Rheumatology Advance Access originally published online on January 4, 2007
Rheumatology 2007 46(5):811-814; doi:10.1093/rheumatology/kel411
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Pulmonary rheumatoid nodules demonstrating features usually associated with rheumatoid synovial membrane
Medicine, Medical and Surgical Sciences, Dunedin School of Medicine, University of Otago, PO Box 913 1Pathology Department, Dunedin Hospital 2Physiology Department Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin 3Green Lane Respiratory Services, Auckland City Hospital, Auckland, New Zealand
Correspondence to: Prof. John Highton. E-mail: john.highton{at}stonebow.otago.ac.nz
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Abstract |
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Objectives. To describe the unusual immunohistological characteristics of two pulmonary rheumatoid nodules showing ectopic lymphoid follicles and the features normally associated with rheumatoid synovial membrane, and to discuss the implications of this novel observation.
Methods. Two formalin-fixed wax-embedded pulmonary rheumatoid nodules were processed for immunohistology.
Results. The central structure of the pulmonary nodules was typical of that uniformly expected in a rheumatoid nodule with central necrosis surrounded by a palisade of macrophages. However, a feature not previously observed in nodules was the presence of lymphoid aggregates containing B lymphocytes and, in some cases, showing characteristic features of lymphoid follicles.
Conclusions. The presence of B lymphocytes and the development of ectopic lymphoid follicles in rheumatoid nodules have not been described previously. It is similar to synovial membrane, and contrasts with the expected structure of subcutaneous nodules where B cells and lymphoid follicles are normally absent. These observations establish that the morphology of rheumatoid nodules can vary in different tissues. They further suggest that the inflammatory process in the nodule and synovial membrane are likely to be similar, and that the characteristics of different tissues may be an important determinant of apparent differences between inflammatory lesions in synovial membrane and extra-articular nodules in rheumatoid arthritis.
KEY WORDS: Pulmonary rheumatoid nodule, Pulmonary granuloma, Immunohistology, Ectopic lymphoid follicles
Submitted 20 June 2006;
revised version accepted 7 November 2006.
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