Angioimmunoblastic lymphadenopathy: an ultrastructural and immunologic study with review of the literature

T-cell neoplasms in the spleen

Hematopoietic neoplasms involving the spleen are uncommon, but T cell neoplasms involving the spleen are extremely rare. The rarity of splenic involvement by T cell neoplasms has resulted in a limited body of literature describing their splenic characteristics. As a result, our purpose in this review article is to provide and summarize some of the characteristics seen by different T cell neoplasms that may involve the spleen.

Angioimmunoblastic Lymphadenopathy with Dysproteinemia Complicated by Kaposi's Sarcoma

A case of clinically and morphologically typical angioimmunoblastic lymphadenopathy (AILD) in a 68-year-old man during a prolonged antibiotic treatment for urinary infection is presented. Lymph node biopsy at first showed findings suggestive of an exhaustion of the germinal center immunological activity (like those characterizing angiofollicular lymph node hyperplasia). A second lymph node biopsy showed the typical pattern of AILD without any clear transition into malignant lymphoma. The course of the disease was characterized by the occurrence of opportunistic infections (toxoplasmosis, herpes zoster), and finally by the onset of a cutaneous Kaposi's sarcoma. The possible relation of AILD to Kaposi's sarcoma is discussed, and the main clinical and morphological data of the cases of AILD (about 200) reported in the literature are reviewed.

Hodgkin's Disease Developing in A Patient with Angioimmunoblastic Lymphadenopathy with Dysproteinemia - A Case Report

The case of a woman presenting the clinical and pathologic phenomena of angioimmunoblastic lymphadenopathy (AILD) with dysproteinemia is reported. The patient developed lesions in the lymph nodes, skin, lungs, liver and spleen, and her response to steroid and cyclophosphamide therapy was poor. At autopsy, microscopic findings in the mediastinal and abdominal lymph nodes were consistent with the diagnosis of Hodgkin's disease. Whereas the development of immunoblastic lymphoma is frequent in AILD, Hodgkin's disease is far less common. It is argued that malignant lymphoma in AILD may be the consequence of chronically depressed lymphocyte functions.

Predominant B-lymphocyte deficiency in a case with lymph node disease resembling angioimmunoblastic lymphadenopathy

A case with clinical and histological features resembling angioimmunoblastic lymphadenopathy, but with a very marked decrease in B-lymphocytes instead of T-lymphocytes is presented.

Genetic changes in atypical hyperplasia and lymphoma with angioimmunoblastic lymphadenopathy and dysproteinaemia in the same patients

The transition between atypical hyperplasia and lymphoma with angioimmunoblastic lymphadenopathy and dysproteinaemia (AILD) was studied in serial lymph node biopsy specimens from five patients using DNA analysis with Southern blot analysis, polymerase chain reaction, chromosomal analysis, and immunophenotyping. The chromosomal analysis showed additional abnormalities as the disease progressed to those present initially, and immunological staining showed a corresponding increase in the numbers of CD4- and Ki67-positive cells. In the first biopsy from each patient a diagnosis of atypical hyperplasia with AILD was made and lymphoma excluding by the finding of only a few atypical lymphoid cells and the preservation of follicles with germinal centres. DNA analysis of lymph nodes at this stage showed either germ lines or oligoclonal rearrangements of the T-cell receptor (TCR) and immunoglobulin heavy chain genes. In the final biopsy, when a diagnosis of lymphoma with AILD was made, either a monoclonal rearrangement of the TCR was observed or one of the rearranged bands had increased in density. These results suggest selective proliferation of a clone of abnormal cells may account for the progression of atypical hyperplasia to lymphoma with AILD.

Lymph node hyalinisation in rheumatoid arthritis and systemic sclerosis

AIMS

To review the histological features of lymph nodes excised from seven patients with rheumatoid arthritis and one with systemic sclerosis.

METHODS

Lymph nodes excised from seven patients with rheumatoid arthritis and one patient with systemic sclerosis over a 10 year period were examined using the stains haematoxylin and eosin, periodic acid Schiff (PAS), Masson-trichrome, and Congo red for amyloid.

