Systemic inflammatory disorders of the lymphoreticular system mimicking lymphoma: A focused group study

ABSTRACT Aims: Inflammation is the process of protecting the body against pathogens mediated by cytokines. Their unprecedented production involves multiple organs with systemic manifestations and causes changes in the morphology of lymphoid tissues, which are nonspecific and are diagnosed as non-lymphomatous reactive lymphadenopathies. We aim to study the different types of histological changes in the lymph nodes and bone marrow (BM) brought about by certain systemic autoimmune and inflammatory disorders and how to corroborate the biochemical, serological, and clinical details to clinch the diagnosis. Materials and Methods: The histological features of a total of 44 lymph node excision biopsies and BM biopsies, suspicious of lymphoma, were studied in conjunction with the biochemical, serological, and radiological findings. Results: After excluding lymphomas, tuberculosis, and mycosis, there were 10 cases that showed nonspecific reactive changes in lymph nodes and BM having either an autoimmune disorder or a nonspecific inflammatory disorder due to unknown etiology. After a detailed histological study, these 10 cases were divided into three groups: idiopathic multicentric Castleman’s disease-not otherwise specified (iMCD-NOS), idiopathic multicentric castleman’s disease without proven-thrombocytopenia, anasarca, fever, reticulin fibrosis, organomegaly (TAFRO), and autoimmune-associated systemic disorder (T-zone dysplasia with hyperplastic follicles and autoimmune myelofibrosis (AIMF)). Conclusion: Any patient with a multisystemic disorder and non-lymphomatous generalized lymphadenopathy showing reactive nonspecific or Castleman-like changes should be thoroughly investigated for a nonneoplastic etiology such as autoimmune disease or infection to help with timely intervention.