Investig Magn Reson Imaging.  2017 Mar;21(1):56-60. 10.13104/imri.2017.21.1.56.

Progressive Transformation of Germinal Centers in Presacral Space: MRI Findings and Literature Review

• Hwang ST
• Sung DJ
• Sim KC
• Han NY
• Park BJ
• Kim MJ
• Lee JH

• KMID: 2376271
• DOI: http://doi.org/10.13104/imri.2017.21.1.56

Abstract

Progressive transformation of germinal centers (PTGC) is an atypical feature seen in lymph nodes with unknown pathogenesis. PTGC most commonly presents in adolescent and young adult males as solitary painless lymphadenopathy with various durations. Cervical nodes are the most commonly involved ones while involvements of axillary and inguinal nodes are less frequent. PTGC develops extremely rarely in other locations. We report a rare case of solitary mass present in the presacral space. The mass as subsequently proven to be PTGC. To the best of our knowledge, PTGC in the presacral space has not been previously reported in the literature.

Keyword

Progressive transformation of germinal centers; Presacral space; Magnetic resonance imaging

MeSH Terms

Adolescent
Germinal Center*
Humans
Lymph Nodes
Lymphatic Diseases
Magnetic Resonance Imaging*
Male
Young Adult

Figure

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  Fig. 1 Axial T2-weighted turbo spin-echo (a) and axial T1-weighted turbo spin-echo (b) MR images showing a well-circumscribed presacral mass with slightly high signal intensity on T2-weighted imaging and iso-signal intensity on T1-weighted imaging. Axial contrast-enhanced T1-weighted subtraction MRI (c) showing homogeneous enhancement on 1-min delayed phase. DWI (b-value = 800 s/mm2) (d) showing high signal intensity in the mass. (e) The mass demonstrates low signal intensity on ADC map. A few small high T2 signal intensity foci (a, arrow) showing strong contrast enhancement (c, arrow) were scattered in the center of the mass. These foci were not shown on DWI or ADC map due to their small sizes.

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  Fig. 2 The specimen with a round shaped soft tissue measured at 3.6 × 3.3 × 1.8 cm. The external surface is smooth. On section, the cut surface shows a diffusely yellowish-gray homogeneous appearance.

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  Fig. 3 The section from lymph nodes with variable sizes and enlarged follicles with indistinct margins. It is composed of follicular mantle lymphocytes and extensive follicular dendritic cells. H&E stain, × 40 (a). Positive CD21 immunostaining of follicular dendritic cells, × 40 (b). Bcl-2-positive mantle zone B cells infiltrate and disrupt germinal centers, × 200 (c).

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