RESULTS

Of the seven nodes examined from the cases of rheumatoid arthritis, three showed definite reactive follicular hyperplasia with a prominence of plasma cells in the interfollicular areas, two showed subtotal replacement of the node by numerous sarcoid like granulomata, and one contained a large central area of necrosis with a surrounding palisade of histiocytes. In all six cases, focal areas of PAS positive eosinophilic hyaline material were present, which did not stain with Congo red. In some cases this hyaline material was focally calcified. In the seventh patient with rheumatoid arthritis the excised lymph node was almost totally replaced by similar PAS positive hyaline material which showed extensive areas of calcification. The lymph node removed from the patient with systemic sclerosis similarly showed almost total replacement by PAS positive hyaline material.

CONCLUSION

In all cases the nodes contained PAS positive extracellular hyaline material to a greater or lesser degree. The lymph nodes from two of the patients with rheumatoid arthritis contained numerous sarcoid like granulomata, further indicating a possible association between sarcoidosis and rheumatoid arthritis. Pathologists and clinicians should include rheumatoid arthritis and systemic sclerosis in their differential diagnosis of lymph node hyalinisation of unknown aetiology.

Danazol in treatment of angio-immunoblastic lymphadenopathy

The clinical manifestations of angio-immunoblastic lymphadenopathy (AILD) suggest that there is an abnormality in the immune system. Most patients with AILD die from opportunistic infections associated with lymphocyte depletion. As chemotherapy further increases the already high susceptibility of infections, the therapeutic management of AILD is difficult. The achievement of complete remission (CR) by the patient described here using a danazol-based regimen raises the hope that treatment of this disease with a noncytotoxic drug may be possible. The rationale behind and advantages of using danazol are discussed.

Immunologic abnormalities in angioimmunoblastic lymphadenopathy

In this study we describe the results of phenotypic, serologic, and functional analyses performed in nine patients with angioimmunoblastic lymphadenopathy (AILD). The study investigates the nature of the T-cell defects which seem to represent a consistent feature in this disease. The study, based on the analysis of T-cell subsets with monoclonal antibodies and on functional in vitro tests, showed the following main abnormalities: reduction of the absolute number of circulating T-cells; inversion of the CD4/CD8 ratio, both in the peripheral blood and in the involved lymph nodes; high percentages of activated T-cells (CD8+/HLA-DR+); defective T-cell response in vitro to the PHA mitogen; and minimal helper and enhanced in vitro suppressor functions. Some of these immunologic dysfunctions are also observed in acquired immune deficiency syndrome (AIDS) which has in common with AILD several clinical features. However, no evidence of HTLV-III infection could be demonstrated in our patients with AILD.

Angio-immunoblastic lymphadenopathy: a clinical, immunological and molecular study

Twenty four patients with angio-immunoblastic lymphadenopathy (AILD) presenting between 1974 and 1985 have been reviewed. Clinical features at presentation included rash, fever, lymphadenopathy and hepatosplenomegaly in 75% of patients. Polyclonal hypergammaglobulinaemia was seen in 19/20 patients; 5 had normal immunoglobulin levels. Combination chemotherapy with MVPP was the optimal treatment with 6/7 patients achieving complete remission. Duration of remission ranged from 9 months to 4 years and was significantly longer in patients achieving complete as opposed to partial remission. In 6 patients phenotype studies were performed on single cell suspensions and immunoperoxidase studies on frozen sections of 7 lymph nodes. There was a reversal of the normal T suppressor/helper cell ratio with a predominance of T suppressor cells. Loss of normal B follicles was observed histologically in all except one lymph node. Germline configuration of the beta B-chain of the T cell receptor was observed in lymph nodes of 4 patients with AILD, and a rearranged T cell receptor was observed in 1 patient in whom a second lymph node biopsy had shown alteration of the histological picture to that of T-zone lymphoma. Frozen sera of 15 patients were screened for antibodies to HTLV I and III and were found to be negative.

