Paediatric nodal marginal zone B-cell lymphadenopathy of the neck: a Haemophilus influenzae-driven immune disorder?

Philip M Kluin, Anton W Langerak, Jannetta Beverdam-Vincent, Willemina R R Geurts-Giele, Lydia Visser, Bea Rutgers, Ed Schuuring, Joop Van Baarlen, King H Lam, Kees Seldenrijk, Robby E Kibbelaar, Peter de Wit, Arjan Diepstra, Stefano Rosati, Max M van Noesel, C Michel Zwaan, Jarmo C B Hunting, Mels Hoogendoorn, Ellen J van der Gaag, Joost W J van EsserEveline de Bont, Hanneke C Kluin-Nelemans, Rik H Winter, Jerome R Lo Ten Foe, Adri G M van der Zanden

Onderzoeksoutput: Bijdrage aan tijdschriftArtikelpeer review

Samenvatting

Many hyperplasias and lymphomas of marginal zone B-cells are associated with infection. We identified six children and one adolescent with cervical lymphadenopathy showing prominent polyclonal nodal marginal zone hyperplasia (pNMZH) and four adolescents with monoclonal paediatric nodal marginal zone lymphoma (pNMZL). The clonality status was assessed using BIOMED-2-IG PCR analysis. Haemophilus influenzae was identified in all six cases of pNMZH that could be tested by direct culture (N = 3) or a very sensitive PCR for the H. influenzae gyrase gene in frozen materials (N = 5). H. influenzae was not detected in three pNMZLs and 28 non-specific reactive cervical lymph nodes of age-matched controls, except for a single control node that was obtained during oropharyngeal surgery for a cleft palate showing very low copy numbers of H. influenzae. pNMZH patients were younger than pNMZL patients (median age 12 versus 21 years). pNMZH showed a prominent nodular appearance with variable fibrosis without acute inflammation. Within the nodules, the expanded germinal centres and variably sized marginal zones were colonized by activated B-cells with weak expression of IgD and lack of CD10 and/or BCL6 expression. Some areas showed skewed light chain expression in plasma cells (4/5 cases lambda). In four cases tested, this was confirmed by flow cytometry for surface Ig (3/4 cases lambda). In contrast, pNMZL showed more extensive expansion of marginal zones by centrocytoid cells and often expression of BCL2 protein. Several H. influenzae strains are known to interact with the constant part of IgD on human B-cells, leading to their polyclonal proliferation and activation. We speculate that in vivo stimulation of IgD+ marginal zone B-cells by this bacterium may be implicated in this particular lymphadenopathy that should be distinguished from monoclonal pNMZL.

Originele taal-2Engels
Pagina's (van-tot)302-14
Aantal pagina's13
TijdschriftThe Journal of pathology
Volume236
Nummer van het tijdschrift3
DOI's
StatusGepubliceerd - feb. 2015
Extern gepubliceerdJa

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