Changes in the tissues of the immune system in dengue haemorrhagic fever.

A total of 100 post-mortems were done on patients clinically diagnosed as dengue haemorrhagic fever from Rangoon Children's Hospital. Histopathological changes in bone marrow, thymus, spleen, lymph nodes and other associated tissues of the immune system were analysed and correlated with the clinical picture and serology results. The major changes in cases with a positive serology result for secondary dengue infection consist of hypoplasia of the bone marrow, acute atrophy and wasting of the thymus, atrophy and depletion of cells in the periarterial lymphatic sheaths of the spleen and the paracortical areas of the lymph nodes. The tissues affected are the thymus-dependent areas of the spleen and lymph nodes, and the thymus itself. Thymus-independent areas of the secondary lymphatic tissues are also affected but to a lesser extent. The pathological observations suggest that immunodepression may be an integral part of the pathophysiology of dengue haemorrhagic fever.     

Inflammatory pseudotumor of intra-abdominal lymph nodes manifesting as recurrent fever of unknown origin: a case report

A 27-year-old man presented with a 7-month history of debilitating recurrent fever and weight loss. Extensive clinical evaluation led to the discovery of splenomegaly and retroperitoneal lymphadenopathy. The patient underwent splenectomy as well as liver and lymph node biopsy. Histologic examination of the lymph nodes, but not the liver and spleen, revealed inflammatory pseudotumor of lymph nodes. The patient has remained asymptomatic for more than 3 years following the surgical procedure despite the absence of further intervention. Inflammatory pseudotumor of lymph nodes should be considered in the differential evaluation of prolonged or relapsing fever of unknown etiology.     

Isolated splenic tuberculosis]

A case of splenic tuberculosis is reported. The patient was a 79-year-old man who was admitted to the Tokyo Metropolitan Geriatric Hospital because of high fever and loss of body weight. Several finger-tip sized superficial lymph nodes were palpable in bilateral inguinal regions. The intermediate PPD skin test was positive. However, there was no evidences of active tuberculosis on the chest roentgenogram. The computed tomogram of the abdomen showed moderate enlargement of the spleen with multiple low density areas and several swollen lymph nodes in the para-aortic region. Although a lymph node of the inguinal region was resected for the pathologic examination, it showed no specific changes. In order to obtain a final diagnosis, laparotomy was performed. The spleen was markedly enlarged and nodular in appearance. No abnormal findings were observed in the other abdominal organs. Splenectomy was carried out. Numerous yellowish nodules, varying from 0.1 to 5 cm in diameter, were observed on the cut surface of the resected spleen (20 x 20 x 8 cm, 700 g). The bacteriologic examination revealed acid-fast bacilli. The fever subsided after splenectomy and following antituberculous therapy. Recently, isolated tuberculosis of the spleen has become very rare. Since 1965, only six cases in five reports can be found in the English, French and German literature. The present case is considered to be one such very rare cases of tuberculosis. Although splenic tuberculosis is rare at the present time, splenic tuberculosis should be included in the differential diagnosis of fever of unknown origin with splenomegaly.     

Hodgkin's disease presenting with progressive liver failure

We report an unusual case of a 70-year-old man with a diagnosis of Hodgkin's disease, who presented with fever and liver dysfunction. A few cervical lymph nodes, less than 1 cm in diameter were palpable, but other lymph nodes were not detected even by CT scan. Blood cell counts showed thrombocytopenia (platelet counts 6.8 x 10(4)/microliter), and some values for liver enzymes were out of the normal range (AST 56 U/l, ALT 87 U/l, LDH 347 U/l, ALP 1,529 U/l, and gamma-GTP 190 U/l). Abdominal CT scan showed diffuse enlargement of the liver and spleen. Endoscopic retrograde biliary cholangiopancreatography was performed because of progressive jaundice, but no abnormality was found in the biliary tract. A few granulomas were observed in bone marrow clot specimens, but tumor cells were not detected. A diagnosis of Hodgkin's disease was established by a cervical lymph node biopsy. Chemotherapy was immediately instituted, and both the jaundice and fever improved dramatically. Because cervical lymph nodes were not detected at one month after the onset and liver dysfunction appeared before cytopenia, it is suggested that the site of the primary lesion in this case was the liver.     

