Multicentric angiofollicular lymph node hyperplasia. Pathology of the spleen

Splenomegaly is a frequent clinical finding in multicentric angiofollicular lymph node hyperplasia (MAFH). However, pathologic descriptions of the spleen in MAFH have been reported in only a few cases. The author studied the spleens of seven patients with MAFH (two hyaline-vascular type and five plasma cell type) and reviewed the literature on the pathology of the spleen in this disorder. The histologic features of the seven spleens paralleled those of the lymph nodes. The two hyaline-vascular cases were characterized by white pulp hyperplasia with numerous atrophic and hyaline-vascular germinal centers, and rare plasma cells. In contrast, four plasma cell cases exhibited white pulp hyperplasia with a spectrum of germinal centers ranging from large, hyperplastic centers to typical hyaline-vascular centers, and prominent plasmacytosis. Marked white pulp fibrosis with severe lymphocyte depletion was seen in the fifth plasma cell case, and marginal zone fibrosis with prominent plasmacytosis was seen in one of the other plasma cell cases. The author concludes that the presence of altered germinal centers, white pulp or marginal zone fibrosis, and prominent plasmacytosis should suggest a diagnosis of MAFH in the spleen.