32-year-old female developed a 30-pound weight loss and extensive lymphadenopathy, which was biopsied in the left axilla and found to have Castleman's disease, hyaline-vascular type. She was significantly symptomatic and had elevated IL-6. She was treated with Actemra (Anti- IL6 treatment), reached remission.  About a decade later disease relapsed with night sweats, weight loss of 15 pounds, and insomnia. Repeat PET scan showed predominantly left axillary lymphadenopathy. Histopathology was significant for preserved, but distorted nodal architecture with numerous hyperplastic follicles and regressed germinal centers. There are rare follicles that show twinning and vessels penetrating the germinal center.