Use of silver staining (dieterlé's stain) in the diagnosis of cat scratch disease.

Lymph node involvement in cat scratch disease is characterized by a granulomatous lymphadenitis with micro-abscesses. Recently, it has been shown that the possible aetiological agent is a micro-organism which stains with some silver stains. In this study 60 lymph nodes were studied from 60 patients, using a modified Dieterlé's stain. In 40 cases (66%) rod-shaped bacilli with rounded extremities were observed. They were negative both with the Gram and Ziehl-Neelsen stains. Since such micro-organisms were demonstrated in the majority of the nodes examined, it can be concluded that silver stains are appropriate for the diagnosis of this condition.

Altered functions of peripheral blood monocytes in homosexual males and intravenous drug users with persistent generalized lymphadenopathy.

Persistent generalized lymphadenopathy (PGL) is observed predominantly in subjects at risk of developing AIDS. Twenty-seven individuals belonging to such groups: twelve homosexual males and fifteen intravenous drug users, were investigated for immunological abnormalities with particular attention to monocyte functions. They were compared with five AIDS patients. Twenty out of twenty-two individuals had anti-LAV/HTLV-III antibodies and most had abnormalities characteristic of AIDS: polyclonal hypergammaglobulinemia, decreased cell-mediated immunity, inverted T-cell helper/suppressor ratio and histological alterations of lymph nodes. As for peripheral blood monocyte functions, phagocytic capacity and production of O2- were normal and bactericidal capacity was decreased. Monocytes cultured in the presence of concanavalin A produced less PGE2 and more IL-1/MCF than normal monocytes. Similar abnormalities were found using monocytes from AIDS patients. These data suggest that monocytes from patients with PGL have functional alterations that may be either intrinsic or secondary to lymphocyte dysfunction(s); these alterations do not account for the decreased capacity of lymphocytes to respond to mitogens but may explain the uncontrolled activation of B cells.

[Persistent generalized lymphadenopathies in homosexuals and drug addicts: changes in humoral and cellular immunity]. / Lymphadénopathies persistantes généralisées chez les homosexuels et les toxicomanes: altérations de l'immunité humorale et cellulaire.

In two groups of subjects at risk for acquired immune deficiency syndrome (AIDS), homosexual males and intravenous drug users with persistent generalized lymphadenopathy, humoral and cell-mediated immunity were compared. A small group of patients with definite AIDS were also studied. It was found that levels of immunoglobulins, serological markers for virus and other infections, cell-mediated immunity and histology of lymph nodes were similar in homosexuals and drug users, whereas the lymphocyte sub-populations differed completely. The number of T4+ lymphocytes was markedly decreased in homosexuals but normal in drug users; the number of T8+ lymphocytes was much higher in drug users than in homosexuals. This discrepancy may explain the extremely low prevalence of AIDS cases observed among Swiss drug users as compared with the high frequency noted among homosexuals.

[Solitary plasmocytoma of the mandible]. / Plasmocytome solitaire de la mandibule.

The authors present a case of solitary bony plasmocytoma of the mandibule, with local amyloid deposition. Diagnosis was made at extemporaneous pathological examination, then confirmed by the examination of the fixed surgical sample. Immunoenzymologically the proliferation proved to be monoclonal, with secretion of kappa light chain. The patient was treated by surgical curettage and homologous cancelous bone filling, followed by 5,500 rads of electrontherapy. He was then regularly controlled during 8 years and remained free from local recurrence. All investigations in search of dissemination (Kahler disease) remained negative.

Lymphadenopathy in drug addicts. A study of the distribution of T lymphocyte subsets in the lymph nodes.

Lymph node biopsies from 24 male heroin addicts and 9 control patients were studied using immunohistochemical, and in 1/3 of cases, quantitative methods. 5 out of these 24 patients were also homosexual. All presented diffuse lymphadenopathy but none had any signs or symptoms of opportunistic infections nor Kaposi's sarcoma. Histologically the lymph nodes showed a very peculiar follicular hyperplasia with atrophy of the paracortex. The germinal centers appeared irregular, ill defined and contained clusters of small lymphocytes. The mantle zone was atrophic. Immunolabelling of T lymphocytes by monoclonal antibodies showed that germinal centers were invaded by small nests of Leu 2a (and OKT8) positive lymphocytes, i.e. chiefly cytotoxic-suppressor phenotype; the number of these cells increased by about 100 times in the follicles. OKT4 (and Leu 3a) positive cells, i.e. chiefly helper-inducer phenotype, appeared to decrease. These histological and immunohistochemical changes are considered to be suggestive of drug addicts' lymphadenopathy, and also possibly of other conditions increasing the risk of AIDS.