Lethal extrapulmonary mycobacteriosis

A 60 yr old previously healthy man was treated for gradually elevating fever and rash followed by leucopenia and mycosis of the gastrointestinal tract; he died within 6 weeks of the first symptoms appearing. Histologic examination revealed disseminated tuberculosis of paratracheal lymph nodes, liver, spleen and bone marrow with the presence of acid fast bacilli by smear examination. Multiple colonies of the same strain of Mycobacterium kansasii were isolated by bacteriological examination of lymph node and spleen tissue. Neither macroscopical nor histological examination showed any evidence of lung tuberculosis. The final diagnosis of the described acute disease and rapid death was stated as generalized extrapulmonary mycobacteriosis, which is a rare observation.     

Altered Nucleic Acids of Antibody-Forming Tissues

RNA.DNA hybridization experiments suggest differences between the DNA from the liver and spleen of the same animal (rabbit) and between the RNAs from lymph nodes stimulated by different antigens. A larger proportion of spleen DNA than of liver DNA was complementary to the RNA isolated from antigen-stimulated lymph nodes. No difference between liver and spleen DNA was observed in hybrids formed with RNA from lymph nodes of nonimmune animals. This suggests the presence of unique or redundant genes coding for immunoglobulin polypeptide chains in antibody-forming cells.     

The ultrasound contrast agent levovist helps with the differentiation between accessory spleen and lymph nodes in the splenic hilum: a pilot study

BACKGROUND: In patients with focal lesions which are isoechogenic to the spleen and which are located next to the spleen it is not easy to differentiate between lymph nodes and the accessory spleen. Therefore, the aim of this study was to evaluate if the color-SAE technique performed after injection of Levovist is able to differentiate between accessory spleens and lymph nodes in patients with a mass in the hilus of the spleen. METHODS: 12 patients with sonographic proof of a hypoechoic mass in the hilus of the spleen were examined (Sonoline-Elegra ultrasound system, Siemens, Erlangen, Germany). Color-SAE was performed 10 minutes after injection of 1 g of Levovist i. v. RESULTS: All patients with accessory spleens (n = 7) showed a color-SAE mosaic pattern in the localization of the mass comparable to the color-SAE mosaic found in the spleen. In contrast, in none of the patients with lymph nodes next to the spleen (n = 5) was a color-mosaic pattern localized to the mass found, wheras the spleen showed regular color-SAE in all cases. CONCLUSION: Color-SAE with Levovist is a new diagnostic tool for the differentiation between accessory spleens and lymph nodes.     

Atypical lymphoma with prolonged systemic remission after splenectomy. Description of three cases

Three patients with an unusual clinicopathologic picture and a striking response to splenectomy are described. All three presented with fever and severe systemic symptoms, pancytopenia and splenomegaly. Two of the patients had hypogammaglobulinemia and absent delayed hypersensitivity. Atypical lymphohistiocytic proliferation consistent with lymphoma was present in the spleen in all three patients, and also in the bone marrow and abdominal lymph nodes in two. Splenectomy led to prompt and prolonged clinical remissions in all three patients, possibly of a permanent nature in one.     

Epstein-Barr virus-associated hemophagocytic syndrome and fatal infectious mononucleosis

Virus-associated hemophagocytic syndrome (VAHS) has been thought to be a distinct clinical entity, characterized by intermittent fever, enlarged liver and spleen, and the appearance of hemophagocytosis. Hemopoietic cells are actively ingested by monocytes/macrophages in various organs, including lymph nodes, bone marrow, liver, and spleen. Epstein-Barr virus (EBV) is now thought to be one of the major causes for the development of this unique syndrome. Additionally, VAHS is often associated with fatal infectious mononucleosis (IM). The relationship between EBV-associated VAHS and fatal IM is discussed in this concise review. © 1996 Wiley-Liss, Inc.     

