Angioimmunoblastic lymphadenopathy: light and electron microscopic studies

The present study evaluates the significance of clinical and histologic features in 16 cases of angioimmunoblastic lymphadenopathy (AIL). The disease observed in the elderly is characterized by an acute onset of constitutional symptoms, generalized lymphadenopathy, hepatosplenomegaly, and immunologic abnormalities. The clinical course is rather short, and autopsied cases show severe infections complications. In the present study, two histologic types were identified: 1) Angio-cellular (A-C) type: the lymph nodes contained lymphocytes, immunoblasts, histiocytes, eosinophils and/or plasma cells. 2) Immunoblastic and plasma cell (I & P) type or lymphocyte depleted (LD) type; the lymph node contained mainly immunoblasts and plasmocytoid cells. Serum protein was examined in 12 cases. Dysproteinemia was noted in 5 of 6 cases of A-C type and in 5 of 6 cases of I & P type. There is a definite relationship between histologic types and survival periods. The A-C type is an expression of slight depletion of lymphocytes and the I & P or LD type represents marked depletion of lymphocytes. AIL has malignant potentiality, though it resembles graft-vs-host reaction in histology, the wide-spread involvement of tissues and clinical features. An immunologic investigation on 3 cases suggests that the disease is based on B-cell disorder.