A rare case of progressive transformation of germinal centers in a 15-year-old child: A diagnostic challenge

This case report describes a 15-year-old male child who presented with cervical and axillary lymphadenopathy. The patient’s physical examination and laboratory tests showed normal results, while imaging studies revealed numerous enlarged lymph nodes with heterogeneous appearances. A comprehensive evaluation led to the diagnosis of Progressive transformation of germinal centers (PTGC) through excisional biopsy of the cervical lymph node. The differential diagnosis included pediatric-type follicular lymphoma and nodular lymphocyte-predominant Hodgkin’s lymphoma. Histomorphology and immunohistochemistry findings were consistent with PTGC, characterized by enlarged follicles with expanded mantle zones, follicle lysis, and reactive changes. The importance of considering PTGC in the differential diagnosis of lymph node enlargement in children is highlighted, especially when imaging features are not specific enough to rule out malignant lymphadenopathy.