Summary
23 cases of angioimmunoblastic lymphadenopathy (AILAP) diagnosed by lymph node biopsy were investigated with regard to bone marrow involvement, using plastic embedding technique. 14 patients (61%) out of 23 displayed a granuloma-like focal or extended infiltrate, predominantly in the center of the bone marrow spaces. This lesion contained lymphocytes, plasma cells, histiocytic reticulum cells and sometimes immunoblasts with whorls of arborizing vessels and increased reticulin fibers. The different types of cellular infiltration in lymph nodes in AILAP are not encountered in bone marrow. Further, there is only a relatively slight increase of vessels which are not always as thick-walled in the bone marrow as in the lymph nodes of AILAP patients. 7 out of 14 (50%) cases with marrow involvement died with recurring lymphomas and infiltration of liver and spleen after 4 to 54 months after the first biopsy. This demonstrates the unfavorable clinical outcome of AILAP with bone marrow infiltration, since only 2 of 9 patients (22%) without marrow involvement at the time of biopsy have died to date: one had toxic heart failure following chemotherapy and another developed septicaemia. Early marrow lesions of Hodgkin's disease and granulomas in hyperergic myelitis of rheumatic origin have a very similar appearance and may therefore be confused with AILAP infiltrates. Histopathology of lymph nodes is therefore an essential requirement in differentiating between these disorders. The outstanding value of bone marrow biopsy in AILAP-patients is firstly, in staging the disease and secondly, in early recognition of systemic spread connected with an unfavorable prognosis.
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Schnaidt, U., Vykoupil, K.F., Thiele, J. et al. Angioimmunoblastic lymphadenopathy. Virchows Arch. A Path. Anat. and Histol. 389, 369–380 (1980). https://doi.org/10.1007/BF00430660
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DOI: https://doi.org/10.1007/BF00430660