Inflammatory Pseudotumors of Lymph Node Origin Show Macrophage-Derived Spindle Cells and Lymphocyte-Derived Cytokine Transcripts Without Evidence of T-Cell Receptor Gene Rearrangements:Implications for Pathogenesis and Classification as an Idiopathic Retroperitoneal Fibrosis-Like Sclerosing Immune Reaction

Abstract

I n f l a m m a t o r y P s e u d o t u m o r s o f L y m p h N o d e O r i g i n S h o w M a c r o p h a g e -D e r i v e d S p i n d l e C e l l s a n d L y m p h o c y t e -D e r i v e d C y t o k i n e T r a n s c r i p t s W i t h o u t E v i d e n c e o fT -C e l l R e c e p t o r G e n e R e a r r a n g e m e n t s Address reprint requests to Dr. Menke: Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224.(KP1) or HAM-56, and HLA-DR (LN3) immunoreactivity and demonstrated production of procollagen-al (I) mRNA by in situ hybridization. Clonal T-cell receptor chain gene rearrangements were undetectable by polymerase chain reaction. Strong specific lymphocyte-derived interleukin-1/J and interleukin-6 mRNA cytokine transcripts were identified. Although all patients with IPT were managed with steroids and nonsteroidal anti-inflammatory medication, some had treatment-refractory disease. Because all-frans retinoic acid has been demonstrated to inhibit the in vitro transformation of monocytes into collagen-producing spindle-shaped macrophages ("neofibroblasts"), it may be of benefit for patients with IPT.

Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia

“…Table 2 summarizes the main aspects in the differential diagnoses of IPTlike FDCT. In this context IPT may be also included, as it represents a lesion composed of ovoid to spindle cells admixed with polymorphic inflammatory cells, mostly T lymphocytes, but also B cells, plasma cells and histiocytes [16][17][18]. The nature of spindle cells in these lesions is still challenging because of their phenotypic variability.…”

“…Proportion of spindle and inflammatory cell components varied, predominating in some areas or mostly replaced by fibrous content in others. Lesions tended to follow the vascular axis, through the hilum [16,43]. Among the cases in which an etiological agent can be detected, pathologist should search for infection, especially for T. pallidum, as it has been shown that luetic lymphadenitis may also cause lymph node IPT [18,44].…”

Oligoclonal T-cell populations in an inflammatory pseudotumor of the pancreas possibly related to autoimmune pancreatitis: an immunohistochemical and molecular analysis

“…Monoclonal T-lymphocytes have been described in inflammatory sclerosing disorders, such as idiopathic retroperitoneal fibrosis [14], which shares some morphological similarities with IPT/IMT. However, they have never been investigated in pancreatic IPT/IMT and have never been found in IPT arising in other anatomical sites [6,28]. The significance and the origin of the clonal T-lymphocytes in this case of IPT/IMT are currently not known, but it can be speculated that they develop in the context of an intense and destructive, maybe also selfstimulating, inflammatory reaction.…”

“…Here, we report a case of IPT/ IMT of the pancreas. We further provide a characterization of its cell population, with particular attention paid to the inflammatory cell component, in view of the fact that the inflammatory cells seem to play a fundamental role in the pathogenesis of the lesion through the production of cytokines and growth factors that, in turn, influence the phenotypic characteristics of the spindle cell and connective tissue elements [23,28]. We also discuss the potential relationship between IPT and autoimmune pancreatitis.…”

The fasciitis‐panniculitis syndromes: histomorphometric assessment of the inflammatory and sclerosing processes affecting the subcutaneous and fascial tissues

“…In addition to its chemotactic potential, transforming growth fac-tor+ as well promotes the production of other growth factors, upregulates the synthesis of extracellular matrix components and expression of cellular integrin receptors, and inhibits the action of proteolytic enzymes that destroy newly formed connective tissue. Consequently, the inflammatory response is enhanced while the proliferation of the collagen-producing cells is boosted (19)(20)(21)(22). This cytokine-initiated and perpetuated cascade-reaction results in certain sclerosing disorders and maybe also portrays the mechanism involved in the pathogenesis of the fasciitis-panniculitis syndromes.…”