

Publisher Website
Google Scholar
Abstract
A relatively benign RE cell hyperplasia appears to comprise the abnormally large germinal follicular centers in the chronic spleno-lymphatic disease, giant follicle hyperplasia, or follicular lymphoblastoma. The specific cellular detail within these grossly and characteristicly enlarged follicles varies from patient to patient, and in the same patient from time to time, in the present series of 16 patients and as interpreted from the medical literature. There may be found a predominance of large fixed reticulum cells without pronounced phagocytic capacities, or free mononuclear phagocytes, or cells interpreted as germinal center lympho-blasts with or without sarcoma characteristics. The clinical course and individual prognosis may be predicted fairly accurately, depending upon the identification of these several morphologically and functionally differing cell types (using the supravital technique). In splenomegaly hypersequestration of circulating blood cell types frequently occurs, reflecting an "hypersplenic" dysfunction. This complication developed in 8 patients in our series of 16, requiring emergency splenectomy. In two instances relapses occurred, but with the removal of accessory splenic tissue, the peripheral cytopenia subsided. Four of the 16 patients developed sarcoma changes while under observation, with a complete reversal of the benign course and a fatal outcome despite the specific therapy now available for lymphosarcoma. The etiology or etiologies of giant lymph follicle hyperplasia are entirely unknown at the present time. The relatively benign character, in at least some of these cases, however, suggests at times a reversible or controllable physiologic functional response, rather than always a progressive irreversible pathologic mutation of the cells in the enlarged germinal centers.