In vitro autoradiographic and in vivo scintigraphic localization of somatostatin receptors in human lymphatic tissue

Receptors for the neuropeptide somatostatin (SS) were evaluated in vitro and in vivo in various human lymphatic tissues, ie, thymus, spleen, and lymph nodes; thymic carcinoids and thymomas were also tested. The receptors were measured in vitro using receptor autoradiography on tissue sections incubated with the SS analog 125I- [Tyr3]-octreotide or 125I-[Leu8,D-Trp22,Tyr25]-SS-28. All tissues were SS-receptor positive for either radioligand, except the thymomas. In thymic tissue, the receptors were diffusely located in the medulla, presumably on epithelial cells. In the spleen, the red pulp was strongly labeled. In the lymph nodes, the germinal centers were preferentially labeled. In all tissues, the receptors were of high affinity (kd thymus, 0.84 nmol/L; kd spleen, 1.6 nmol/L; kd lymph node, 0.62 nmol/L) and specific for SS. Displacement by nanomolar concentrations of SS-14, SS-28, and octreotide was observed, as was guanosine triphosphate dependency. The in vivo visualization of somatostatin receptors was performed after injection of 111In-DTPA- octreotide and gamma-camera scintigraphy. The spleen, but not thymus or lymph nodes, were visualized. These data suggest an important role for SS in regulating immune functions through SS receptors in thymus, spleen, and lymph nodes. Furthermore, SS may regulate neuroendocrine functions in the thymus.     

Lymphomatoid granulomatosis. A report of 2 cases

Two patients with lymphomatoid granulomatosis were diagnosed by postmortem autopsy or exploratory thoracotomy. The lung, skin, spleen, renal and lymph nodes were involved. The most common presenting complaints are fever, cough, expectoration shortness of breath. The radiographic manifestations are multiple, bilateral nodular shadows. The histologic features is a unique form of pulmonary angiitis and granulomatosis, which is a necrotizing angiocentric and angio-destructive infiltrative process composed of small lymphocytes and atypical lymphoreticular cells.     

On the Origin of Foà-Kurloff Cells

The thymic and splenic release of Foà-Kurloff cells into the blood was studied in estradiol-treated male guinea pigs by comparison between the cellular content in afferent and efferent blood. The amount and distribution of such cells in thymus, spleen, lymph nodes, and bone marrow was investigated. The treatment with estradiol caused involution of the thymus and splenomegaly. An abundance of Foà-Kurloff cells was found in the red splenic pulp and a considerable release of such cells from the spleen into the blood was demonstrated. At the same time the output of lymphocytes from the spleen was reduced, suggesting that the Foà-Kurloff cells are transformed lymphocytes. The spleen contained an increased amount of erythroblasts, indicating a stimulation of splenic erythropoiesis by estradiol. In the bone marrow and the thymus the number of Foà-Kurloff cells was much smaller than in the spleen and no emigration of such cells from the thymus into the blood was demonstrated. A very small amount of Foà-Kurloff cells was found in the lymph nodes and very few occurred in the thoracic duct lymph. Thus, the Foà-Kurloff cells of the blood do not originate in the lymph nodes and do not recirculate between blood and lymph. It is concluded that the spleen is the major producer of Foà-Kurloff cells and that they are released from the spleen into the blood.     

Studies on T and B lymphocytes in rats bearing methylcholanthrene-induced tumor.

The authors have studied the influence of primary, methylcholanthrene-induced tumor on T and B lymphocytes of spleen, thymus, draining lymph nodes and peripheral blood of rats. Differences in weight of tumors were found to correlate with changes in proportionality of T and B lymphocytes of followed organs. Small tumors induced but insignificant changes. There was increased trapping of T lymphocytes in spleen and lymph nodes with simultaneous decrease in peripheral blood. The authors noted a high percentage of blasts. B lymphocytes showed a tendency to compensate for the loss of T cells. Large, progressively growing tumors caused evident exhaustion in the number of both cell types in lymph nodes and peripheral blood. In the spleen there was slower exhaustion. Reduction in the number of B lymphocytes correlated with the size of tumor. Blasts disappeared. Proportionality of T and B lymphocytes in thymus did not appear to be influenced by the size of tumor.     

