Chronic lymphadenopathy in children and adolescents.
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A causative agent ("D" strain) was isolated from the contents of an affected lymph node of a patient with beningn lymphoreticulosis. According to the biological and antigenic properties this agent is identified with Chlamydia but is a distinct species. The chlamydial etiology of benign lymphoreticulosis is determined also by the complement-fixation test with sera from convalescents.
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A case of cat scratch disease, presenting as a parotid tumor, is described. In its oculo-glandular form, this disease may be associated with swelling of the intraparotid lymph nodes, and the possibility should be considered in the differential diagnosis of parotid tumors in children. A careful history, and skin testing with cat scratch antigen, may aid in the diagnosis of this condition.
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The purpose of this study was to determine whether human tissue macrophages (M phi s) in various inflammatory/reactive conditions express different immunophenotypes. Using a large panel of monoclonal antibodies to monocyte/M phi-related antigens and a frozen-section immunoperoxidase technique, the following conditions were studied: granulomatous inflammation of unknown etiology, sarcoidosis, cat-scratch fever, toxoplasmosis, Gaucher's disease, and juvenile xanthogranulomas. The results show that there is immunophenotypic variation of the M phi s among the various inflammatory/reactive conditions. For example, the M phi s in cat-scratch fever are nearly unique in the expression of the "early inflammation" antigen identified by antibody 27E10, and the M phi s in juvenile xanthogranulomas, unlike those in most of the other conditions, lacked the antigen detected by antibody 25F9. The M phi s in Gaucher's disease differed from those in the other disorders by the combined absence of CD11b, CD14, G16/1, CD1a, CD25, and CD30. The inflammatory/reactive M phi s also exhibited differences from those in "normal" tissues, namely, a tendency toward acquisition of the antigens identified by antibodies Mac 387 and G16/1 and the more uniform expression of the "activation" antigens CD25, CD30, and CD71. The antigenic variations described here probably reflect differences in antigenic stimuli and M phi function. In addition to the possible biologic implications, this M phi immunophenotypic diversity may have practical diagnostic applications.
Twelve patients (eight men and four women) had previously undiagnosed lymphoreticular disease associated with or simulating an inguinal (nine) or femoral (three) hernia. The disease was present on the left side in eight. Four patients (three women and one man) did not have an actual hernia. Two of these women had a preoperative diagnosis of femoral hernia. Seven of the patients, including all of the women, had non-Hodgkin's lymphoma (three diffuse large cell, two follicular mixed cell and two follicular small cleaved cell) and one patient had lymphocytic predominance (nodular lymphocytic and histiocytic) Hodgkin's disease. No stage predominated. Inguinal lymph nodes from two patients showed, histologically, Kaposi's sarcoma and type I human immunodeficiency virus (HIV) associated disease. Each patient was homosexual and HIV seropositive. Changes suggestive of viral cause were present in the lymph node of one patient. The enlarged lymph nodes of the 12th patient showed stellate suppurative granulomas containing cat-scratch bacilli demonstrated by Warthin-Starry stain. Because of the special processing needs for lymphoreticular diseases and potential for misdiagnosis, surgeons, clinicians and pathologists should be aware of the spectrum of lymphoreticular processes occurring in lymph nodes associated with or masquerading as a hernia, particularly in women.
Mac387 monoclonal antibody (MAb) recognizes two calcium binding, myeloid-associated proteins, now termed calgranulins, expressed at high levels by neutrophils and monocytes. Calgranulins are related to migration inhibitory factor (MIF) and are lost in a few days from monocytes differentiated in vitro. This marker is therefore potentially useful to analyze macrophage heterogeneity and turnover in tissue sections. In this study, we developed an immunohistochemical multimarker technique, including calgranulin demonstration, suitable for analyzing different inflammatory cells on paraffin-embedded material. The technique was carried out in subsequent steps demonstrating (a) naphthol AS-D chloroacetate esterase (CAE); (b) S100 immunoreactivity using a rabbit antibody in peroxidase-antiperoxidase (PAP) staining; and (c) Mac387 immunoreactivity using the alkaline phosphatase-anti-alkaline phosphatase (APAAP) technique. CAE staining was introduced in this method to distinguish Mac387+/CAE- macrophages from Mac387+/CAE+ neutrophils, and Mac387-/CAE+ mast cells. S100 protein is strongly expressed within lymphoid tissues by dendritic accessory cells and was then applied to distinguish these cells from S100-macrophages. We have also verified the possibility of reducing the staining time for this time-consuming procedure by use of microwave irradiation. The technique was applied to a representative variety of normal and pathological samples to assess its usefulness for study of cell heterogeneity. Our results showed the multimarker technique to be highly informative in the study of inflammatory lesions (e.g., rheumatoid arthritis, sarcoid and cat-scratch granulomas, dermathopathic lymphadenopathy), and is of wide potential value as an aid to histopathological diagnosis of several diseases.