Evidence for monoclonal T lymphocyte proliferation in angioimmunoblastic lymphadenopathy

The arrangement of the T cell receptor and immunoglobulin genes was analysed in lymphoid tissue biopsy specimens from 25 cases of angioimmunoblastic lymphadenopathy. Nineteen cases showed a rearrangement of the gene coding for the beta chain of the T cell receptor, and in one case a clonal rearrangement of immunoglobulin genes was shown (in which the T cell receptor gene was in a germline configuration). These findings indicate that a monoclonal T cell proliferation is present in most cases of angioimmunoblastic lymphadenopathy, and they also correlate with the fact that some patients who present with this disorder subsequently develop a T cell lymphoma.

Angioimmunoblastic lymphadenopathy (AIBL): a case report from Saudi Arabia

Angio immunoblastic lymphadenopathy (AIBL) is a recently described disease. It occurs most commonly in elderly patients with an average age of about 60 years. In children, few cases have been reported so far in the English literature (three occurred after thymic transplant and one case after infectious mononucleosis). AIBL has characteristics manifested by clinical, pathological and laboratory findings. Steroids, alone or with chemotherapy, are used for treatment with variable results. Herein, we report one child with AIBL who was treated with prednisone initially and then relapsed. Chemotherapy (cyclophosphamide, vincristine and prednisone) was added and she has been in remission for more than 3 years. The purpose of this report is to add AIBL to the differential diagnosis of acute generalized lymphadenopathy in children.

A study of lymphocyte subsets in patients with angioimmunoblastic lymphadenopathy

Immunological marker studies of peripheral blood lymphocytes in 22 patients with typical angioimmunoblastic lymphadenopathy were carried out. There was a decrease of the absolute lymphocyte number, of T-helper cells and the T4/T8 ratio in the active stage of the disease. The active T-cells and total T-cells were reduced both in the active and in the inactive state. The number of B-cells was in both states increased. Implications and possible mechanism of these observations are discussed. The histological findings and the clinical picture of angioimmunoblastic lymphadenopathy (AILD) or immunoblastic lymphadenopathy (IBL) were described by Frizzera et al (1974) and Lukes & Tindle (1975). The aetiology and pathogenesis of AILD are unknown. Hyperimmune phenomena, hypersensitivity (Lukes & Tindle, 1975), and chronic antigenic stimulation (Neiman et al, 1978) were suggested as possible factors. A defect in T-cell regulatory function with secondary B-cell system proliferation was also postulated due to the decreased T-suppressor cells (Lukes & Tindle, 1975; Frizzera et al, 1974). In almost all of the reported cases of AILD there has been a decrease in T-cells and an increase in B-cells (Pruzanski, 1980). In this report we describe the results of immunological studies of peripheral blood lymphocytes in 22 patients with typical AILD. We have found that the active state of the disease is characterized by T-lymphopenia due to the decrease of OKT4 positive cells.

Angioimmunoblastic lymphadenopathy with dysproteinemia. Circulating immune complexes and the review of 18 cases

Eighteen patients with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) have been analyzed by reviewing all available biopsy, laboratory, and clinical data. Because of features suggesting the presence of circulating immune complexes (CIC), CIC serial sample determinations were performed throughout their disease in available patients. Age, sex, and clinical and laboratory characteristics were consistent with previously reported series. Six of 18 (33%) patients having a drug exposure associated with onset or exacerbation of symptoms demonstrated a significantly decreased survival (P less than 0.02). Achievement of complete remission was a significant indicator of longevity (P less than 0.001). Only one patient (6%) developed diffuse histiocytic lymphoma. Elevated CIC were detected in the four patients tested. In two patients fluctuating CIC levels could clearly be correlated to clinical remission or exacerbation. Despite the small number of patients tested, it was concluded tha CIC may provide useful information for therapy selection, prediction of relapse, and further insight into pathogenetic mechanisms in AILD.

Infectious antecedent of immunoblastic lymphoma. Progressive immunosuppression in a patient with lymphogranuloma venereum

Angioimmunoblastic lymphadenopathy is a nonmalignant disease of unknown etiology often progressing to immunoblastic lymphoma. Immunologic deficiency is evident in these patients as well as in those with various infections found in association with the acquired immune deficiency syndrome (AIDS). This report describes a previously healthy young woman in whom angioimmunoblastic lymphadenopathy developed in association with lymphogranuloma venereum, with progressive loss of immunologic competence. This deterioration paralleled the evolution of angioimmunoblastic lymphadenopathy into a rapidly fatal immunoblastic lymphoma.

