Plasma cell giant lymph node hyperplasia responding to radiation therapy

Abstract

Introduction Giant lymph node hypemplasia was first described by Castleman et al. [1] in 1956. Since then this lesion has been reported under various synonyms, including lymph nodal hamartoma, folliculan lymphometiculoma, angiofolliculam mediastinal lymph node hypenplasia, and angiomatous lymphoid hamartoma [2]. Giant lymph node hypemplasia has been described as a benign lesion, most common in the mediastinum. About 71% of lesions are within the chest [3], but they are also found in extnathoracic sites, usually where lymph nodes are found. However, six were found in muscle [2]. Giant lymph node hypemplasia may present as an asymptomatic mass on a chest film or as a palpable mass. Two patterns have been described after histopathologic study. The hyaline vascular type is the most frequent, occurring in 80%-91#{176}/oof the cases [2, 3]. The other pattern is the plasma cell type which occurred in 9%-20% of the reported cases [2, 3]. Whereas only 3% of patients with the hyaline vascular type were symptomatic [3], 50% of the patients with plasma cell variant had one or more symptoms, including anemia-either mild with nommochnomic nonmocytic cells, or severe with hypochromic microcytic ned cells [3-5]. One possible mechanism for the anemia is an antiemythmopoietic factor produced by the lesion [6]. Other possible symptoms indude fever, fatigue , sweating , hypengammaglobulinemia, elevated a2 globulin , leukocytosis, thrombocytosis, splenomegaly, peripheral lymphadenopathy, elevated alkaline phosphatase, growth failure, and nephrotic syndrome [3, 5, 7]. While the etiology of the lymph node hypenplasia is unknown, the clinical and histologic features are similar to those seen in inflammation [3]. If an infectious agent is responsible, a respiratory route could possibly account for the high percentage of the lesions (71%) appearing in the tracheobmonchial tree [3]. It has been postulated that the plasma cell type is the earlier active stage of the disease and the hyaline vascular type, the end stage [3, 8]. This would support the theory of an infectious etiology and could explain why symptoms are most often associated with the plasma cell variant. The lesions have been described as nadioresistant [3]. Treatment of choice has been surgical resection with resolution of symptoms. We report a patient in whom radiation therapy produced prompt palliation of unmesectable giant lymph node hyperplasia.