Interpretation of Head and Neck Biopsies in Wegenerʼs Granulomatosis

Devaney, Kenneth O.; Travis, William D.; Hoffman, Gary S.; Leavitt, Randi Y.; Lebovics, Robert S.; Fauci, Anthony S.

doi:10.1097/00000478-199006000-00006

Cited by 333 publications

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“…We hypothesized that in the event apoptotic or necrotic neutrophils are not cleared by macrophages, DCs may be recruited. In WG, granulomas containing large numbers of freshly activated, apoptotic, and necrotic neutrophils are present in upper airways early in the development of vasculitis (31)(32)(33). As neutrophils undergo apoptosis, they express PR3 and MPO on their surface (26,34).…”

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confidence: 99%

Dendritic cell uptake of human apoptotic and necrotic neutrophils inhibits CD40, CD80, and CD86 expression and reduces allogeneic T cell responses: Relevance to systemic vasculitis

Clayton¹,

Prue²,

Harper³

et al. 2003

Arthritis & Rheumatism

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Objective. There is a breakdown of tolerance to neutrophil components during systemic vasculitis, which is marked by autoantibodies and T cells with specificity for proteinase 3 or myeloperoxidase, expressed on the surface of apoptotic neutrophils. This study was undertaken to investigate the effects of human apoptotic and necrotic neutrophils on human dendritic cell (DC) phenotype and ability to stimulate allogeneic T cell proliferation.Methods. DCs were generated from human peripheral blood mononuclear cells and allowed to interact with human apoptotic and necrotic neutrophils in the presence or absence of tumor necrosis factor ␣ (TNF␣). Effects on DC phenotype and ability to stimulate T cell proliferation were observed.Results. Immature DCs engulfed apoptotic and necrotic neutrophils, resulting in up-regulation of CD83 and class II major histocompatibility complex molecules, but down-regulation of CD40, CD80, and CD86, and a decreased ability to stimulate T cell proliferation. When TNF␣ was added in combination with apoptotic neutrophils, the inhibitory effects were overcome to some extent.Conclusion. Our results suggest that DC uptake of apoptotic or necrotic neutrophils alone does not shift the immune response from tolerance to autoimmunity in systemic vasculitis. However, cytokines found at sites of inflammation in vasculitis patients may act as maturation factors for DCs, and in combination with apoptotic neutrophils, may lead to an autoimmune phenotype.

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mentioning

confidence: 99%

Dendritic cell uptake of human apoptotic and necrotic neutrophils inhibits CD40, CD80, and CD86 expression and reduces allogeneic T cell responses: Relevance to systemic vasculitis

Clayton¹,

Prue²,

Harper³

et al. 2003

Arthritis & Rheumatism

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“…Biopsies of affected tissues should classically show the triad of granulomas, necrosis and vasculitis before a diagnosis of WG can be made. However, only 16% of upper airway biopsy specimens demonstrate the full histopathologic triad [10] and repeated biopsies may be necessary for diagnosis, as is illustrated by our case. When only the respiratory tract is involved the sensitivity of the cANCA test is only 67%, and a negative test does not exclude the disease [2].…”

Section: Discussionmentioning

confidence: 77%

Limited Wegener's granulomatosis with central nervous system involvement and fatal outcome

Nordmark¹,

Boquist²,

Rönnblom³

1997

Journal of Internal Medicine

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Nordmark G, Boquist L, Rönnblom L (Boden Hospital and University Hospital, Umeå, Sweden). Limited Wegener's granulomatosis with central nervous system involvement and fatal outcome (Case Report). J Intern Med 1997; 242: 433–36. A 74‐year‐old woman was admitted to the medical department with vertigo and confusion, and suffered seizures three days later. Clinical, radiological and histopathological examination revealed limited Wegener's granulomatosis (WG) with central nervous system (CNS) involvement. Initially she was treated successfully with prednisolone and cyclophosphamide, but she relapsed after 25 months and died four weeks later. Autopsy showed widespread granulomas with vasculitis in the cerebrum. These findings emphasize the importance of considering WG in CNS disease of unclear origin, and demonstrate the aggressive nature of the disease.

