Clinical Pathology: General Principles, Hematology & Coagulation, Immunology & Histocompatibility, Urinalysis, Body Fluids, Clinical Microscopy, Genetic Testing

449) A 32-year-old woman develops multiple enlarged cervical lymph nodes and presents to her physician. He decides to send her for an excisional biopsy of one of the nodes, as shown in the figures. Which one of the following infections is most often linked to this patient’s adenopathy?

• Lymph nodes affected by Castleman disease frequently show atretic follicles surrounded by concentric mantle cell lymphocytes, creating an onion-skin appearance.

• The atretic follicles in Castleman disease are often perforated by a single prominent venule, which enters at a 90-degree angle and creates a lollipop appearance.

• Castleman disease can be of the hyaline vascular, plasma cell, or plasmablastic variants.

• Plasma cell and plasmablastic Castleman disease are associated with human herpesvirus-8 (HHV-8) and human immunodeficiency virus (HIV) infection and show expansion of plasmacytoid cells in the interfollicular areas.

• HHV-8-associated multicentric Castleman disease has a propensity to progress to large B-cell lymphoma.

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