Histological, immunohistological and autopsy findings in lymphogranulomatosis X (including angio-immunoblastic lymphadenopathy)

172 cases of lymphogranulomatosis X (LgX) were studied by light microscopy. In 53 cases immunohistological techniques for detecting intracytoplasmic immunoglobulins were applied. In the lymph nodes of all cases the nodal architecture was found to be effaced. Active germinal centres were absent, and there was a generalized, markedly increased proliferation of epithelioid venules. A polymorphic infiltrate was present in all cases. It was dominated by immunoblasts in 14%, by plasma cells in 16%, by epithelioid cells in 23% and by lymphocytes in 6% of the cases. In the remaining 41% of the cases no special type of cell predominated (mixed cell type of LgX). The clusters of clear cells present in some cases with immunoblastic predominance did not stain for intracytoplasmic immunoglobulins; in contrast, the basophilic immunoblasts exhibited a polyclonal Ig pattern. In some of the cases with lymphocytic predominance most of the lymphocytes showed abundant cytoplasm with azurophil granules. Transformation into malignant lymphoma was proven at autopsy in 5 of 38 cases (13.2%). Malignant transformation (biopsy and autopsy material) was confirmed in a total of 11 of 172 cases (6.4%) and suspected in an additional 7%. Among the malignant lymphomas were one immunologically proven B-immunoblastic lymphoma, one peripheral T cell lymphoma and 5 cases of Hodgkin's disease. An association between LgX and carcinoma was histologically verified in 7 cases. 26 cases with active germinal centres and 11 cases with only locally pronounced vascularization but with histological and cytological changes that were otherwise similar to LgX were designated as hyperimmune reactions (HR). These cases had a significantly better prognosis. Two cases that presented as HR with active germinal centres later developed into LgX. It is suggested that the disappearance of active germinal centres is important in the pathogenesis of LgX. The possibility that this may correspond morphologically to an alteration of different components of the T-cell system is discussed.

The blood microvasculature in T-cell lymphomas. A morphological, ultrastructural and immunohistochemical study

The microvasculature of lymph nodes of 55 cases of T-cell lymphoma was studied by light microscopy, immunohistochemistry and electron microscopy. A modified peroxidase-antiperoxidase (PAP) method was used for staining paraffin sections with lectin I of Ulex europaeus (UEA-I), which is a specific marker for vascular endothelial cells. The T-cell nature of each case was proven by immunohistochemistry, including immunoperoxidase staining of frozen sections with monoclonal T-cell antibodies. The cases were subclassified according to previously established criteria, but with the addition of a separate group showing a high content of clear cells. For the purpose of the present study, the small blood vessels were separated into two main variants, viz.: high endothelial venules (HEV) and all other types of vessels with flat endothelium (SVFE). The development of each of these variants and the extent of lymphocyte migration through the vascular wall were assessed semiquantitatively. The findings suggest that the blood microvasculature, as a whole, is similar in all types of T-cell lymphoma. There were distinct differences, however, in the development of the two main categories of small vessels between the various types. Chronic lymphocytic leukaemia of T-type (T-CLL) and Sézary's syndrome were poor in SVFE and rich in HEV, and there was considerable lymphocyte traffic through the latter. In contrast, T-immunoblastic and especially T-lymphoblastic lymphocyte traffic. The appearance of the microvasculature varied markedly in the various subtypes of "pleomorphic T-cell lymphoma". In the small cell subtype HEV predominated and SVFE represented only a small or moderate fraction of the microvasculature. As the size of the neoplastic lymphoid cells increased towards the medium-sized and large cell subtype, there was a decrease in the number of HEV and an increase in the number of SVFE accompanied by a decrease in lymphocyte migration. In T-cell lymphoma of the clear cell type the microvasculature showed features between those of T-CLL and the small cell subtype of pleomorphic T-cell lymphoma. Electron microscopy confirmed the light microscopic findings and revealed many similarities in vascular changes between "pleomorphic T-cell lymphomas" and lymphogranulomatosis X.