Kikuchi-Fujimoto Disease Masquerading as Metastatic Papillary Carcinoma of the Thyroid

Kikuchi-Fujimoto disease also known as histiocytic necrotizing lymphadenitis is a rare cervical inflammatory lymphadenitis that is most commonly seen in young Asian women. It is mainly characterized by lymphadenopathy, hepatosplenomegaly, fever, nocturnal sweats, myalgia, weight loss, and arthralgia, and commonly follows a self-limited course. The differential diagnosis is challenging as many other conditions such as malignant lymphoma, metastatic disease, tuberculosis and infectious lymphadenopathies can present in a similar way. We present an unusual case of Kikuchi-Fujimoto disease masquerading as metastatic papillary carcinoma of the thyroid.A 30-year-old young female presented, 2 months post-partum, with complaints of neck pain and fever. A computed tomography scan showed enlarged right-sided lymph nodes and a thyroid nodule. Subsequent biopsy of a thyroid nodule revealed papillary thyroid carcinoma and reactive inflammation in one of the lymph nodes. She underwent an elective total thyroidectomy, central node dissection and a right modified lymph node dissection for enlarged lymph nodes. Her recovery was uneventful and the pathology report was consistent with a papillary carcinoma of the thyroid with one lymph node positive for metastatic disease and several other lymph nodes showing histiocytic necrotizing lymphadenitis.This coexistence of Kikuchi-Fujimoto disease with localized metastatic papillary thyroid cancer is unusual and presents an interesting, challenging, and complex management dilemma.     

犬蠕形螨病病理组织学观察

目的　研究蠕形螨病病犬皮肤、淋巴结及内脏中蠕形螨的寄生情况及病理组织学变化。　方法　解剖蠕形螨病病犬 ,分别对皮肤、腮腺淋巴结、下颌淋巴结等 13个部位淋巴结以及肺脏、肝脏、肾脏、脾脏、心脏等分别用 5 %NaOH消化法和病理组织切片法进行检查 ,并测量虫体大小。　结果　除了在重症蠕形螨病病犬的皮肤组织外 ,在部分浅表淋巴结中也检查到了蠕形螨虫体和虫卵 ,而内脏中除了肝脏、肺脏外 ,其他脏器未查到蠕形螨虫体和虫卵。皮肤病变主要发生于毛囊和真皮 ,破坏的毛囊周围组织见以淋巴细胞为主的炎性细胞浸润病变 ,并有程度不同的炎性细胞浸润和结缔组织增生 ,病变淋巴结均呈现不同程度的增生性淋巴结炎、出血性淋巴结炎和卡他性淋巴结炎。而各脏器切片均未发现有明显病变。经对皮肤和淋巴结内虫体进行测量 ,淋巴结内成虫明显比皮肤内的小 (P <0 .0 1)。而若虫大小及虫卵大小则差异不明显 (P >0 .0 5 )。　结论　蠕形螨不仅寄生于犬皮肤 ,还能在许多浅表淋巴结寄生 ,并能造成明显病变。     

Haemophagocytic syndrome and cutaneous T-cell lymphoma

Haemophagocytic syndrome is a rare disorder of immune regulation. Clinical features are fever, haemophagocytosis, hepatosplenomegaly, pancytopenia, lymph nodes enlargement, hypertriglyceridaemia and coagulopathy. Systemic findings may also include pulmonary infiltrates, renal failure and an inappropriate antidiuretic state. It has been described associated to many diseases, like lymphomas, most of them T-cell lymphomas, infections and systemic diseases, among other entities. Haemopoietic cells are actively ingested by monocytes and macrophages in lymph nodes, bone marrow, liver and spleen. This is a diagnostic criteria for haemophagocytic syndrome. The treatment of haemophagocytic syndrome is difficult and requires intensive supportive therapy, treatment of coagulopathy disorders, high-dose corticosteroids and immunosuppressive treatment, although in most cases there is no response to treatment and the evolution is fatal. The T-cell lymphomas that involve subcutaneous tissue and simulate panniculitis are classified recently as primary cutaneous T-cell lymphomas, and their presentation as inflammatory nodules of the legs are uncommon.     

