Pandit H, Vlychou M, Whitwell D, Crook D, Luqmani R, Ostlere S, Murray D W, Athanasou N A
Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK.
Virchows Arch. 2008 Nov;453(5):529-34. doi: 10.1007/s00428-008-0659-9. Epub 2008 Sep 4.
Clinical, radiological and histological findings were analysed in four patients who developed bilateral pseudotumours following metal-on-metal (MoM) resurfacing arthroplasties of both hips. Using a panel of monoclonal antibodies directed against HLA-DR, macrophages (CD14, CD68), dendritic cells (DC-SIGN, S100, CD11c), B cells (CD20), and T cells (CD3, CD4, CD8), the nature of the heavy inflammatory response seen in these cases was examined. Bilateral masses developed in periprosthetic soft tissues following the second MoM arthroplasty; these were characterised histologically by extensive coagulative necrosis, a heavy macrophage infiltrate and the presence of granulomas containing macrophages and giant cells; there was also a diffuse lymphocyte and variable plasma cell and eosinophil polymorph infiltrate. Immunohistochemistry showed strong expression of HLA-DR, CD14 and CD68 in both granulomatous and necrotic areas; lymphocytes were predominantly CD3+/CD4+ T cells. The clinical, morphological and immunophenotypic features of these necrotic granulomatous pseudotumours, which in all cases develop following a second resurfacing hip arthroplasty, is suggestive of a type IV immune response, possibly to MoM metal alloy components.
对4例双侧髋关节金属对金属（MoM）表面置换关节成形术后出现双侧假肿瘤的患者的临床、放射学和组织学检查结果进行了分析。使用一组针对HLA - DR、巨噬细胞（CD14、CD68）、树突状细胞（DC - SIGN、S100、CD11c）、B细胞（CD20）和T细胞（CD3、CD4、CD8）的单克隆抗体，研究了这些病例中所见重度炎症反应的性质。第二次MoM关节成形术后，假体周围软组织出现双侧肿块；组织学特征为广泛的凝固性坏死、大量巨噬细胞浸润以及含有巨噬细胞和巨细胞的肉芽肿；还存在弥漫性淋巴细胞以及数量不等的浆细胞和嗜酸性多形核白细胞浸润。免疫组织化学显示，在肉芽肿和坏死区域HLA - DR、CD14和CD68均呈强表达；淋巴细胞主要为CD3 + /CD4 + T细胞。这些坏死性肉芽肿性假肿瘤的临床、形态学和免疫表型特征，在所有病例中均于第二次髋关节表面置换术后出现，提示为IV型免疫反应，可能针对MoM金属合金成分。
