Morphological differences between follicular lymphomas and follicular hyperplasia of the lymph nodes

A study was performed in 80 patients with follicular lymphomas and 61 patients with follicular hyperplasia of lymph nodes. The sensitivity, specificity, prognostic value, and the positive and negative likelihood ratio of various histological differentially diagnostic parameters were estimated. The signs that are of great informative value were as follows: the presence (or absence) of concentric layers of mantle cells, follicular polarization, the presence of histiocytes with phagocytosed nuclear debris in the follicles and atypical follicular cells outside the follicles.     

Prevalence of follicular lymphoma in situ in consecutively analysed reactive lymph nodes

Henopp T, Quintanilla‐Martínez L, Fend F & Adam P
(2011) Histopathology 59 , 139–142 Prevalence of follicular lymphoma in situ in consecutively analysed reactive lymph nodes Aims: Follicular lymphoma (FL) in situ is defined as strongly bcl‐2‐positive B cells in germinal centres of morphologically inconspicuous lymph nodes. The prevalence and biological and clinical significance of this lesion are still not clear. Therefore we aimed at the detection of the prevalence of this phenomenon in an unselected series of lymph nodes, as a surrogate for the normal population. Methods and results: All 1294 reactive lymph nodes from unselected consecutive surgical specimens of 132 patients in a 3‐month period were stained for bcl‐2 protein. The t(14;18) translocation was investigated by fluorescence in‐situ hybridization (FISH) analysis. FL in situ was identified in 22 lymph nodes in 3/132 patients (2.3%) without evidence or history of malignant lymphoma, and confirmed by detection of the t(14;18) translocation by FISH. Interestingly, in one patient, a lymph node excised 2 years before also contained FL in situ. Conclusions: We found a prevalence of 2.3% for FL in situ lesions in an unselected series of lymph nodes, as a surrogate for the normal population. Taking into account the incidence of manifest FL, the risk of progression of this lesion is probably limited. It can be speculated that some FL in situ lesions do indeed represent an early step in lymphomagenesis, whereas others persist without further progression to overt FL. The underlying mechanisms, however, remain to be elucidated.     

Immunohistological study of reactive follicular hyperplasia of lymph node in childhood]

Reactive follicular hyperplasia (RFH) of lymph nodes, which is often found in the peripheral nodes in children, is usually caused by viral, bacterial, or other specific infections, and sometimes complicated with dermatopathic lesions, or immunological disorders. Those nodal lesions might result from one of the various immunological reactions to some antigen. In this histologic and immunohistologic study, we mainly investigated the cells in the involved nodes. As the results, in the cases of the conspicuous follicular hyperplasia, there were prominent increase of the T-cell with positive UCHL1, the antigen presenting cells with positive S100 protein in T-nodule, and the B-cell with positive L26 in germinal center and cortical sinuses. The nodes with conspicuous follicular hyperplasia also showed foci of infiltration of the polymorphous leukocytes or the lysozyme positive mono-macrophages in the cortical sinuses at the early or acute stage. Decreasing the grade of RFH, the polymorphous or the macrophage infiltration disappeared, while S100 protein positive histiocytes remained as the persistent nodules or aggregates in the cortical sinuses. It was also noted that the B-cells with polyclonal surface immunoglobulins, IgM, kappa, or lambda, increased in number in the case of conspicuous RFH. The RFH might be the result of increased activity of the cellular and humoral immunity, with which T-cells, B-cells, antigen presenting cells, and mono-macrophages are concerned.(ABSTRACT TRUNCATED AT 250 WORDS)     

Angiofollicular hyperplasia of the lymph nodes

Clinicomorphologic features of the hyaline-vascular and plasmacytic variants of lymph nodes angiofollicular hyperplasia are defined on the basis of literature data and the authors' own observations. Problems of morphologic diagnosis and nosology of this kind of the lymph node lesion are discussed.     

