ABSTRACT
Follicular lymphoid hyperplasia (FLH) is a reactive lymphoid proliferation that can simulates lymphomas, both clinically and histologically. The aim of the present study was to investigate the clinical, morphological and immunohistochemical characteristics of a series of FLH cases of the oral cavity, and discuss important diagnostic aspects and differential diagnosis concerning follicular lymphomas. A retrospective analysis of the records of a database comprising 38 years revealed nine cases diagnosed as FLH of the oral cavity. Patient age ranged from 8 to 44 years. Most lesions were located in the buccal mucosa and the presence of a painless nodule was the most common clinical finding. Histopathological analysis revealed the proliferation of lymphoid cells arranged in a follicular pattern, presenting primary and secondary follicles with a germinal center and mantle zone, with evidence of macrophages containing apoptotic bodies in their interior, as well as evidence of typical mitosis figures. Interfollicular region, lymphocytes, macrophages and epimioepithelial islands were observed. Immunohistochemical analysis revealed positivity of the lymphoid follicles for CD20, CD68, CD3 and B-cell lymphoma 2 (Bcl-2). The clinical presentation of FLH and histopathological evidence of lymphatic follicles presenting indistinct germinal centers with poorly defined mantle zone may represent a problem due to theresemblance to follicular lymphoma.
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A) surgical excision of nodular lesion on the left buccal mucosa; B) ultrasonography showed radiolucent image of a nodular solid, well-defined, hypoechoic with echogenic halo and texture, poorly vascularized with well-defined margins; C) clinical evidence of lymphoid hyperplasia on the left lateral border of the tongue, showing a lesion of small dimensions (0.8 cm), nodular and yellowish color.
A) presence of primary lymph nodes in close proximity to the oral mucosa lining epithelium; B) secondary lymph nodes with the formation of well-defined germinal centers (HE, pannoramic viewer – 1000 μm); C) interfollicular areas populated by small lymphocytes; D) lymphocyte with typical mitosis figure (black circle) in interfollicular region; E) presence of macrophages (black arrows) in the germinal centers of secondary lymphatic follicles; F) presence of epimioepithelial island (black circle) (HE, pannoramic viewer – 50 μm).HE: hematoxylin and eosin.
A) immunopositivity in lymphoid follicles for CD20, exhibiting greater immunoreactivity in the mantle zone relative to the germinal center; B) immunoreactivity for CD68 in macrophages located in both lymphoid follicles and parafollicular regions; C) CD3 with evident immunolabeling in parafollicular regions; D) immunostaining for Bcl-2 in the mantle zone and parafollicular regions, abscence of positivity in the germinal center of follicles.Bcl-2: B-cell lymphoma 2.