[Non-Hodgkin's lymphoma with splenic granulomatous reaction]

A 44-year old female had centrofollicular stage IV non-Hodgkin lymphoma, with splenic and bone marrow infiltration. The histological study of the spleen showed abundant nodes, some of them predominantly lymphoid and others consisting of epithelioid granulomas. With double labelling immunohistochemical techniques three types of nodes were observed: neoplastic lymphoid ones, surrounded by histiocytic cells, others also lymphoid with histiocyte infiltration, and, finally, others constituted by epithelioid granulomas. This suggests an evolution from the tumoral lymphoid nodule to the epithelioid granuloma, which may be caused by a defensive phenomenon against lymphomatous proliferation. The major importance of the recognition of this histological pattern lies in that it may obscure the diagnosis of lymphoma.