Autoimmunity and increased c-myb transcription

A single recessive gene, lpr, induces an autoimmune-lymphoproliferative syndrome in several strains of mice. The lymphoid organs of lpr/lpr mice contained cells with increased amounts of myb RNA, which codes for a protein found in the nucleus. A similar human lymphoproliferative disorder also had an increase in c-myb expression. Mouse T cells induced by mitogens to proliferate did not express large amounts of myb RNA, indicating that marked myb expression is not a general feature of lymphocyte activation and proliferation.

Angioimmunoblastic lymphadenopathy with associated selective myeloid hypoplasia

Angioimmunoblastic lymphadenopathy is a disease characterized systemic symptoms, lymphadenopathy, hepatosplenomegaly and polyclonal hypergammaglobulinemia. Hematologic abnormalities are common, especially anemia, which is often Coombs positive, and lymphocytopenia. This report cites a case of angioimmunoblastic lymphadenopathy associated with selective hypoplasia of the myeloid line and normal maturation of all other marrow-derived cell lines. Possible relationships of this finding to the immunologic abnormalities associated with angioimmunoblastic lymphadenopathy are discussed.

Angioimmunoblastic lymphadenopathy and squamous cell carcinoma of lung

The development of angioimmunoblastic lymphadenopathy in a patient with a slowly growing squamous cell carcinoma of the lung is reported. The possible relation between the two concomitant conditions in this rare case is proposed.

Immunoblastic lymphadenopathy with a high serum Yersinia enterocolitica titer. A case report

An old man with systemic illness initially treated with trimethoprim-sulfa, clinically, histologically and immunohistologically typical of immunoblastic lymphadenopathy (IBL) subsequently appeared to have a high serum Yersinia enterocolitica titer. The possibility that Y. enterocolitica has played some role in the course of IBL in this case is considered.

Multicentric giant lymph node hyperplasia: an immunohistochemical study

Biopsy specimens from five cases of multicentric giant lymph node hyperplasia were studied by standard histochemical techniques and by immunoperoxidase staining and double immunoenzyme labeling to determine the distribution of intracytoplasmic immunoglobulins and kappa and lambda light chains. Microscopically, the affected lymph nodes showed a nodular pattern characterized by multiple lymphoid follicles permeated by numerous small vessels. A striking proliferation of post-capillary venules with many plasma cells and immunoblasts was observed in the interfollicular areas. Immunoperoxidase staining revealed that the cells were positive for IgG, IgA, and IgM with both kappa and lambda chains in the normal ratio. The IgM-positive cells had a perifollicular distribution, whereas the IgG- and IgA-positive cells were located mainly in interfollicular areas. The presence and distribution of different classes of intracytoplasmic immunoglobulins seemed to reflect a normal, albeit tumultuous, immunologic response. Therefore, the disease can be considered a lymphoproliferative disorder due to an inappropriate immunologic reaction.

Angioimmunoblastic lymphadenopathy. Long-term follow-up study

The clinical course of 41 previously reported patients with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) on whom follow-up information has been obtained for five or more years is described. Of the 41 patients, 27 achieved a complete remission (CR). The durations of the CR ranged from two to 214 months, with a median of 48 months. Nine of these 27 complete responders are still alive and well without evidence of disease, whereas the remaining 18 patients have died of pneumonia, septicemia, immunoblastic lymphoma, or unrelated causes. These 27 patients had a significantly longer median survival (51 mos) than did the 14 patients who had partial or no response (9 mos) (P = 0.0006). Only two of these 14 patients who did not initially achieve a CR are alive (survivals, 66 months and 70 months). There was a trend suggesting that patients who received combination chemotherapy which included prednisone had a slightly longer survival than did the remaining patients (P = 0.087). Lymphocytopenia was evident in a higher proportion of dead patients than in those who remained alive (P = 0.089).

Immunoblastic lymphoma with extracellular and intravascular immunoglobulin deposits: immunocytochemical and electron microscopic studies

Immunoblastic lymphoma (IBL) showing features of angioimmunoblastic lymphadenopathy (AIBL) is described. Abundant eosinophilic extracellular deposits were present in lymph nodes. Electron microscopic and immunoperoxidase studies showed this material was composed of degenerating tumor cells and polyclonal immunoglobulins (Mu and Alpha heavy chains and Kappa and Lambda light chains). Numerous arborizing vessels were thickened with monoclonal IgM(K) immunoglobulins. The tumor cell lysis and degeneration are though to be due to the high cell turnover and immune reaction to unrecognized substances.

