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LYMPH NODE HISTOPATHOLOGY

TO MEET THE MAJOR CRITERIA FOR iMCD DIAGNOSIS, PATIENTS MUST HAVE
GRADE ≥2 ‘HYPERVASCULAR’ OR ‘PLASMACYTIC’ LYMPH NODE HISTOPATHOLOGY –
OR A MIX OF BOTH (FIGURE 2, TABLE 1).1

Figure 2: iMCD lymph node histopathology

Figure 2: iMCD lymph node histopathology

Figure 2: iMCD lymph node histopathology

Table 1: Spectrum of lymph node histopathology for iMCD diagnoses<sup>1</sup>

Table 1: Spectrum of lymph node histopathology for iMCD diagnoses1

HYPERVASCULAR
PATHOLOGY 		MIXED
PATHOLOGY 		PLASMACYTIC
PATHOLOGY
  • Regressed GCs
  • FDC prominence
  • Hypervascularisation
  • Patient sinuses
  • ‘Onion skinning’
  • ‘Lollipop signs’
  • ‘Budding’ or ‘twinning’ of follicles
  • Regressed follicles with plamacytosis
  • Sheet-like plasmacytosis
  • Increased numbers of follicles with large hyperplastic GCs
  • Occasional regressed GCs and mild vascularity

Images below are examples of the respective grades for each histopathological feature (Figure 3).

Figure 3: Grades for each histopathological feature seen in iMCD

Figure 3: Grades for each histopathological feature seen in iMCD

Grade 2 or 3 for either regressed GCs or plasmacytosis is needed to meet the major criteria for iMCD diagnosis
(other features consistent with the iMCD histologic spectrum should also be present)

Grade

A Regressed Germinal
Centres (GCs)

No Regressed GCs

No Regressed GCs

Few Regressed GCs

Few Regressed GCs

Many Regressed GCs

Many Regressed GCs

Most Regressed GCs

Most Regressed GCs

B Follicular Dendritic Cell
(FDC) Prominence

No FDC Prominence

No FDC Prominence

Mild FDC Prominence

Mild FDC Prominence

Moderate FDC Prominence

Moderate FDC Prominence

Very Prominent FDCs

Very Prominent FDCs

C Vascularity

Normal

Normal

Mildly Increased

Mildly Increased

Moderately Increased

Moderately Increased

Very Prominent

Very Prominent

D Hyperplastic Germinal
Centres

No Hyperplastic GCs

No Hyperplastic GCs

Few Hyperplastic GCs

Few Hyperplastic GCs

Many Hyperplastic GCs

Many Hyperplastic GCs

Most GCs Hyperplastic

Most GCs Hyperplastic

E Plasmacytosis

Normal

Normal

Mildly Increased

Mildly Increased

Moderately Increased

Moderately Increased

Very Increased (’Sheet-like’)

Very Increased (’Sheet-like’)

The above images are examples of the respective grades for each histopathologic feature. Deidentified lymph node
slides were prestained with hematoxylin and eosin. Bars represent 500 mm (A,D), 80 mm (B), 200 mm (C), 60 mm (E).

Adapted from Fajgenbaum DC et al.1

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EUSA Sylvant © 2021 EUSA Pharma      Date of prep: November 2021    GL-SIL-2100101

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