Tsurumaru H
Department of Otorhinolaryngology, Faculty of Medicine, Kagoshima University.
Nihon Jibiinkoka Gakkai Kaiho. 1996 Nov;99(11):1662-75. doi: 10.3950/jibiinkoka.99.1662.
While the presence of mucosa-associated lymphoid tissue (MALT) in the human upper respiratory mucosa is still being debated, it is known that lymphoid follicles (LFs) are present in the mucosa of patients with chronic sinusitis. In the present study, we investigated LFs in chronic sinusitis mucosa samples for the first time immunohistochemically to reveal the frequency and process of lymphoid follicle formation. Forty maxillary sinus mucosa samples from 27 surgical cases were examined. Of the 31 samples, 15 (48.4%) contained primary and/or secondary LFs, 27 (87.1%) contained lymphocyte aggregates (LAs), and 27 (87.1%) contained high endothelial venules (HEVs) located in the LAs and around the LFs. In the inflammatory site above the lesion of the LAs or LFs, respectively, intraepithelial lymphocyte infiltration and a non-ciliated structure or lympho epithelium were seen. In the first phase of diffuse lymphocyte infiltration, CD8+ T cells (suppressor/cytotoxic) were the predominant cells observed in a spreading pattern under the epithelium. In the next phase, while OPD4+ T cells (helper/inducer) were infiltrating, L26+ B cells were gradually aggregating to form lymphocyte clusters (LCs). S-100+ antigen-presenting cells and DRC+ follicular dendritic cells (FDCs) had already appeared during lymphocyte aggregation to promote lymphoid follicle formation. The region of LFs was morphologically divided into the lympho epithelium (LE), the sublympho epithelial area (SLA), the parafollicular area (PFA), and the follicular area (FA). The LE was invaded focally by L26+ B cells and sporadically by UCHL1+ T cells. In the SLA, L26+ B cells and small numbers of OPD4+ T cells were dominant. In the PFA, both OPD4+ and CD8+ T cells were present. The FA consisted of B cells, FDCs, and a few OPD4+ T cells in germinal centers (GCs). In the GCs, we observed VLA-4+ lymphocytes, VCAM-1+ FDCs, IgM+ B cells, and a few IgA+ B cells. On the basis of this study, LFs with lympho epithelium and HEVs are considered prevalent pathological findings in the mucosa humans with chronic sinusitis. Immunohistochemical study revealed the infiltration patterns of T and B lymphocyte subpopulations and FDCs, which clarified the process of LAs, LCs and LFs. This study confirms that LFs are immunologically activated areas that produce plasma cells and are supported by the cellular interaction between FDCs and B cells in their GCs. These MALTs in chronic sinusitis play an important role in mucosal immunity and persistent local inflammation.
虽然人类上呼吸道黏膜中黏膜相关淋巴组织（MALT）的存在仍存在争议，但已知慢性鼻窦炎患者的黏膜中存在淋巴滤泡（LFs）。在本研究中，我们首次采用免疫组织化学方法对慢性鼻窦炎黏膜样本中的LFs进行研究，以揭示淋巴滤泡形成的频率和过程。对27例手术病例的40个上颌窦黏膜样本进行了检查。在31个样本中，15个（48.4%）含有初级和/或次级LFs，27个（87.1%）含有淋巴细胞聚集物（LAs），27个（87.1%）含有位于LAs中和LFs周围的高内皮微静脉（HEVs）。在LAs或LFs病变上方的炎症部位，分别可见上皮内淋巴细胞浸润以及无纤毛结构或淋巴上皮。在弥漫性淋巴细胞浸润的第一阶段，CD8 + T细胞（抑制/细胞毒性）是上皮下呈扩散模式观察到的主要细胞。在下一阶段，当OPD4 + T细胞浸润时，L26 + B细胞逐渐聚集形成淋巴细胞簇（LCs）。在淋巴细胞聚集过程中，S - 100 + 抗原呈递细胞和DRC + 滤泡树突状细胞（FDCs）已经出现，以促进淋巴滤泡形成。LFs区域在形态上分为淋巴上皮（LE）、淋巴上皮下区域（SLA）、滤泡旁区域（PFA）和滤泡区域（FA）。LE被L26 + B细胞局灶性侵入，并被UCHL1 + T细胞散在侵入。在SLA中，L26 + B细胞和少量OPD4 + T细胞占主导。在PFA中，OPD4 + 和CD8 + T细胞均存在。FA在生发中心（GCs）由B细胞、FDCs和少量OPD4 + T细胞组成。在GCs中，我们观察到VLA - 4 + 淋巴细胞、VCAM - 1 + FDCs、IgM + B细胞和少量IgA + B细胞。基于本研究，具有淋巴上皮和HEVs的LFs被认为是慢性鼻窦炎患者黏膜中普遍存在的病理表现。免疫组织化学研究揭示了T和B淋巴细胞亚群以及FDCs的浸润模式，从而阐明了LAs、LCs和LFs的形成过程。本研究证实LFs是产生浆细胞的免疫激活区域，并在其GCs中受到FDCs与B细胞之间细胞相互作用的支持。慢性鼻窦炎中的这些MALTs在黏膜免疫和持续性局部炎症中起重要作用。