Angioimmunoblastic lymphadenopathy. A case with an unusual clinical course with marked tumorous infiltration of multiple organs and striking intestinal involvement

An unusual case of angioimmunoblastic lymphadenopathy (AILD) with a rare clinical course and marked gastrointestinal involvement is reported. Two years after the onset of AILD, there was a dramatic alteration in the clinical picture which appeared to take on a malignant course. Despite the clinical course and the presence of macroscopic tumors in multiple sites at autopsy, there was no transformation to immunoblastic sarcoma. The typical histologic picture of AILD was still evident in all organs examined. The rarity of massive gastrointestinal involvement in AILD is stressed.

Angioimmunoblastic lymphadenopathy progressing to immunoblastic lymphoma with prominent gastric involvement

Two unusual cases of angioimmunoblastic lymphadenopathy with dysproteinemia (AILD), with progression to immunoblastic lymphoma (IL) and prominent gastric involvement are presented, and detailed immunohistologic studies described. In one case, Bence Jones proteinuria of the kappa type was observed during the course of AILD and was identified immunohistochemically in lymph node biopsy specimens and at autopsy. The potential significance of an M component and the importance of recognizing gastric involvement by AILD are discussed.

Angioimmunoblastic lymphadenopathy with hypogammaglobulinemia. Possible role of monocyte suppression

A patient wit angioimmunoblastic lymphadenopathy had low serum immunoglobulin values and no antibodies to injected immunogens. This occurred despite the proliferation of polyclonal B cells. T cells were deficient in number and in lymphoproliferative responses, but their helper and suppressor functions were maintained. Ia-antigen bearing leukocytes from the patient stimulated poorly in mixed leukocyte culture. In vitro immunoglobulin synthesis by mononuclear leukocytes form the patient was severely impaired. These leukocytes actively suppressed immunoglobulin synthesis by normal cells from healthy subjects in co-culture. The responsible cell had characteristics of a monocyte. The suppression was selective for humoral immunity and was manifest despite normal numbers of monocytes. It appears that heterogeneous immunoregulatory abnormalities can underlie the syndrome of angioimmunoblastic lymphadenopathy. Furthermore, monocyte suppressor abnormalities may be implicated in clinical disease phenomena.

Immunohistologic studies of cytoplasmic immunoglobulins in rheumatic diseases including two patients with monoclonal patterns and subsequent lymphoma

Tissue specimens from five patients with rheumatic disease who developed lymphadenopathy were studied by an immunoperoxidase method; available biopsy material was examined for cytoplasmic immunoglobulin determinants. Three patients had follicular hyperplasia of lymph nodes with polyclonal patterns. Two patients with Sjogren's syndrome had monoclonal patterns; both of these patients subsequently developed lymphoma with similar monoclonal patterns. Implications of the monoclonal patterns with regard to the biology of these lymphoproliferative disorders are discussed.

Rheumatoid arthritis associated with bronchiolitis obliterans and immunoblastic sarcoma

A case is reported of a 72 year old man suffering from classical seropositive RA for 10 years. Two months before admission he experienced general illness, fever and itching. Lymph nodes enlargement and hepatosplenomegaly were found. Histologic features of lymph node biopsy were compatible with angioimmunoblastic lymphadenopathy and Lennert lymphoma. Rapidly progressive pulmonary deterioration followed with hilar invasion and honeycombing. Sternal punction, bone biopsy, bronchus biopsy and blind lung biopsy however, did not reveal lymphomatous invasion. On the contrary, lung biopsy, showed bronchiolitis obliterans, an often fatal, small airway disease whose connection with RA is discussed. Plasmapheresis induced a correction of leucopenia and thrombocytopenia. A fatal evolution evolved within six months. Autopsy revealed diffuse invasion by immunoblastic sarcoma. The clinicopathological entities angioimmunoblastic lymphadenopathy and Lennert lymphoma are referred to. The relationship with autoimmune disorders is stressed.