Epstein–Barr virus-associated post-transplant lymphoproliferative disorders after allogeneic peripheral blood stem cell transplantation for Hodgkin-like adult T-cell leukemia/lymphoma

A 56-year-old woman with Hodgkin-like adult T-cell leukemia/lymphoma was treated with allogeneic peripheral blood stem cell transplantation on 17 April 2009. She manifested a moderate fever on day 41. CT scanning and other examinations detected slightly swollen lymph nodes, and pathological findings of right axillary lymph nodes revealed an Epstein-Barr virus-associated post-transplant lymphoproliferative disorder. She was successfully treated with rituximab.     

原位杂交法检测艾滋病尸检组织中病毒核酸

对曾用免疫组织化学方法检测了人免疫缺陷病毒１型（ＨＩＶ－１）抗原的１例艾滋病尸检病例的脑、肝、肾、心、肺、胰、肠、脾、胸腺、淋巴结和兰尾等组织标本，采用地高辛标记的ＨＩＶ－１ｃＤＮＡ探针检测病毒ＲＮＡ。结果发现在脑组织神经胶质细胞和星形细胞，肠上皮细胞以及淋巴结、脾和胸腺的淋巴细胞ＨＩＶ－１ＲＮＡ阳性。     

Four cases of the tuberculous adenitis

We report four cases of tuberuculosis with the lymph nodes swelling in the porta hepatis. Case 1 is 52 years-old man, who was admitted to our hospital because of anorexia. The chest X-ray film showed abnormal shadow and he was diagnosed as tuberculosis by sputum examination. At the time of hospitalization, patient's conjunctiva is icteric on physical examination. The serum T-Bil was 3.21 mg/dL and D-Bil was 2.54 mg/dL. The enhanced CT showed compression of the extrahepatic common bile duct which was caused by enlarged lymph nodes secondary to tuberculous adenitis. Case 2 is 25 years-old man, who was admitted to our hospital because of low grade fever and lower abdominal pain. The chest X-ray film showed abnormal shadow and he was diagnosed as tuberculosis by sputum examination. An enhanced CT showed the swelling of the lymph nodes in the porta hepatis. Case 3 is 21 years-old woman, who visited the outpatient clinic bacause of neck lymph node swelling. And she was diagnosed as tuberculous adenitis of the cervical lymph-nodes by the neck lymph node biopsy. The patient complained of upper abdominal pain during the clinical course. The enhanced CT showed the swelling of the lymph nodes in the porta hepatis. A Case 4 is 31 years-old man, who visited to outpatient clinic bacause of fever. The chest X-ray film showed mediastinal lymphadenopathy, and he was diagnosed as tuberculosis by the thoracoscopic biopsy. The enhanced abdominal CT showed lymph nodes swelling in the porta hepatis. All of lymph nodes swelling found in our four cases markedly reduced in size on abdominal enhanced CT or ultrasonography after the initiation of anti-tuberculous standard chemotherapy. Symptom of all cases got better as well. In these clinical circumstances, it was clinically important to rule out malignant lymphoma and lymphadenopathy caused by cancer. The enhanced abdominal CT were useful for diagnosis and follow-up as tuberculous adenitis.     

Junin virus infection of guinea pigs: immunohistochemical and ultrastructural studies of hemopoietic tissue

An association between viral antigens, cytopathic effect (CPE) and viral titers in blood and lymphoid tissues suggests a direct CPE of Junin virus on the lymphopoietic organs of guinea pigs infected with 10(3) 50% lethal doses of the XJ prototype strain. After seven days of infection, all lymphoreticular organs had infectivity titers higher than those for blood. Virus was recovered from bone marrow and lymph nodes at day 5 after infection; peak titers were obtained from bone marrow, spleen, and lymph nodes after day 10. Granular specific fluorescence was detected in the cytoplasm of reticular monocytes after day 7; megakaryocytes showed positive fluorescence, but specific staining of other lymphoid cells was not observed. Necrosis of bone marrow, lymph nodes, and spleen was observed after day 9. CPE consisted of overdevelopment of reticuloendoplasmic cisterne of reticulomonocytes and myeloblasts. Typical Junin virus particles were observed. Reticular cells were gradually destroyed, and simultaneous necrosis of surrounding lymphoid cells was observed.