Histiocytic reactions

Wood C, Severin GL. Unusual histiocytic reaction to Monsel s solution. Am J Dermatopathol 1980 2(3) 261. ... 

Anaphylactic and serum sickness reactions to ALG and murine monoclonal antibodies have been observed and usually require cessation of therapy. Complexes of host antibodies with horse ALG may precipitate and localize in the glomeruli of the kidneys. Even more disturbing has been the development of histiocytic lymphomas in the buttock at the site of ALG injection. The incidence of lymphoma as well as other forms of cancer is increased in kidney transplant patients. It appears likely that part of the increased risk of cancer is related to the suppression of a normally potent defense system against oncogenic viruses or transformed cells. The preponderance of lymphoma in these cancer cases is thought to be related to the concurrence of chronic immune suppression with chronic low-level lymphocyte proliferation. 

The vessel wall changes found more frequently and more distinctly in the animals subjected to ECT consist of characteristic sac-like dilatations of the perivascular spaces, which in some cases contain histiocytic elements. The glial reaction, of the progressive type, consists of an increase in the number of the small glial elements in the parenchyma and satellitosis beside the nerve cells. The nerve cell changes observed are in the form of various stages of chromophobia, frequently with coincident nuclear hyperchromatism. The arrangement of such cells is mainly focal. 

Mesenchymal reaction shows an activation of the stellate cell system the stellate cells and the mononuclear phagocytosis system proliferate, (s. p. 397) Stellate cell nodules form. (s. fig. 22.3) This process spreads from the sinusoids at the site of the lesion to include neighbouring parenchymal cells. The reticular lattice fibre is damaged and sometimes even destroyed. In a more massive lesion, the inflammatory process spreads to the portal zone histiocytes, lymphocytes and eosinophilic leucocytes lead to portal zone cellulations with oedematous dilations, in some cases subsequent to portal fibrosis (s. fig. 21.14), or to cholangitis of the PBC type (s. fig. 29.5) as well as of the PSC type. 

Granular cell tumors may occasionally arise in the vulva. Their appearance is similar to tumors at other anatomic sites. They are thought to derive from peripheral nerve sheath and express S-100 protein, inhibin, and calretinin (Fig. 18.2). The diagnosis is usually straightforward but occasionally the differential may include melanoma, histiocytes, or even a decidual reaction. 

The majority of tissue reactions are of inflammatory origin. Indeed, most granuloma contain different cell types with inflammatory characteristics, including multinucleated giant cells, histiocytes, plas-mocytes, mast cells, and lymphocytes (Griffith et al. 1987 Nasser et al. 1990). In addition, neutrophilic polymorphonuclear cells frequently exhibit degranulation (Shanbhag etal. 1992). 

Microscopically, toxocara granulomas consist of a central mass of karyorrhectic nuclear debris, and eosinophilic structureless and often fibrinoid-like material (Spencer 1973. In less severe tissue reactions the centres of the lesions are occupied by a mass of eosinophils without cellular necrosis. In a minority of lesions a portion of the causative larva may be identified near the centre of the lesion and cross sections may show the characteristic alar ridges projecting from the exterior of the cuticle. Around the central necrotic area the lesions consist of masses of eosinophil cells, plasma cells, lymphocytes and histiocytic cells, the latter often arranged in a characteristic pallisaded fashion. 

For instance, carbon fibers have been used widely for orthopedic applications. Matrices of carbon fibers were implanted in patients for the treatment of chronic painful articular defects of the patella [47], with mixed results at 33 months mean follow-up with low patient satisfaction. Synovial biopsies have pointed out consistent seeding of the joint with diffuse carbon fiber debris and histiocytic giant-ceU reaction in the synovium, sometime associated with low-grade inflammatory response. These results discouraged further procedures for lesions of the articular cartilage of the patella with carbon fiber matrix. 

Skin An interstitial granulomatous reaction to anakinra resulted in pink dermal plaques and nodules in the periaxillary region which resolved after withdrawal of anakinra and recurred on rechaUenge [82 ]. Biopsy showed diffuse dermal infiltration of lymphocytes and histiocytes with interspersed neutrophils and eosinophils, and... 

The extent and duration of tissue reactions to polymeric implant materials is important in assessing biocompatibility. In general, the ideal foreign body reaction in soft tissue to a pol nneric implant is one in which the acute inflammatory response, marked by pol3nnorpho-nuclear leukocytes, exudation and hyperemia, resolves quickly with little or no chronic inflammatory phase, marked by lymphocytes, plasma cells or histiocytes, and increasing fibrosis and eventual encapsulation of the implant by fibrous tissue occurs (7-9). Interaction of the tissue with the polymeric implant may result in a continuation of the chronic inflammatory phase or lead to increased fibrosis. This increased fibrosis or over-development of the fibrous capsule may involve adjacent organs or tissues and lead to adverse reactions (10, 11). 

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