Florid Lymphoid Hyperplasia: An Overview

Introduction:

Florid hyperplasia is the degree of proliferation of cells in a tissue. The abnormal proliferation of cells in the lymph nodes due to any kind of stress caused is called lymphoid hyperplasia. Hyperplasia could be due to physiological or pathological factors.

What Causes Florid Lymphoid Hyperplasia?

Florid lymphoid hyperplasia is a malignant condition arising from the blood. It starts from the bone marrow and circulates throughout the distant parts of the body. These malignancies are of various kinds and are present as tumor masses of the lymph nodes or other organs. These tumor masses are made up of plasma cells that produce partial or complete monoclonal immunoglobulin polypeptide. Due to its lymphatic drainage system, it tends to spread throughout the body, such as the liver, spleen, and bone marrow. Often these abnormal cells get flushed out throughout the body, mimicking blood cancer. The cause of such conditions is the invasion of foreign bodies like viruses and bacteria into the lymph nodes giving rise to lymphocytes. They are also caused as a result of growth factor-induced proliferation of mature cells, increased output of new cells from the stem cells, increased local production of growth factors that lead to an increased level of growth factor receptor on responding cells, and also due to activation of particular intercellular signaling pathways.

What Are the Types of Hyperplasia Present?

• Physiological Hyperplasia: Enlargement of breast tissue seen during puberty or lactation period. Another citation of tissue enlargement is seen in the uterus during the proliferation phase of the cycle in the endometrium.

• Hormonal Hyperplasia: This is caused due to excessive hormone production, as seen during pregnancy.

• Compensatory Hyperplasia: This is caused by removing an organ or a part of an organ, like paired organs. For example, regeneration of liver cells is seen in partial hepatectomy, epidermis regeneration after skin abrasion, and hyperplasia is seen in the nephrons of kidney cells after nephrectomy.

• Pathological Hyperplasia: It occurs due to the overstimulation of hormones or growth factors. For example, endometrial hyperplasia is seen due to excessive production of estrogen, granulation tissue is seen in wound healing areas due to excessive production of fibroblasts, hyperplasia of the epidermis caused due to human papillomavirus seen as warts, hyperplasia of the skin seen as pseudo carcinomas, and intraductal epithelial hyperplasia of the breasts seen in fibroblastic breast disease. Hyperplasia is observed in the prostrate gland during aging. The tumors arising from adrenal glands and parenchymal organs in acromegaly show hyperplasia.

What Are the Different Types of Lymphocytes Present in the Human Body?

Lymphocytes are cells of the lymph nodes and are an essential part of the immune system. These lymphocytes are present as white blood cells in the blood. The lymph nodes play defense mechanisms by producing antigens against the antibodies. There are three types of lymphocytes:

• B-Cells: These cells are derived from the bone marrow. They produce antibodies from the helper T cells of the plasma.

• T-Cells: These cells are made in the bone marrow and mature in the thymus. They are further classified into three subtypes. Namely, the cytotoxic T-cells that help to destroy the antigens; helper T-cells that help B-cells and macrophages fight against infection; regulatory T-cells, otherwise known as suppressor cells, help suppress cells in the immune system and maintain tolerance against self-antigen by preventing autoimmune disease.

• Natural Killer Cells: When the number of lymphocytes decreases, it is called lymphocytopenia, and when their production is increased, it is called lymphocytosis. Such fluctuations are common in infectious conditions. Natural killer cells are a part of the innate immune system. They are in the bone marrow, liver, uterus, spleen, lung, and thymus. It plays an important role in identifying and killing stress cells in the absence of antibodies.

What Is Reactive Lymphoid Hyperplasia?

It is a common condition where the lymph nodes enlarge in size. They are more commonly seen in the neck regions. It is caused due to infections like tuberculosis, measles, drug interactions, human immunodeficiency virus (HIV), dental infections, cancer of lymph nodes (lymphoma), lymphadenitis, reactive lymphadenopathy, ear infection, throat infections, and disorders of the autoimmune system. Once the infection subsides, the lymph node resumes back to its normal size. The oral lymphoid tissues are the highest reactive tissue among all the body's lymphoid tissues. They are also known as focal lymphoid hyperplasia.

What Are the Pathological Changes Observed in Lymphoid Hyperplasia?

Any tissue or organ affected with hyperplasia shows the following changes:

• Increase in tissue or organ size.

• Increase in volume due to increased number of cells.

• The rate of DNA synthesis increases.

• Increased mitotic rate of cells occurs.

What Are the Symptoms of Lymphoid Hyperplasia?

Some of the presenting symptoms are:

• Fever.

• Unintentional weight loss.

• Fatigue.

• Night sweats.

• Nausea.

• Enlarged lymph nodes.

• Enlarged liver or spleen.

• Reddening of the skin.

• Pain.

How Can We Check for Lymphoid Hyperplasia?

Various tests are available to diagnose the condition. Such as:

• Blood Tests: Tests such as complete blood count are done to obtain the platelet and white blood cell count. Blood tests are also done to detect the human papillomavirus (HPV), HIV, hepatitis-C virus (HCV), and hepatitis-B virus (HBV).

• Urine Tests: Urine analysis is done to check for the presence of antigens.

• Imaging Tests: Diagnostic imaging tests like ultrasonography (USG), magnetic resonance imaging (MRI), and computed tomography (CT) are performed to capture the tumor sites of internal structures.

• Comprehensive Metabolic Panel: This is done to evaluate the number of chemicals in the blood.

• Immunoelectrophoresis: A serum immunoglobulin test is done to check the presence of immunoglobulins in non-Hodgkin's lymphoma (NHL).

• Cytogenetic Analysis: It is done to study any abnormality present in the chromosomal structure of the DNA molecule.

• Lymph Node Biopsy: Various methods of biopsy studies are present. It is done by collecting sample tissues from the body using fine needle aspiration cytology (FNAC) and other studies like immunophenotyping, where the biopsy tissue is sliced and treated with antibodies to identify different tumor markers cells from that of normal lymphocyte cells.

• Serum Lactate Dehydrogenase (LDH): This helps detect Hodgkin’s disease.

• Tumor Markers: The presence of CD2, CD3, CD4, CD7, and CD8 are indicative of tumor cells. The presence of CD10, CD19, and CD20 indicates cancerous lesions. The presence of CD16 and CD 56 helps in the detection of natural killer (NK) cells. Disorders such as myeloid and lymphoid leukemias have CD13, CD14, CD15, and CD64 cells.

How Can We Get Treated for Lymphoid Conditions?

Treatment varies from condition to condition and the specific factors causing them. Some treatment options are:

• Immunotherapy: The administration of drugs to treat infections like acute lymphadenitis caused by bacterial infections given antibiotics like the enzyme Beta-Lactamase.

• Chemotherapy: Chemicals are used to kill malignant cells.

• Corticosteroids: For subconjunctival hyperplasia, corticosteroid injection of Triamcinolone of 20mg is administered.

• Antiviral Drugs: Antiviral drugs inhibiting the protease and nuclease inhibitor are given, like Acyclovir, Valganciclovir, Ritonavir, and Atazanavir.

Conclusion:

Florid lymphoid hyperplasia is always followed by lymph node swelling. The swelling of the regional lymph nodes is a symptom and not a disease as such. These voluminous masses of tissue pathogens can progress into malignancies. Due to its peripheral circulation, the spread to distant tissues leads to metastasis, making the prognosis much more difficult. Hence, a thorough examination at the preliminary stage of symptoms is advised for a faster recovery.