Multicentric giant lymph node hyperplasia

A patient with retroperitoneal and axillary lymphadenopathy and splenomegaly was demonstrated histologically to have the hyaline vascular type of giant lymph node hyperplasia, with plasma cell infiltrates in each region. The abdominal lesions were not surgically resectable and did not respond to radiotherapy. The clinical findings included polyclonal gammopathy, high cold agglutinin titers, neuropathy, and bilateral papilledema. All of these abnormalities have persisted three years since the initial diagnosis.     

Multicentric angiofollicular lymph node hyperplasia: a clinicopathologic study of 16 cases

A clinicopathologic analysis of 16 cases of multicentric angiofollicular lymph node hyperplasia (MAFH) was performed. Histologically, the disease was characterized by recognizable lymph node architecture that was at least partially intact, by paracortical hyperplasia with prominent vascular proliferation, and by numerous evenly distributed, apparently benign germinal centers of various types, usually including some typical hyaline-vascular centers. At the onset of the disease, 12 patients had the plasma cell (PC) type of MAFH, three patients had the hyaline-vascular (HV) type, and one patient presented with PC and HV types at separate sites. Transitions between the PC and HV types were observed in two cases. Immunologic studies demonstrated polyclonal populations of plasma cells in the lymph nodes of all patients and the absence of suppressor T lymphocytes in the one patient tested. Clinically, the patients had constitutional symptoms, multicentric lymphadenopathy, hepatosplenomegaly in many cases, and abnormal laboratory findings, including anemia, polyclonal hypergammaglobulinemia, and bone marrow plasmacytosis. The 16 patients were placed in four different clinical groups based on presentation and course: stable disease, chronic relapsing disease, aggressive disease, and development of malignant lymphoma. Ten of the 16 patients died (median survival, 26 months; range, eight to 170 months). Multicentric angiofollicular lymph node hyperplasia appears to be a variant of classic angiofollicular lymph node hyperplasia (Castleman's disease) and is associated with significant morbidity and mortality.     

Angiofollicular lymph node hyperplasia (Castleman's disease): an immunohistochemical and enzyme-histochemical study of the hyaline-vascular form of lesion

Tissues from five cases of angiofollicular lymph node hyperplasia have been studied. All had the histological structure of the hyaline-vascular type of lesion; large numbers of very compact lymphoid follicles were distributed evenly throughout a highly vascular tissue. The follicles were characterized by their small size, a vascular poorly cellular and frequently hyalinized centre, and a 'tight' concentric mantle of small lymphocytes arranged in layers producing an 'onion-skin' appearance. The interfollicular tissue was characterized by the large numbers of small vessels mainly hyalinized capillaries and a few high endothelial venules and the presence of variable numbers of lymphocytes, plasma cells, immunocytes and immunoblasts. The immunoperoxidase method demonstrated polytypic cytoplasmic immunoglobulin in the small numbers of centroblasts and plasma cells within the follicle centres and in the plasma cells and immunocytes in the interfollicular tissue. Large numbers of suppressor T cells were present in the interfollicular areas and only scattered helper T cells were seen within the lymphocyte mantles. A strong reaction for factor VIII-related antigen was seen in the endothelium of the interfollicular high endothelial venules but only a weak reaction in the vessels in the follicle centres. A concentric distribution pattern of the dendritic reticulum cells was seen with the metalophil impregnation method of Marshall and with the enzyme histochemical methods for acid alpha-naphthyl acetate esterase and 5'-nucleotidase. This pattern differs from the zonal distribution of these cells seen in reactive lymphoid follicles. The nature and possible pathogenesis of AFLNH are discussed and contrasted with reactive hyperplasia.     

Angiofollicular lymph node hyperplasia (Castleman)

Six personally observed cases of this lesion are reported and the literature is reviewed. One hundred and thirty-four cases have been reported to date. The lesion has occurred in many sites, but is commonest in the thorax (60%), abdomen (11%), neck (14%), and axilla (4%).Ninety per cent of cases are symptomless or have only the pressure symptoms, 10% have systemic signs, namely, fever, raised ESR, anaemia, cured by removal of the tumour. These cases have a slightly different histology. All recorded cases have been benign. Microscopically the lesion is follicular but instead of germinal centres the follicles have one or more thick-walled arteries and often some surrounding histiocytes. Increased numbers of vessels occur between the follicles, whilst sinuses are absent. These vessels have thick, cellular walls like post-capillary venules. Sometimes they become hyaline.The cases with symptoms have true reaction centres as well as a few intrafollicular vessels. Between the follicles there are increased numbers of vessels and, in addition, there may be collections of plasma cells or eosinophils.     

