S13C10bP8b-Lymphoplasia


S13C10bP8b-1: There are laminated, perivascular deposits of hyalin. In this field, the lymphoid infiltrates are composed of lymphocytes and histiocytes. The hyalin might be compared to the “toxic hyalin” of granuloma faciale, but the character of the infiltrate is basically lymphoid. There are scattered plasma cells. The perivascular deposits lack the features of amyloid, but a paraprotein (para-amyloid) should be ruled-out. The deposits are reminiscent of similar deposits that might be encountered in lymph nodes in so-called “angiofollicular lymphadenopathy” (Castleman disease). The patient should be examined for evidence of a proteinopathy.


S13C10bP8b-2: The hyalin is laminated; some of the material is perivascular in distribution. To the right and above the center of the field, plasma cells are a prominent component of the infiltrates. Cytologic atypia is not a feature (in the face of the plasmacytosis, the patient should be examined for a monoclonal gammopathy; immunoreactions for the demonstration of kappa and lambda light chains would be of interest).

S13C10bP8b-3: The infiltrates are lymphoplasmacytic. Hyalin deposits are laminated; some are perivascular in distribution. Castleman disease should be considered in the differential diagnosis.

S13C10bP8b-4: Cytologic atypia is not a feature. There are scattered eosinophils. The infiltrates below the center of the field are rich in plasma cells. Hyalin surrounds a vessel. The hyaline deposits are of a type sometimes characterized as para-amyloid. The material is more fibrous than classic amyloid; it is not congophilic. Reactions for kappa and lambda light chains showed a restriction to kappa light chains in the reaction of the “para-amyloid” to the antibodies. On this basis, additional studies to rule out a lymphoplasmacytic lymphoma might be indicated.

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