Lymphocyte responsiveness to thymosin in angioimmunoblastic lymphadenopathy with lymphomatous transformation

Lymphocytes from a patient with angioimmunoblastic lymphadenopathy with lymphomatous degeneration were tested in vitro for thymosin responsiveness. The percentage of lymphocytes forming spontaneous (E) rosettes to sheep red blood cells (SRBC) was 37 and 32% in the absence of thymosin on two separate occasions. Lymphocytes incubated with thymosin formed rosettes in 55 and 43% when incubated with 0.1 micrograms/ml and 66 and 63% when incubated with 100 micrograms/ml, respectively. The patient subsequently received thymosin while in a preterminal condition. No clinical response to thymosin was apparent and lymphocytes tested 8 days after starting thymosin treatment demonstrated reduced thymosin responsiveness (31% without thymosin vs 37% with 100 micrograms/ml). The failure to respond clinically to thymosin treatment may be related to the preterminal condition. The in vitro responsiveness to thymosin suggests that thymosin effect should be examined earlier in the course of this disease process.

Angioimmunoblastic lymphadenopathy with paraproteinemia: a T- and B-cell disorder

A case is reported of angioimmunoblastic lymphadenopathy (AILD), in which a IgM Kappa monoclonal gammopathy developed. On the first admission the immunoblasts were shown to be T cells by surface-marker studies. Although the number of circulating T cells was normal, their functional capacities were markedly reduced. The patient was followed for two months at the end of which she died with hematologic features of immunoblastic plasma cell leukemia.

Angioimmunoblastic lymphadenopathy: clinical spectrum of disease

The clinical features of 13 patients with angioimmunoblastic lymphadenopathy were analyzed to determine prognostic factors and response to therapy. Eleven patients presented with sudden onset of fever, weight loss, generalized lymphadenopathy, and hepatosplenomegaly. Laboratory features included autoimmune hemolytic anemia and polyclonal hypergammaglobulinemia. Pulmonary involvement was seen in six cases and skin rash in four. Two patients had localized lymphadenopathy without systemic symptoms. Both are alive at 5.5 and 2.5 years, respectively, after diagnosis, although the latter patient has required intermittent prednisone for recurrent lymphadenopathy. An additional patient is alive on treatment for months following diagnosis. The remaining ten have died, nine of sepsis and one of cerebral hemorrhage. The immunosuppression and myelosuppression of combination chemotherapy may have hastened their deaths. An individualized, conservative treatment approach is recommended.

Angioimmunoblastic lymphadenopathy with dysproteinemia: report of the first case in childhood evolving toward spontaneous remission

This is the first known report of a case of angioimmunoblastic lymphadenopathy, with dysproteinemia (AILD) in childhood which evolved toward a spontaneous remission. The disease had an acute onset with generalized lymphadenopathy, hepatosplenomegaly, high-grade fever and polyclonal hypergammaglobulinemia. The lymph nodes met all of the histologic criteria required for diagnosis as established by Frizzera et al. It is emphasized that AILD should be taken into consideration in the differential diagnosis of lymphadenopathy in childhood.

The lung in immunoblastic lymphadenopathy

Immunoblastic lymphadenopathy presents with fever, malaise, cough, dyspnea, lymphadenopathy, hepatosplenomegaly, hypergammaglobulinemia, interstitial pulmonary infiltrates, mediastinal adenopathy, and effusions. The diagnosis is made on the basis of lymph node biopsy. Based on the course in our patients and the cases presented in previous reports, a suggested program of treatment for immunoblastic lymphadenopathy includes administration of moderate doses of steroids initially, with a subsequent increase to a higher dosage if desired improvement does not occur. Chemotherapy with three drugs, cyclophosphamide, vincristine, and prednisone, is indicated if remission using steroids fails. The diagnostic dilemma of whether pulmonary infiltrates are due to the disease itself or to pulmonary infection or to cytotoxic changes from chemotherapy always exists and often requires specimens from either transbronchoscopic or open-lung biopsy for definitive diagnosis and treatment.

