Diagnostic specificity of histologic features in lymph node biopsy specimens from patients at risk for the acquired...

The most common histologic pattern observed in lymph node biopsy specimens from homosexual men with the syndrome of persistent generalized lymphadenopathy is that of florid hyperplasia of germinal centers. This change has been characterized as showing large and irregular germinal centers, mantle zone effacement, follicle lysis, germinal center hemorrhage, granuloma formation, and focal sinusoidal monocytoid cell hyperplasia. Fifty lymph node biopsy specimens coded as nonspecific reactive follicular hyperplasia and antedating the epidemic of the acquired immunodeficiency syndrome (AIDS) (1976 to 1977) were studied to assess the specificity of these features in identifying patients at risk for AIDS. The incidence of these features was as follows: large irregular germinal centers, 10 per cent of the cases; mantle zone effacement, 44 per cent; follicle lysis, 42 per cent; germinal center hemorrhage, 24 per cent; sinus monocytoid cell hyperplasia, 16 per cent; and granuloma formation, 8 per cent. Large irregular germinal centers were seen in five cases, four of which had additional abnormalities. A combination of three germinal center changes was seen in 18 per cent of the cases and a combination of two changes in 16 per cent. Comparison of these data with previously published descriptions of lymph node biopsies from patients with persistent generalized lymphadenopathy indicates that, while some of the reported features may be more common in these patients, none of them, either singly or in combination, can be considered diagnostic of this disorder.