Two recurrent progressive transformations of germinal centers: A case report

The term 'progressive transformation of germinal centers (PTGC)' refers to a follicular structure that is much larger than a normal germinal center, which consists of small lymphocytes and remnants of germinal center cells. The histological similarity between PTGC and nodular lymphocyte predominance Hodgkin's disease (NLPHD) and the frequent association between these two disease entities suggest that PTGC are precursors of NLPHD. The authors discuss the case of a 49-year-old female who presented an asymptomatic right submandibular lymphadenopathy. Although an excised lymph node revealed the presence of PTGC, the results of a physical examination and a hematological study showed no abnormalities. Sixteen months later, however, a relapse in the same lymph node region occurred and an excised node again revealed PTGC. Twenty-three months later, another relapse occurred but this time in the left submandibular lymph node region, and an excised node again showed the presence of PTGC. Therefore, to prevent the transformation of these PTGC into a malignant lymphoma, cervical and supraclavicular radiation was initiated. At 58 months following this third appearance and irradiation, no further evidence of a disease recurrence has been noted. Previously reported PTGC cases have shown a long delay before the development of NLPHD. Therefore, prolonged follow-up will be necessary in this case.