[Focal lymphoid hyperplasia (pseudolymphoma) of the terminal ileum in adults]

We report two cases of focal lymphoid hyperplasia (FLH) of terminal ileum in adult patients. Both cases showed identical morphological findings. The first was discovered during cholecystectomy in a 75-year-old woman who complained mild non-specific abdominal discomfort. The second was manifested by right lower quadrant abdominal pain in a 32-year-old man. The surgical specimens revealed a thickened wall, a narrowed lumen and multiple ulcerations. The histologic features were small cell, well differentiated lymphocyte infiltration, with several follicles showing large germinal centers; regional lymph nodes revealed a conspicuous reactive size enlargement. Further clinical investigations revealed no other abnormalities. Clinical course showed benign evolution after 6 and 3 years of respective follow-up. FLH should be differentiated from terminal ileum inflammatory and infectious diseases. It can be differentiated from Crohn's disease by the absence of characteristic histological features; from Yersinia infection by the absence of significant rates of specific serum antibodies. Moreover, FLH can be differentiated from malignant lymphoma by the presence of follicles and enlarged germinal centers and by the long-term benign evolution. The nature of FLH in terminal ileum, as well as those of the stomach and colo-rectum is still to be determined. Several hypothesis are proposed: reactive, benign neoplastic, or prelymphomatous lesion?