Multinucleated giant cells in enlarged axillary lymph nodes

Routine preoperative ultrasound examination of axillary lymph nodes in patients with breast cancer will identify enlarged lymph nodes. This enlargement may be due to metastatic breast cancer or it may be due to unrelated causes. These enlarged lymph nodes are likely to be sampled by needle core biopsy and submitted for histopathology examination. This paper reports two cases where the enlargement was not related to breast cancer. In both cases multinucleated giant cells were a prominent feature of the histopathology. In one case these cells were macrophage-derived multinucleate giant cells formed as a reaction to a ruptured breast implant, in the other they were megakaryocytes in a patient with an undisclosed myeloproliferative disorder.     

Chronic neutrophilic leukaemia with enlarged lymph nodes and lysozyme deficiency

A further case of chronic neutrophilic leukaemia is reported and compared to fourteen previously reported cases. The presence of enlarged lymph nodes as the first clinical sign and the existence of a relative lysozyme deficiency of the granulocytes were striking features.     

Studies on the reactive process in lymph nodes

Summary By means of a lengthy method of continuous cytologic and histologic study, an experimentally produced reactive process in lymphnodes was analyzed. This analysis was made both qualitatively and quantitatively, in an attempt to clarify the mechanisms of reaction and the underlying cellular alterations producing this change.The reaction begins in the medullary cords and gradually spreads to the cortex. New cells are formed. This cytopoesis, considered accidental, quantitatively exceeds the physiologic process, and depends upon stimulation of the reticulo-cellular system.The cells of this accidental cytopoesis are characteristically very variable in form. A constant transition of forms occurs. This dynamic cell, as it is seen in the reactive formation of new cells, can be observed only by continuous study. The small reticulum cell proves to be a particularly adaptable and plastic element, and is the real basis of the reaction. Large and small lymphocytes, as well as transitional forms and plasma cells are derived from it. For these cell types, no other parent cells can be postulated.The reactive formation of new cells reaches its maximum between the 20th and 26th day, and then shows a steady decrease in spite of further stimulation of the lymphnode. During the course of the reaction numerous quantitative interrelationsships among the individual groups of cells can be found. The conclusions gained from the cellular preparations are substantiated by means of histological controls and supplemented by a few important other points.The observation of the cytologic and histologic cellular movements, of the quantitative interrelationships among the individual groups of cells, and of the continuous change in form of the cells during the reaction are made the basis for the survey of the cytopoesis in lymphatic tissue. The large reticulum cell is considered to be the parent cell for the accidental formation of cells in reactive processes. The cellular supply is maintained probably by means of hemihomo-hemiheteroplastic reproduction. The small reticulum cell with the highest mitotic rate apparently reproduces itself in the homoplastic way. Those cells derived from it are responsible for the polymorphous picture of cells in the reactive processes of the lymphatic tissue. The theories of determinate developmental processes and the retrograde transformation of cells in lymphatic tissues are rejected.Both the bud-like formations on the nuclei of the small reticulum cells, and the appearance of dwarfed nuclei, in conjunction with the quantitative relation to the number of binucleated reticulum cells, suggest a mechanism of growth which shows similarity to the karyonomia or meroamitosis.     

Common reactive erythrophagocytosis in axillary lymph nodes

Erythrophagocytosis by histiocytes in the sinuses of axillary lymph nodes is a common yet little-known phenomenon. The axillary lymph node dissections of 23 patients were studied by light microscopy and graded for the amount of erythrophagocytosis. None of the patients had evidence of a systemic hemolytic process. Nineteen of them exhibited some degree of erythrophagocytosis, and this was present even in four of the six patients who never had a prior breast biopsy. Breast biopsy was associated with massive degrees of erythrophagocytosis in 8 of 17 patients, and after a postbiopsy interval of two weeks 11 of 13 patients had hemosiderin deposition in the lymph nodes, evidence of red blood cell breakdown. This study serves to substantiate statements, made by others without confirmatory data, that large degrees of erythrophagocytosis may be seen in axillary lymph nodes after breast biopsies and that small amounts of erythrophagocytosis may be identified in lymph nodes of patients with no prior trauma history.     

