Localized herpes simplex lymphadenitis mimicking large-cell (Richter's) transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma.
We report a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) who presented with rapid enlargement of a cervical lymph node due to localized herpes simplex lymphadenitis, which was clinically indistinguishable from large cell (Richter's) transformation. The diagnosis was made by excisional lymph node biopsy, which demonstrated CLL/SLL and zonal necrosis due to herpes simplex infection. The herpetic zone was surrounded by a brisk proliferation of immunoblasts. This case demonstrates the need for excisional biopsy and histologic examination of rapidly enlarging nodes in patients with CLL/SLL. The diagnosis of herpes simplex lymphadenitis in patients with CLL/SLL is especially important because, unlike large cell transformation, the infection usually responds well to treatment.
Joseph
L
L
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. josephlija@uams.edu
Scott
M A
MA
Schichman
S A
SA
Zent
C S
CS
D001706:Biopsy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D003937:Diagnosis, Differential; D006561:Herpes Simplex / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000473:pathology / Q000821:virology; D008198:Lymph Nodes / Q000473:pathology / Q000821:virology; D008199:Lymphadenitis / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged