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Massive hyperplasia of marginal zone B-cells with clear cytoplasm in the lymph node: a case report
Masaru Kojima1, Shigeo Nakamura, Hiroshi Tanaka
1Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, Ohta, Japan. mkojima@gunma-cc.jp
Insights
Systemic bacterial infection caused enlarged axillary lymph nodes with proliferating marginal zone B-cells. This benign condition requires differentiation from B-cell lymphomas.
Area of Science:
- Hematology
- Immunology
- Pathology
Background:
- Marginal zone B-cells are key players in immune responses.
- Understanding B-cell hyperplasia is crucial for diagnosing lymphoproliferative disorders.
Observation:
- An enlarged axillary lymph node exhibited proliferating marginal zone B-cells in nodular and aggregate patterns.
- These cells infiltrated surrounding fatty tissue, displaying specific morphological and immunophenotypical characteristics.
Findings:
- Immunohistochemistry revealed CD20+, CD79a+, Bcl-2+, sIgD-, CD5-, CD10-, CD21-, CD23-, CD45RO-, Bcl-6-, cyclin D+.
- A subset of cells tested positive for sIgM and CD43.
- Polymerase chain reaction and immunohistochemistry confirmed the polytypic nature of the cells, indicating a reactive process.
Implications:
- Systemic bacterial infection is identified as the likely cause of this marginal zone B-cell hyperplasia.
- Distinguishing this reactive hyperplasia from low-grade B-cell lymphomas, especially nodal marginal zone B-cell lymphoma, is essential for accurate diagnosis and patient management.
Abstract:
An enlarged axillary lymph node from a 63-year-old woman showed proliferating marginal zone B-cells arranged in a vague nodular pattern or in band-forming aggregates throughout the cortex. Marginal zone B-cells, which also infiltrated the adjacent fatty tissue, had round or slightly indented nuclei of medium size and a moderate amount of clear cytoplasm. Immunohistochemically, these cells were CD20+, CD79a+, Bcl-2+, sIgD-, CD5-, CD10-, CD21-, CD23-, CD45RO-, Bcl-6-, and cyclin D-. A portion of the cells were sIgM- and CD43-positive. The polytypic nature of these cells was demonstrated by immunohistochemistry and polymerase chain reaction. Systemic bacterial infection appears to be the cause of marginal zone B-cell hyperplasia. This unusual marginal zone B-cell hyperplasia should be differentiated from low-grade B cell lymphomas, and particularly from nodal marginal zone B-cell lymphomas.
