Reactive lymph node hyperplasia with giant follicles

Twenty-two cases are presented of patients whose solitary painless, enlarged lymph nodes demonstrated an extreme degree of reactive hyperplasia with giant follicles which were misdiagnosed as lymphoma in 11 (50%) instances. Parotid or submandibular nodes were involved most frequently, and the mass was thought clinically to be a salivary gland tumor in at least one-third of the cases. Occurrence in men predominated (6.3:1) with a median age of 24.5 years (mean, 26.8 years). There were no recurrences during follow-up periods which ranged from 6 months to 15 years. No specific etiologic factors were identified. Microscopically, the enlarged giant follicles involved the entire surface area of the lymph node, frequently assuming a serpentine configuration resulting from coalescence. The description of findings in these exemplary cases is followed by discussion of the histologic differential diagnosis.