Progressive transformation of germinal centers (PTGC) is a benign reaction pattern whereby follicles of varying size, many of which contain prominent germinal centers, are infiltrated by small mantle zone B-cells. The frequency of PTGC has been estimated to be around 3.5 %. It is seen more commonly in adult males (male–female ratio, ~3:1). In one study, patients ranged from 10 to 78 years in age, with a median age of 53 years, whereas in another study patients were younger, with a median age of 28 years.
It seems likely that PTGC is a reaction pattern for which there are multiple etiologies. Progressive transformation of germinal centers is usually identified focally in a lymph node with reactive follicular hyperplasia. Another form of PTGC manifests itself as an acute and generalized process, often in adolescents and young adults. In another subset of patients, PTGC is identified in association with lymphoma, most commonly nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). In a recent study, Grimm et al. identified PTGC in lymph nodes with increased IgG4+ plasma cells. The pathogenesis of PTGC remains unknown, but evidence points to a continuum of reactive changes that starts with follicular hyperplasia followed by follicular lysis, eventually forming PTGC with mantle zone B-cells infiltrating into the germinal center. Progressive transformation of germinal centers can recur in a subset of patients, up to one third in a recent pediatric study.
Follicular Lymphoma Germinal Center Mantle Zone Classical Hodgkin Lymphoma Follicular Hyperplasia
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