Abstract
Genital herpes simplex virus (HSV) infections are a common cause of inguinal lymphadenopathy. However, surgical excision of enlarged inguinal nodes is almost never performed to initially diagnose genital herpes simplex virus, due to the distinct external presentation of genital herpetic vesicles that usually occur with the first symptoms of infection. Therefore, the histologic and immunophenotypic features of HSV-associated inguinal lymphadenopathy are unfamiliar to most pathologists. The current report describes the lymph node pathology of two immunocompetent patients, whose initial HSV diagnosis was established through surgical excision of enlarged inguinal lymph nodes. Histologic examination showed features consistent with viral lymphadenopathy, including florid follicular hyperplasia, monocytoid B-cell hyperplasia, and paracortical hyperplasia without extensive necrosis. Immunohistochemical stains for HSV antigens, using polyclonal anti-HSV I and II antibodies, demonstrate strong immunoreactivity for HSV in a small number of cells in the subcapsular sinuses, especially in areas with monocytoid B-cell hyperplasia. Rare scattered HSV-positive cells also are identified in paracortical areas and germinal centers. We conclude that an initial diagnosis of genital HSV infection may be established by inguinal lymph node biopsy.
Highlights
Surgical excision of enlarged inguinal lymph nodes is often performed to exclude hematologic malignancies
The initial histologic diagnosis of genital herpes simplex virus (HSV) by inguinal lymph node biopsy is rare [3], we describe two immunocompetent patients with active genital herpes diagnosed by inguinal lymph node biopsy
An initial diagnosis of HSV-associated lymphadenopathy was established by inguinal lymph node biopsy in both of our patients
Summary
Surgical excision of enlarged inguinal lymph nodes is often performed to exclude hematologic malignancies. These lymph node biopsy specimens often show lymphoid hyperplasia, which may be due to a wide variety of reactive conditions including various sexually transmitted infections [1]. It is unusual for genital herpes simplex virus (HSV) to present initially as inguinal lymphadenopathy, which is significant enough to warrant nodal excision, unless the patient has a known underlying lymphoma [2]. The initial histologic diagnosis of genital HSV by inguinal lymph node biopsy is rare [3], we describe two immunocompetent patients with active genital herpes diagnosed by inguinal lymph node biopsy
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