[Lymphomatoid granulomatosis, polymorphic reticulosis and angioimmunoblastic lymphadenopathy with pulmonary involvement. Similar or different entities?]. / Granulomatose lymphomatoïde, réticulose polymorphe et lymphadénopathie angioimmunoblastique avec atteinte pulmonaire. Trois entités distinctes ou semblables?

This study attempts to demonstrate that typical lymphomatoid granulomatosis, polymorphic reticulosis and angioimmunoblastic lymphadenopathy with pulmonary involvement, are three related anatomo-clinical conditions. Three groups of patients with clinical and pathological signs corresponding to each of these three conditions are studied. In group A, the clinical, radiographic and histologic data for 11 patients presenting "classical lymphomatoid granulomatosis" are reported. In this group, all subjects presented a poor general condition, with fever and immunological disorders (hypo- or hypergammaglobulinemia, often monoclonal gammopathy). Chest X-rays always showed bilateral, nodular, poorly defined lung infiltrates. Most patients have had rash and/or dermal infiltrates and ENM involvement. Some of them developed liver and/or spleen, and/or lymph node enlargement. Whatever the localization of the lesions, there were angiocentric polymorphic granulomas with atypical cells spread between lymphocytes, plasma cells and rare polymorphonuclear leucocytes. In group B, the clinical, radiographic and biological data for 4 patients presenting a so-called polymorphic reticulosis are reported. All subjects presented ENM involvement; only one had a poor general condition and hypogammaglobulinemia. Only one patient presented a lung involvement. Histologically the lesions were angiocentric granulomas composed of numerous lymphocytes, plasma cells intermingled with some polymorphonuclears and numerous characteristic large atypical cells. In group C, the clinical, radiographic and biological data for 3 out of 26 cases diagnosed as angioimmunoblastic lymphadenopathy (AIL) are summarized. These 3 cases were selected because of presence of lung involvement; all three had a typical AIL with fever, poor general condition, rash, hemolytic anemia (Coombs +) and lymph node enlargement. All of them presented bilateral, nodular, poorly defined lung infiltrates. Lymph node lesions were typical for AIL: destruction of follicular structure, vascular proliferation and numerous immunoblasts. Lesions in other organs (mainly lung, dermal and ENM lesions) were characterized by angiocentric granulomas containing numerous blast cells. The biological behavior with eventual development of a monoclonal gammopathy, associated or not with a malignant immunoblastic lymphoma, as well as resemblance of clinical and histological manifestations during the course of the disease, suggest that these three conditions represent variants of a basically identical entity.

Lymphomatoid granulomatosis of the lung. An immunohistochemical study.

11 cases of lymphomatoid granulomatosis, selected because of available immunological data, are presented. The evolution of these cases has been studied by repeated biopsies and/or eventual autopsy using immunohistochemical methods. The follow-up period ranged between 1 and 144 months. All cases but 2 died of a direct or indirect consequence of their disease; 1 of the 2 patients still alive presented a recurrence after 3 years. The histological changes which occurred in the infiltrates argue in favor of a neoplastic transformation of the disease after a variable lapse in time, in spite of treatment. The death is due either directly to the neoplasia or to an infectious complication enhanced by the treatment. The malignancy which follows is generally an immunoblastic lymphoma. Immunohistochemical studies show that the infiltrates are polyclonal in the early phases of the disease and become monoclonal in the late stages. In many cases the transformation into a 'B' immunoblastic lymphoma is marked by the appearance of a monoclonal gammopathy. These immunohistochemical studies support the opinion that the lymphomatoid granulomatosis is a peculiar situation between a reactive and neoplastic state but which evolves eventually into the latter.

Polymorphic reticulosis (lethal midline granuloma) and lymphomatoid granulomatosis: identical or distinct entities?

Two cases of polymorphic reticulosis were studied. Both cases had a fatal clinical course, that of the second case being rapid and progressive and ending 6 months after the onset of the disease with little demonstrable effect of steroid therapy. Biopsy material was obtained in both patients, and both were submitted to a post-mortem examination. The first case showed typical angiocentric, angiodestructive, polymorphous lymphoreticular infiltrates, involving the pharyngeal region and the tongue. The second case demonstrated these same lesions in the midfacial region, the lungs and the skin. A possible identify between polymorphic reticulosis and lymphomatoid granulomatosis is discussed (because of the coexistence of identical lesions in the midfacial region and in the lung parenchyma in the second case). Wegener's granulomatosis in limited and disseminated forms and malignant lymphoma are considered in the differential diagnosis.