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)     

Plasmacytoid T cells: a cell population normally present in the reactive lymph node. An immunohistochemical and electronmicroscopic study

Plasmacytoid T cells (PTCs) are medium-sized cells characterized by abundant rough endoplasmic reticulum. They occur in the thymic-dependent area in human lymph nodes. PTCs are hardly identified in routinely stained sections. We studied their occurrence in 100 reactive lymph nodes with the use of monoclonal antibodies MB2, MT1, LN1, LN2, reactive on paraffin-embedded tissue, and with electron microscopy in nine selected cases. PTCs strongly reactive with MT1 and LN2 were found in 87 of 100 lymph nodes. They were observed in clusters, loose aggregates, and as singular cells. An association between PTCs, postcapillary venules, small T lymphocytes, and interdigitating reticulum cells (IDRCs) was found. Our results indicate that PTCs are normally present in the human lymph node. Their immunophenotype suggests a relationship with a monocyte/macrophage lineage, but does not rule out a T cell origin. If the various distribution patterns represent the morphologic substrate of functional stages of PTCs it can be assumed that PTCs play a role in T cell-mediated immune response.     

Nephrotic syndrome associated with angiofollicular lymph node hyperplasia

A women presented at the age of 22 with anemia, hepatosplenomegaly, polyclonal hypergammaglobulinemia and a mediastinal shadow. At thoracotomy she had enlarged mediastinal lymph nodes which displayed histological features typical of angiofollicular hyperplasia. Marrow plasmacytosis was present. She developed diabetes mellitus at the age of 29 yrs after she had received oral steroid treatment for one year. The nephrotic syndrome supervened another year later. Her kidneys were enlarged before the onset of diabetes. The glomerular changes included a marked increase of mesangial matrix and segmental hypercellularity. The association of the nephrotic syndrome and angiofollicular lymph node hyperplasia is extremely rare and their interrelation remains enigmatic.     

Extramedullary plasmacytoma associated with angiofollicular lymph node hyperplasia

We report a case of hyaline-vascular type of angiofollicular lymph node hyperplasia involving the left pulmonary lymph nodes and lung. It clinically presented as an obstruction of the left lower lobe main bronchus secondary to the development of an extramedullary plasmacytoma in the lesion. An immunoperoxidase stain revealed a monoclonal IgG-lambda pattern of the tumor, contrasting with the polyclonal plasma cell population of the angiofollicular lymph node hyperplasia. This case demonstrates the neoplastic potential of angiofollicular lymph node hyperplasia.     

Vascular transformation of lymph node sinuses--a diagnostic pitfall. Histopathologic and immunohistochemical study

Histopathologic and immunohistochemical features in two cases of lymphoadenopathy caused by congestion are described. The diagnostic differences between this type of lymphoadenopathy and Kaposi's sarcoma are stressed. The histogenesis of the lesion is discussed and the term "stasis lymphadenopathy" is suggested.     

Hepatic giant cell carcinoma. An ultrastructural and immunohistochemical study

Hepatocellular carcinoma with osteoclast-like giant cells (hepatic giant cell carcinoma [HGCC]) is a rare entity, with only three cases reported. The tumor is histologically similar to giant cell tumor (GCT) of bone, and the origin of the multinucleated giant cells and mononuclear stromal cells has not been determined. The purpose of this report is to present a case of this rare tumor and compare its ultrastructural and immunohistochemical features with those of a conventional GCT of bone. Histologically, the HGCC consists of sheets of osteoclast-like giant cells with a background of mononuclear cells. The giant cells lack the pleomorphism seen in hepatocellular carcinomas with anaplastic giant cells. At the light microscopic level, most of this tumor was nearly identical to a GCT of bone, but several microscopic fields (less than 5% of the tumor) had the histologic appearance of a "usual" hepatocellular carcinoma. The hepatic tumor was negative for HAM 56, epithelial cytokeratins, muramidase, and alpha-1-antitrypsin, with only focal positivity for chymotrypsin in mononuclear and giant cells. The GCT was strongly positive for alpha-1-antitrypsin and chymotrypsin in both the mononuclear and giant cells and showed focal, weak staining for AE1 and AE3 in the mononuclear stromal cells. Ultrastructurally, both mononuclear and giant cells of the HGCC showed features typical of hepatocellular carcinoma. Although the patient presented in this report died, the pattern of growth was different from most hepatocellular carcinomas. The overall histologic features of this tumor are distinctive and appear to justify separating this variant from other types of hepatocellular carcinoma.     

Histopathological and immunohistochemical study of laterocervical lymph node metastases of unknown primary origin

In this study, we examined histopathologically and immunohistochemically 24 cases of laterocervical lymph node metastases with unknown primary origin. For immunohistochemical study, we used a large panel of antibodies represented by CK7, CK19, CK20, CKAE1/AE3, CK34betaE12, TTF1, HBME-1, CEA, MUC5AC and EBV. In the cases studied tumors accompanied by seemingly primitive adenopathies were located in the thyroid, lung, esophagus, stomach, rhinopharynx, hypopharynx, oropharynx and larynx.     

Giant lymph node hyperplasia in an angiolipomatous mediastinal mass

A case of an unusual association of giant lymph node hyperplasia (Castleman's disease)--the hyaline vascular variant--originating within a mediastinal angiolipomatous mass is studied and its clinical and pathologic characteristics compared with those of two previously reported cases. Histogenetic implications of this finding are briefly considered.