Lymphadenopathy in homosexual men. Morbid anatomy with clinical and immunologic correlations

This is a study of the histopathologic features of lymph nodes removed from eleven young, homosexual men, all of whom presented with lymph node enlargement of more than 3 months' duration, accompanied, in the majority of cases, by fever and weight loss. Reactive follicular and sinusoidal hyperplasia were the main findings in 10 patients. The medullary sinuses were packed with monomorphic round sinusoidal cells associated with neutrophils. In one of the 10 patients, granulomas packed the subcapsular sinuses, especially. Another patient presented with lymphoid-depleted nodes with absent germinal centers and a prominent vascular skeleton; this latter feature made it difficult to distinguish this picture from the nodal form of Kaposi's sarcoma. All patients had a history of sexual promiscuity and used "recreational" drugs. Nine of 10 patients had deficient cellular immunity and inverted T-cell helper/suppressor ratios. The only patient with normal cellular immunity had nodal granulomas. Humoral immunity was normal in all patients.