Infiltrative Mass in the Neck as a Presenting Feature of Lupus-Like Illness in a Middle-Aged Man
A middle-aged man presented with a mass in the cervical region associated with severe constitutional symptoms, generalized lymphadenopathy and hepatosplenomegaly. Histopathology showed angiocentric immunoproliferative lesions consisting of a mixture of lymphocytes, plasma cells, immunoblasts and histiocytes on a background of hyperplastic vascular structures. Active vascular necrosis with fibrinoid changes was present with expansion of T-cell areas with reactive changes typical of angiocentric lesions. Detailed clinical and laboratory workup showed features suggestive of systemic lupus- or latent-lupus-like disease. The patient showed an excellent response to prednisolone and chloroquine with complete recovery of all the clinical features. During the 22 months of follow-up the patient remained in complete normal health. Different histopathological varieties of lymph node lesions seen in systemic immunological diseases are discussed with emphasis on features which help in distinguishing them from lymphomas.