[Disease-specific renal failure in angioimmunoblastic lymphadenopathy - remission by high dose prednisolone. A case report (author's transl)]

The case of a 64 years old male with angioimmunoblastic lymphadenopathy (AIL) is reported, who developed disease specific infiltration of the kidneys with progressive destruction of renal parenchyma leading to high grade renal insufficiency. This unusual organ manifestation of AIL has not been previously reported. By treatment with high dose prednisolone and intense supportive therapy the patient underwent complete remission of AIL with preservation of the remaining renal function. Clinical, laboratory and immunological data are given as well as a light and electron microscopic evaluation of the renal involvement.

Immunoblastic lymphoma: an immunologic study

An immunologic study of a 59-year-old man with immunoblastic lymphoma is presented. Shortly after his hospital admission, an uncompensated hemolytic process developed, caused by cold agglutinins. These antibodies had anti-i specificity, were of low titer at cold temperature, but demonstrated a high thermal amplitude. An apparent paraprotein was found by further immunochemical analysis to be polyclonal. The majority of cells in the peripheral blood (over 2000/cu nm), lymph node, and bone marrow that contained cytoplasmic IgG or IgM were plasma cells, although a small number of cells resembled lymphoblasts. Their staining with anti-lambda and anti-kappa chain reagents confirmed the polyclonality of the immunoglobins. Some plasma cells displayed the concomitant presence of both IgM and IgG immunoglobulins. Free immunoglobin was also demonstrated intercellularly in the lymph node section. The patient's acute hemolysis was controlled by plasmapheresis and eventually by combination chemotherapy. After chemotherapy, the clinical improvement was rapid, immunoglobulin levels returned to normal, and the patient remains asymptomatic 40 months after completing six courses of combination chemotherapy. This report provides evidence for polyclonal proliferation of B-lymphocytes in immunoblastic lymphoma.

Rapidly fatal respiratory failure and angioimmunoblastic lymphadenopathy: possible contributions of immunoblastic leukaemia, chemotherapy, and multiple antibodies directed against mature blood cells

A patient with angioimmunoblastic lymphadenopathy, immunoblastic leukaemia, pulmonary immunoblastic infiltration, and multiple antihaemocytic antibodies in his serum deteriorated rapidly after chemotherapy due to severe progressive respiratory of dysfunction. The haematological and immunological changes that accompanied this are described and discussed in the light of the pulmonary changes observed at necropsy of pulmonary oedema, fibrinous thrombi within venules, and immunoblastic infiltration of these thrombi and the venule walls. A pathophysiological mechanism is postulated in an attempt to rationalise these findings, and to act as a guide for the future assessment and management of similar cases.

Immunoblastic lymphadenopathy and asbestosis

Immunoblastic lymphadenopathy was diagnosed in a 71-year-old white man who had weakness, with weight loss, fever, cough, and generalized lymphadenopathy. The patient had a long occupational history of shipyard work. Diagnosis of asbestosis was made clinically by chest x-ray, and ferruginous bodies were found in the lung at autopsy. Recent reports have suggested a possible association between asbestos exposure and lymphoproliferative neoplasms. Chronic antigenic stimulation by asbestos could predispose one to the immunoproliferative disorder seen in this patient or be responsible for it. The possible significance of this relationship, previously unreported, is discussed for future consideration.

Angioimmunoblastic lymphadenopathy in a patient with allergy to insulin: a case report

A patient with allergy to insulin experienced reactive lymphadenopathy and, later, angioimmunoblastic lymphadenopathy; all occurred within 18 months. It is suggested that insulin may be added to the list of drugs associated with the appearance of angioimmunoblastic lymphadenopathy.

Skin lesions in angioimmunoblastic lymphadenopathy: histological and immunological studies

Angioimmunoblastic lymphadenopathy with drysproteinaemia is reported (AILD) in four patients with different skin pictures. As the disease progresses two main forms predominate; papulonodular and erythroderma. In all cases the histological picture of the skin mirrors that of the lymph-node. Our results point to an increase in the peripheral blood, lymph-nodes and skin of T and subsequently of B lymphocytes suggesting that a proliferation of helper T cells and hence activation of the B-cell subpopulation may be involved in the pathogenesis of some cases of AILD.