Stanford University School of Medicine, Department of Pathology, Stanford, CA, United States of America.
University of California, Department of Pathology, San Francisco, CA, United States of America.
Ann Diagn Pathol. 2020 Feb;44:151421. doi: 10.1016/j.anndiagpath.2019.151421. Epub 2019 Nov 13.
The formation, development and dissolution of germinal centers is a major part of immune system function. It is important to differentiate neoplastic processes from follicular hyperplasia and regressive follicular changes. Better understanding of germinal center development and dissolution also provides diagnostic clues to the underlying pathologic process. It is also important in identifying the immune basis of different pathologic entities as well as in immunotherapy decision making and follow up. In this study, we characterize the immunoarchitecture of lymphoid follicles with a focus on germinal center in one representative case, each of commonly encountered benign and malignant lymph node disorders, with morphologic and immunohistochemical alterations of germinal centers. The cases include reactive follicular hyperplasia (FH), florid follicular hyperplasia (FFH), follicular lymphoma (FL), angioimmunoblastic T-cell lymphoma (AITL), hyaline-vascular Castleman disease (HVCD), progressive transformation of germinal centers, nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), lymphocyte-rich classic Hodgkin lymphoma (LR-CHL), human immunodeficiency virus (HIV)-associated follicular dissolution and chronic lymphocytic leukemia (CLL) with proliferation centers (PC). A panel of antibodies were used namely CD3, CD20, CD10, BCL2, BCL6, CD21, CD23, CD35, FOXP1, GCET1, HGAL/GCET2, LMO2, MUM1, IgD, Ki67, PD1 and PD-L1. We found that these entities show distinct immunoarchitectural patterns of germinal center formation, development and regression, particularly, the distribution of mantle zone B-cells, follicular helper T cells (Tfh) and FDC meshworks, confirming the influence of antigenic stimulation and status of immune system in these changes. This also confirms the interrelationship of underlying immunologic mechanisms in these disease processes.
生发中心的形成、发展和消退是免疫系统功能的重要组成部分。将肿瘤性过程与滤泡增生和滤泡退行性改变区分开来非常重要。更好地了解生发中心的发育和消退也为潜在的病理过程提供了诊断线索。它对于确定不同病理实体的免疫基础、免疫治疗决策以及随访也非常重要。在这项研究中，我们通过对一个代表性病例中的淋巴滤泡免疫结构进行研究，重点关注生发中心，描述了常见的良性和恶性淋巴结疾病中具有形态学和免疫组织化学改变的生发中心。这些病例包括反应性滤泡增生（FH）、滤泡性增生（FFH）、滤泡性淋巴瘤（FL）、血管免疫母细胞性 T 细胞淋巴瘤（AITL）、透明血管型 Castleman 病（HVCD）、生发中心进行性转化、结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）、富含淋巴细胞的经典霍奇金淋巴瘤（LR-CHL）、HIV 相关滤泡溶解和增殖中心（PC）的慢性淋巴细胞白血病（CLL）。使用了一组抗体，包括 CD3、CD20、CD10、BCL2、BCL6、CD21、CD23、CD35、FOXP1、GCET1、HGAL/GCET2、LMO2、MUM1、IgD、Ki67、PD1 和 PD-L1。我们发现，这些实体具有不同的生发中心形成、发育和消退的免疫结构模式，特别是，外套带 B 细胞、滤泡辅助 T 细胞（Tfh）和 FDC 网的分布，证实了抗原刺激和免疫系统状态对这些变化的影响。这也证实了这些疾病过程中潜在免疫机制的相互关系。