Adrenergic innervation in reactive human lymph nodes

Several experimental models have demonstrated that the central nervous system is functionally linked to the immune system by means of the autonomic nervous system. Samples of 36 lymph nodes of patients whose ages ranged from 16 to 69 y were studied. In order to demonstrate the existence and distribution of sympathetic nerve fibres, a polyclonal antibody antityrosine hydroxylase (TH), with the streptavidin-biotin system of detection, was used. TH-positive nerve fibres appeared in all reactive patterns of the lymph nodes studied. Thin nerve fascicles ramified at the hilar region and also in the connective tissue septae. Adventitial adrenergic nerve fibres were found following afferent, and to a lesser extent, efferent blood vessels. Another source of incoming nerve fibres was found at capsular level, accompanying blood vessels. On the arterial side, the innervation ceased before reaching the follicular arterioles. Our demonstration of innervation in postcapillary venules could support a regulatory role of adrenergic neurotransmitters in lymphocyte traffic. Occasional nerve fibres were also seen in T areas among parenchymatous cells. These findings confirm the existence of sympathetic innervation in human lymph nodes, and provide indirect evidence that the psychoneuroimmune axis could also exist in humans.     

IgM expression in paraffin sections distinguishes follicular lymphoma from reactive follicular hyperplasia

The trapping of IgM-containing immune complexes (ICs) by follicular dendritic cells (FDCs) serves as an important step in promoting germinal center (GC) formation. Thus, the deposition of IgM-containing ICs on FDCs can be detected by antibodies recognizing IgM. The present investigation provides the first comprehensive report on the IgM staining pattern in follicular lymphoma (FL, n = 60), with comparisons to reactive follicular hyperplasias (RFH, n = 25), demonstrating that immunohistochemical staining for IgM in paraffin-embedded sections seems to be an additional tool for differentiating between FL and RFH. In RFH, IgM highlighted processes of FDCs, with stronger and more compact staining in light than in dark zones, with occasional very dim staining of GC B cells. In FL, IgM expression patterns were of three types. Pattern I (38 cases) stained tumor cells within neoplastic follicles, with no staining of FDCs. Pattern II (15 cases) stained neither tumor cells nor FDCs. Pattern III (7 cases) stained tumor cells with (3 cases) or without (4 cases) IgM expression; however, variable and attenuated IgM expression was observed on FDCs in each case. Interestingly, significant numbers of IgD+ mantle cells were preserved around the neoplastic follicles in these 7 cases. The data suggested that a complete or considerable loss of IgM expression in FDCs, reflecting the loss of IgM-containing ICs in FDCs, is a typical feature of FL. Increased IgM expression by GC B cells can also serve as an indicator of immunophenotypic abnormality in FL.     

Evaluation of 18F-fluorodeoxyglucose uptake in enlarged mediastinal lymph nodes in patients with lung cancer

Accurate lymph nodal staging of lung cancer is critical for determining the treatment options. With the help of ¹⁸F-fluorodeoxyglucose positron emission tomography/computer tomography (¹⁸F-FDG-PET/CT), the clinician can rule out/in the regional lymph nodes positive for metastasis in the patients with lung cancer in a majority of cases. However, a small proportion of cases with false positivity of metastasis have been reported. Transbronchial needle aspirations and mediastinoscopic biopsies are still necessary to determine whether enlarged hypermetabolic mediastinal lymph nodes are positive for lung cancer metastasis. Here we report three intricate cases showing hypermetabolic activity in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer on PET/CT. The first patient had squamous cell carcinoma in the left upper lobe of the lung with surrounding necrotizing granulomas and concurrent with silicosis and granulomatous inflammation in the lymph nodes; the second presented with symptoms of viral pneumonia, which was pathologically diagnosed as a lung adenocarcinoma, stage IA, concurrent with sarcoidosis involving the lymph nodes; the last case was diagnosed as squamous cell carcinoma in the right upper lobe of the lung, but lymph nodes showed reactive hyperplasia. These cases suggest that some cases are so complex that avid ¹⁸F-FDG uptake in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer should be carefully analyzed based on individual patients’ clinical background.     

