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  Indian J Med Microbiol
 

Figure 1: Histologic findings. (a) Medium power view of a follicle with a typical “lollipop” lesion [H and E], ×400. (b) Low power view of a follicle demonstrating two piercing blood vessels and three small germinal centers (arrows) [H and E], ×200. (c) Another follicle contains two germinal centers “twinning” (arrows) and a small penetrating vessel (arrowhead) [H and E], ×200. (d) This follicle demonstrates prominent onion skinning; however, the border between the mantle zone and the center is indistinct. [H and E], ×200. (e) A focus of sclerosis (arrow) is noted in this follicle [H and E], ×200. (f) Follicular dendritic cells (arrows) exhibit enlargement, coarse chromatin, and prominent nucleoli in few follicles, note the prominent onion skinning. Another example is in the inset [H and E], ×400 (g) The sinuses are patent and show dissemination of small lymphocytes (arrows), a common feature in low-grade B-cell lymphomas. Note the penetrating vessel (arrowhead) [H and E], ×200. (h) Capsular permeation by follicles is evident in this lymph node (arrows), which is a feature of follicular lymphoma rather than Castleman disease [H and E], ×20. (i) In other areas of the lymph node, the follicles had the typical morphology of follicular lymphoma, by virtue of lacking polarization and tangible body macrophages [H and E], ×200. (j) Bone marrow trephine biopsy shows sheets of small lymphocytes around bone trabeculae (arrows), which is characteristic of follicular lymphoma [H and E], ×20. (k) The follicles are positive for PAX5, Bcl-6, and Bcl-2 immunohistochemical stains. Smooth muscle active (SMA) reveals exuberant positivity in the interfollicular areas, similar to HV-CD pattern [Hematoxylin counter stain], ×20

Figure 1: Histologic findings. (a) Medium power view of a follicle with a typical “lollipop” lesion [H and E], ×400. (b) Low power view of a follicle demonstrating two piercing blood vessels and three small germinal centers (arrows) [H and E], ×200. (c) Another follicle contains two germinal centers “twinning” (arrows) and a small penetrating vessel (arrowhead) [H and E], ×200. (d) This follicle demonstrates prominent onion skinning; however, the border between the mantle zone and the center is indistinct. [H and E], ×200. (e) A focus of sclerosis (arrow) is noted in this follicle [H and E], ×200. (f) Follicular dendritic cells (arrows) exhibit enlargement, coarse chromatin, and prominent nucleoli in few follicles, note the prominent onion skinning. Another example is in the inset [H and E], ×400 (g) The sinuses are patent and show dissemination of small lymphocytes (arrows), a common feature in low-grade B-cell lymphomas. Note the penetrating vessel (arrowhead) [H and E], ×200. (h) Capsular permeation by follicles is evident in this lymph node (arrows), which is a feature of follicular lymphoma rather than Castleman disease [H and E], ×20. (i) In other areas of the lymph node, the follicles had the typical morphology of follicular lymphoma, by virtue of lacking polarization and tangible body macrophages [H and E], ×200. (j) Bone marrow trephine biopsy shows sheets of small lymphocytes around bone trabeculae (arrows), which is characteristic of follicular lymphoma [H and E], ×20. (k) The follicles are positive for PAX5, Bcl-6, and Bcl-2 immunohistochemical stains. Smooth muscle active (SMA) reveals exuberant positivity in the interfollicular areas, similar to HV-CD pattern [Hematoxylin counter stain], ×20