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“…La granulomatosis de leishmaniasis en otras instituciones y de interWegener es primariamente granulomatosa y consulta psiquiátrica. Sería aconsejable la necrotizante, antes que vasculítica (12,13). Su confirmación de esta etiología con exámenes diagnóstico requiere correlación clínica y patoló-paraclínicos que incluyan la dosificación de coqica con demostración de la tríada de lesiones caína en sangre y orina (25,26).…”

Section: Discussionunclassified

“…Tanto los granulomas como el infiltrado de PMN, pueden comprometer la pared de los vasos que, además, muestran necrosisfibrinoide. El cuadro histológicoesflorido y típicosóloen el 15% de los casos (12). En su patogenia se involucra la presencia de anticuerpos antigránulos de los PMN en el suero de los pacientes (12,23,24).…”

Section: Discussionunclassified

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Leishmaniasis mucosa y otras lesiones destructivas centrofaciales

Rodríguez¹,

Sarmiento²,

Hernández³

1994

biomedica

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ResumenVarias enfermedades producen lesiones del área centrofacial. Una de las más frecuentes en nuestro medio es la leishmaniasis destructivas mucosa. Como el INS es un centro de estudio de leishmaniasis, se atendieron pacientes o sus biopsias con afecciones del macizo centrofacial, primariamente remitidas con el diagnóstico clínico de leihsmaniasis mucosa. En un período de 7 años (1987)(1988)(1989)(1990)(1991)(1992)(1993), se estudiaron 134 biopsias de estos pacientes. El diagnóstico de leishmaniasis mucosa fue definitivo en 26 casos, por demostración del amastigote con la coloración de hematoxilina eosina y el mismo diagnóstico se estableció por patrón histopatológico solamente, en 27 casos. Una técnica inmunoenzimática para demostrar los amastigotes no fue satisfactoria. La perforación banal del tabique nasal (52 biopsias) es la.entidad que el clínico y el patólogo confunden con mayorfrecuenciacon la leishmaniasis mucosa. Otras entidades demostradas fueron la paracoccidioidomicosis (3), histoplasmosis (2), rinosporidiosis (2). esporotricosis (l), tuberculosis bucal (3), lepra leprornatosa (l), escleroma nasal (2), granulomatosis de Wegener (2), linfomas angiocéntricos (4), aspiración crónica de cocaína (l), y carcinoma escamocelular palatino (1).La biopsia, luego de la historia clínica, es el pilar esencial para identificar y manejar adecuadamente estas lesiones, que pueden originar destrucción facial grave, a veces letal, si no se dispone del diagnóstico preciso y del tratamiento oportuno. SUMMARYVarious illnesses produce lesions in the central facial area. One of the most frequently encountered in our environment is mucotaneous leishmaniasis. As the INS is a centre for the study of mucotaneous leishrnaniasis, patients or their biopsies are seen with diseases relating to the greater facial area, being remitted primarily with a diagnosis of mucotaneous leishmaniasis. In aperiod of 7 years (1 987-1993), 134 biopsies taken from these patients were studied. The mucotaneous leishmaniasis diagnosis was confirmed in 26 cases by staining with hematoxylin-eosin to reveal the presence of amastigotes and the same diagnosis was suggested solely by histopathology in another 27 cases.An immunoenzymetechnique toshow amastigote presence proved to be unsatisfactory. Commonplace perforation of the septum (52 biopsies) is most frequently confused by the physician and the pathologist as being mucotaneous leishmaniais. Other entities which were revealed were paracoccidioidomicosis (3), histoplasmosis (2), rhinosporidiosis

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Interpretation of Head and Neck Biopsies in Wegenerʼs Granulomatosis

Cited by 333 publications

References 0 publications

Dendritic cell uptake of human apoptotic and necrotic neutrophils inhibits CD40, CD80, and CD86 expression and reduces allogeneic T cell responses: Relevance to systemic vasculitis

Dendritic cell uptake of human apoptotic and necrotic neutrophils inhibits CD40, CD80, and CD86 expression and reduces allogeneic T cell responses: Relevance to systemic vasculitis

Limited Wegener's granulomatosis with central nervous system involvement and fatal outcome

Leishmaniasis mucosa y otras lesiones destructivas centrofaciales

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