HIV lymphadenopathy


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  • Clinical

    • most commonly due to the virus itself
    • rule out lymphoma, MCD, Kaposi, secondary infections

  • Histology

    • hyperplastic phase: florid follicular hyperplasia, persistent (> 3 mo) generalized lymphadenopathy
      • back-to-back germinal centers, attenuated mantle zone
      • GCs with increased centroblasts, tangible body macrophages
      • follicle lysis, hemorrhage
      • paracortex with increased vessels, plasma cells, monocytoid cells, granulomas
    • intermediate phase: in between
    • involuted phase: follicle atrophy, depletion
      • smaller, fewer follicles
      • hyalinized follicles
      • expanded paracortex
      • vessels, fibrosis, amorphous pink material

  • Ddx

    • follicular lymphoma (BCL2+, clonal)
    • infectous mono
    • nonspecific follicular hyperplasia
    • Castleman disease, hyaline vascular type
    • AITL
    • Kaposi sarcoma
    • other secondary infections
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