Enzyme- and immunohistochemical study of a case of histiocytic necrotizing lymphadenitis

Abstract

A combined morphological, immunohistological, and enzyme histochemical analysis was performed on frozen and fixed lymph node tissue in a case of histiocytic necrotizing lymphadenitis (HNL) using conventional histology, a panel of monoclonal and polyclonal antibodies, and a series of common haematological enzyme reactions. Histology showed multiple paracortical necrotizing foci which, in a prominently necrobiotic background devoid of granulocytes, contained large numbers of foamy histiocytes and macrophages intermingled with cells resembling degenerating plasmacytoid T-cells. Most of the histiocytes were alpha1-antichymotrypsin positive and foamy cells were also distinctly Leu-M1 positive. Strong granular acid phosphatase (AP) positivity was present in the cytoplasm of the macrophages and histiocytes. The cells with plasmacytoid features showed weaker and homogeneously diffuse AP staining. Alpha-naphthyl acetate esterase (ANAE) activity was much less striking than AP in the necrotizing foci and most of the ANAE negative cells corresponded to those with plasmacytoid features. No cells with B-cell lineage markers were present within the necrotizing foci; most of the occasional T-cells (Leu-1+, Leu-4+) present in the foci were Leu-2a+ (OKT8+) whereas OKT10+ lymphoid cells were abundant and appeared to correspond with the cells with plasmacytoid features. Our combined data confirm that the special type of necrosis found in HNL develops within foci of plasmacytoid T-cells undergoing regressive changes and apparently exhibiting distinct immunohistological and enzyme histochemical features.

Kikuchi Disease: A Clinicopathological Analysis of 13 Cases from Riyadh Central Hospital

“…However, it also could be prominent, as reported in the literature. 11 Since the lymph nodes show an inconspicuous germinal center with a monotonous configuration associated with reactive immunoblasts, the lesion may be mistaken for a malignant lymphoma. An interesting pattern in our cases is the presence of fibrin thrombi in the lumen of the capillaries (76.9%) which were more distinctly seen with PTAH stain (Figure 3).…”

Histiocytic necrotizing lymphadenitis without granulocytic infiltration (Kikuchi's lymphadenitis). Morphological and immunohistochemical study of eight cases

“…It must be underlined that, as in other previously reported series (Pileri et , Turner et al 1983, Ali & Horton 1985, Carbone et al 1986), the lesion was occasionally misinterpreted by referring clinicians or pathologists as a high-grade malignant lymphoma. This may be due to the fact that it is still a poorly recognized entity in western countries and often presents with clinical symptoms which mimic a systemic disease.…”

“…1980, Imamura et al 1982, Pileri et al 1982, Eimoto et al 1983, Feller et al 1983, Michaeleck & Henzan 1983, Turner et al 1983, Ali & Horton 1985, Gleeson et al 1985, Carbone et al 1986). …”

“…They are in keeping with previous accounts (Fujimoto et al 1972, Kikuchi 1972, 1978, Shimamine et al 1974, Wakasa et al 1975, 1978, Kikuchi & Uryu 1976, Kikuchi et al 1977, Michaeleck 1977, Imamura et al 1980, Yamaguchi & Shimamine 1980, Pileri et al 1982, Eimoto, Kikuchi & Mitusi 1983, Feller ef at. 1983, Michaeleck & Henzan 1983, Turner et al 1983, Ali & Horton 1985, Gleeson et al 1985, Carbone et al 1986). …”

Necrotizing lymphadenitis: A review of clinicopathological, immunohistochemical and ultrastructural studies

“…Recently, this type of lymphadenitis has also been reported in America and Europe (Pileri et al, 1982;Feller et al, 1983;Kikuchi et al, 1983Kikuchi et al, ,1986Ali et al, 1985;Carbone et al, 1986). The pathogenesis of the disease, however, is still unknown.…”