Granulomatous and lymphocytic hypophysitis - are they immunologically distinct?

Autor: Rao S; Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India., Mahadevan A; Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India., Maiti T; Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India., Ranjan M; Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India., Shwetha SD; Human Brain Tissue Repository, National Institute of Mental Health and Neurosciences, Bangalore, India., Arivazhagan A; Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India., Saini J; Neuroimaging and Intervention Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.
Jazyk: angličtina
Zdroj: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica [APMIS] 2016 Dec; Vol. 124 (12), pp. 1072-1077. Date of Electronic Publication: 2016 Oct 05.
DOI: 10.1111/apm.12603
Abstrakt: Hypophysitis includes three histopathologically distinct entities - granulomatous, lymphocytic and xanthomatous forms. Etiopathogenesis and the immunological differences among these is not well characterized. This study aims to explore the immunopathogenesis of granulomatous and lymphocytic forms of hypophysitis. Demographic, clinical, endocrine function and radiological features of 33 histologically confirmed cases of hypophysitis were reviewed. Immunophenotyping of inflammatory component was performed in 13/33 cases. Visual disturbances (46%), headache (36%), polyuria/polydipsia (6%), menstrual disturbance (6%) and galactorrhoea (6%) were the frequent presenting symptoms. Endocrine abnormalities were noted in 11/18 cases evaluated (61%). Hypothyroidism was the most common endocrine abnormality (33.33%) followed by hyperprolactinaemia (22%) and hypocortisolism (16.66%). On neuroimaging, sellar mass with variable contrast enhancement was observed. On histology, granulomatous hypophysitis (GH) was more common (84.84%) than lymphocytic hypophysitis (LH) (15.15%). In GH, the infiltrate had almost equal proportions of CD3+ T cells and CD68+ histiocytes. Cytotoxic T cells (CD8+) predominated [CD4:CD8 < 1]. CD20+ B cell component ranged from <5% to 50%. Fibrosis, necrosis and giant cells accompanied GH. LH in contrast, had CD4+ T-helper cell predominance [CD4: CD8 > 1]. CD68+ histiocytes constituted <20% and CD20+ B cells, 5-40% of the infiltrates. In conclusion, GH revealed cytotoxic T cell and histiocyte rich infiltrate in contrast to CD4+ T-cell predominance in LH suggesting that the two forms have distinct immunological mechanisms in evolution, an autoimmune process in LH and type IV hypersensitivity response in GH.
(© 2016 APMIS. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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