Aberrant humoral immune reactivity in DOCK8 deficiency with follicular hyperplasia and nodal plasmacytosis

Mutations in the DOCK8 gene define the most common form of autosomal-recessive Hyper-IgE-syndrome (AR-HIES/OMIM#243700). In a patient with extensive molluscum contagiosum lesions, a homozygous DOCK8 gene deletion was demonstrated.     

淋巴结单核细胞样B细胞反应性结节性增生

1．病例简介：患者女,30岁。发现右侧颈部淋巴结肿大2d。无发热及其他不适,故未行特殊检查。临床诊断：右颈部淋巴结肿大。     

Sarcomatoid tumours of lymph nodes showing follicular dendritic cell differentiation

Putative sarcomas of follicular dendritic cells are extremely uncommon and only small case numbers have been clearly documented. A major difficulty in their delineation has been the persistent controversy over the phenotype and ontogeny of normal follicular dendritic cells. Two new cases arising in adult females are presented herein, both of which had initially been mistaken for metastases from a true soft tissue sarcoma. Their morphology, immunophenotype, and ultrastructure (in one case) are described in order to aid their wider recognition. In the light of these findings, the nature and origin of follicular dendritic cells are discussed.     

Tenascin in reactive lymph nodes and in malignant lymphomas.

Tenascin is an extracellular matrix protein which accumulates in the stroma of various malignant and some benign neoplasms. This has been verified in several immunohistochemical studies. The distribution of tenascin immunoreactivity in lymphatic tissues and neoplasias, however, has not been thoroughly studied. In this investigation we analyzed tenascin immunoreactivity in several benign and malignant lymphatic lesions, including both Hodgkin's and non-Hodgkin's lymphomas. In benign lymph nodes, faint reticular immunoreactivity could be observed in the lymphatic tissue. In benign reactive hyperplasias, a stronger reticular pattern of tenascin immunoreactivity was observed in the interfollicular and medullary areas, while the lymphoid follicles contained only a few positive fibers. A similar immunoreactivity was observed in malignant follicular lymphomas. In diffuse lymphomas, a diffuse meshwork of positively stained fibers was seen. This was also the case for the three cases of Hodgkin's disease of the lymphocyte-predominance nodular subtype. There was no difference in the intensity of the immunoreactivity between benign and malignant disorders. However, in Hodgkin's disease of the nodular sclerosis and lymphocyte-depletion subtypes, a much more pronounced immunoreactivity could be observed in the fibrous septa and the cords. This suggests that the tumor cells are possibly capable of synthesizing growth factors which stimulate fibroblasts to synthesize tenascin. The results indicate that tenascin does not accumulate in the stroma of malignant lymphoid neoplasms with the exclusion of some subtypes of Hodgkin's disease. The distribution of tenascin immunoreactivity in lymphatic tissue is similar to that of the reticular fibers suggesting that the molecules are associated with these structures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Expression of CD45 isoforms in lymph node reactive hyperplasia

The CD45 antigen family consists of multiple molecular isoforms ranging from 180 to 220 kDa. The highest Mr isoforms are recognized by monoclonal antibodies (MoAbs) designated CD45RA, while those recognizing the low Mr isoforms are designated CD45RO. T cells expressing CD45RA are "naive" or unprimed, while those expressing CD45RO have "memory." Further, stimulation of CD45RA+ T cells induces an isoform switch to the CD45RA-/CD45RO+ phenotype. The present study examined this in vitro process by determining the in vivo CD45 isoform expression of T cells from human hyperplastic lymph nodes. Hyperplastic, as opposed to nonhyperplastic, lymph nodes exhibited the expected CD45 isoform switch from CD45RA+ to CD45RO+ T cells that has been described in vitro. The percentage of CD45RO+ T cells did not correlate with other parameters of lymphoid activation. Thus, CD45RO expression probably represents a marker of differentiation and acquisition of "memory" or late cellular activation.