Discussion
SLE cases may manifest with localized or generalized LAD. Although LAD is not regarded in the SLE classification criteria, in cases with SLE, LAD is a frequent presentation. Biopsy of lymph nodes was more common in SLE cases to differentiate malignant or benign causes in recent years. The varying coagulative necrosis degrees histologically with hematoxylin bodies in lesions of the lymph node are specific to SLE. While these feature findings are found in the biopsy. Overall, nonspecific findings like hyperplasia of follicular are detected in biopsy specimens (4, 8).
The CD is a lymphoproliferative disorder polyclonal group with unclear etiology, showing two main characteristic histopathologic features: plasma-cell type and hyaline vascular type (9). Based on the disease course and clinical manifestation, CD is categorized into unicentric CD (UCD), a single lymph node involved, and is a reversible and localized disease (9, 10). Multicentric CD (MCD) is a progressive and systemic with LAD in multiple nodes, often fatal disease (11). Recently, ‘regional CD’ or ‘oligocentric CD,’ referred to as an intermediate subtype, has been described. A few lymph nodes are involved and are mostly deliberate to have a UCD-similar clinical course (12). According to these definitions and the patient’s CT scan results, he can be MCD or oligocentric CD. Most cases with MCD are plasma cell type, while UCD is the hyaline vascular type like ours (1).
The CD histopathological findings have been relatively rarely reported in SLE cases. Recently, the lymph node biopsy frequency for SLE subjects exhibiting lymphadenopathy has elevated to exclude lymphoma risk, which results in case reports accumulation about the morphology of CD manifesting in SLE patients with LAD. A study showed that 26 percent of SLE cases with LAD demonstrated similar CD histological characteristics, which shows a close correlation between SLE and CD (5, 13).
A study showed SLE and CD together. In their case, only one lymph node was involved in the cervical area, while in our case, several cervical lymph nodes were involved. Also, in their cases, the onset of SLE, CD was diagnosed, and it was plasma cell type, while in our case, it was of the Hylan vascular type, and LAD was several years after initiating the SLE (7). In the study of Zhang et al. (14), another CD case of Hylan vascular type has been shown, in which the LAD was generalized and responded well to Rituximab treatment. Additionally, Simko et al. and Hu et al. reported two children with CD and SLE at 11 and 16 years, respectively.