Morphologic Spectrum of Lymphadenopathy in Adult-onset Immunodeficiency (Anti-interferon-gamma Autoantibodies)

doi:10.1097/PAS.0000000000001736

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/23766

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/23766

Title:	Morphologic Spectrum of Lymphadenopathy in Adult-onset Immunodeficiency (Anti-interferon-gamma Autoantibodies)
Authors:	Thingujam, B;Syue, LS;Wang, RC;Chen, CJ;Yu, SC;Chen, CC;Medeiros, LJ;Liao, IC;Tsai, JW;Chang, KC
Keywords:	adult-onset;immunodeficiency;anti-interferon gamma;morphologic features;differential diagnosis
Date:	2021
Issue Date:	2022-08-05T09:42:31Z (UTC)
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
ISSN:	0147-5185
Abstract:	Adult-onset immunodeficiency syndrome (AOIS) caused by anti-interferon-gamma autoantibodies is an emerging disease. Affected patients present typically with systemic lymphadenopathy, fatigue, and fever. We studied 36 biopsy specimens, 31 lymph nodes, and 5 extranodal sites, of AOIS confirmed by serum autoantibody or QuantiFERON-TB Gold In-Tube assay. We describe the morphologic features and the results of ancillary studies, including special stains, immunohistochemistry, and molecular testing. The overall median age of these patients was 60.5 years (range, 41 to 83 y) with a male-to-female ratio of 20:16. All biopsy specimens showed nontuberculous mycobacterial infection, and most cases showed the following histologic features: capsular thickening with intranodal sclerosing fibrosis, irregularly distributed ill-formed granulomas or histiocytic aggregates with neutrophilic infiltration, interfollicular expansion by a polymorphic infiltrate with some Hodgkin-like cells that commonly effaces most of the nodal architecture and proliferation of high endothelial venules. In situ hybridization analysis for Epstein-Barr virus-encoded RNA showed scattered (<1%) to relatively more common (4% to 5%) positive cells in 29 of 30 (97%) tested specimens, reflecting immune dysregulation due to an interferon-gamma defect. In the 31 lymph node specimens, 23 (74%) cases showed increased immunoglobulin G4-positive plasma cells (4 to 145/HPF; mean, 49.7/HPF) with focal areas of sclerosis reminiscent of immunoglobulin G4-related lymphadenopathy, 4 (13%) cases resembled, in part, nodular sclerosis Hodgkin lymphoma, and 9 (29%) cases mimicked T-cell lymphoma. Among 33 patients with available clinical follow-up, 20 (61%) showed persistent or refractory disease despite antimycobacterial therapy, and 1 patient died of the disease. We conclude that the presence of ill-defined granulomas, clusters of neutrophils adjacent to the histiocytic aggregates, and some Epstein-Barr virus-positive cells are features highly suggestive of AOIS. A high index of clinical suspicion and awareness of the morphologic features and differential diagnosis of AOIS are helpful for establishing the diagnosis.
URI:	http://dx.doi.org/10.1097/PAS.0000000000001736 https://www.webofscience.com/wos/woscc/full-record/WOS:000706785000013 https://ir.csmu.edu.tw:8080/handle/310902500/23766
Relation:	AMERICAN JOURNAL OF SURGICAL PATHOLOGY ,2021,v45,issue 11, P1561-1572
Appears in Collections:	[中山醫學大學研究成果] 期刊論文

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