Angiofollicular lymph node hyperplasia (castleman's disease)—A case report

Abstract

A 55 year's old female presented with a painless swelling on the left side of the neck of 20 year's duration. She had history of t rauma over" that region following which she noticed the swelling. It increased in size g radua l ly . It was p y r i f o r m in shape and f i rm in consistency. It occupied the entire left anterior triangle and part of the posterior triangle of the neck. She had no dysphagia, voice changes, weight loss or fever. No significant lymphadenopathy in other areas of the body could be detected. Liver and spleen were not palpable. Previous haematological tests, X rays neck and chests, thyroid scan, serum T3, T4 and TSH were within normal limits. Rheumatoid factor was negative. Her bleeding time and clotting time were 1 rain. 15 seconds and 4 rain. 20 seconds respectively. Fine needle Aspiration Cytology (FNAC) revealed non specific lymphadenitis. Excision biopsy revealed an oval firm encapsulated mass, externally covered with greyish white membrane, wi th prominent blood vessels and areas of shaggy looking fibrous adhesions. The specimen was 7.0 cm x 4.5 c m x 1.0 cm in size. Cut surface was irregular, lobulated and soft yellowish in colour. On microscopic examination, multiple sections revealed structure of a l y m p h node wi th cel lular infi l t rates. There were irregular bands of connective tissues, containing a large number of hyalinised blood vessels running fi'om the capsules to the interior, dividing the lymph node into lobules. Through out the specimen there were lymphoid follicles of varying sizes having both prominent and inconspicuous germinal centres, with hyalinised blood vessels in many of them and having a thick mantle zone of lymphocytes . The interfoll icular zone contained