title: Foreign body reactions in lymph nodes of oncology patients with joint prostheses--light-, electron microscopic and immunohistological investigations.
abstract: Foreign body reactions in lymph nodes caused by wear particles from joint prostheses can mimic different lymphadenopathies, including metastatic cancer. The knowledge of these alterations is particularly important for pathologists performing frozen section diagnosis for oncology patients. As recent investigations of pseudocapsules have revealed that most of the wear particles are submicron-sized, transmission electron microscopic investigations were additionally performed. The histological investigation of the pelvic lymph nodes of 22 oncology patients with joint prostheses showed that the bone cement wear prevailed. At least small amounts of polyethylene wear particles were also found in all cases. Metallic wear particles were detected in 90% of the cases. The wear particles induce a macrophage-rich foreign body reaction that can cause an architectural effacement of the lymph nodes. The electron microscopic investigations showed that submicron-sized wear particles prevail. Some of them form conglomerates in size ranges detectable by light microscopy. The immunohistochemical studies showed that the foreign body reactions comprised mature CD163- and PGM1-positive macrophages and few lymphocytes, predominantly T-lymphocytes. The knowledge of the characteristic alterations of regional lymph nodes seems important in order to avoid misinterpretations. Therefore, in particular the detection of intracytoplasmatic wear particles is helpful in this respect.
authors.affiliation: Institute of Pathology, University of Schleswig-Holstein, Campus Lübeck, Germany. bos@patho.mu-luebeck.de
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Bos
authors.forename: Reiner
authors.initials: R
authors.lastname: Johannisson
mesh_terms: D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D003937:Diagnosis, Differential; D005549:Foreign-Body Reaction / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D002479:Inclusion Bodies / Q000378:metabolism / Q000648:ultrastructure; D007595:Joint Prosthesis / Q000009:adverse effects*; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008264:Macrophages / Q000378:metabolism / Q000648:ultrastructure; D008495:Medical Oncology / Q000379:methods*; D046529:Microscopy, Electron, Transmission; D010316:Particle Size; D010733:Phosphoglucomutase / Q000378:metabolism; D020959:Polyethylene / Q000302:isolation & purification; D011956:Receptors, Cell Surface / Q000378:metabolism; D015040:Zirconium / Q000302:isolation & purification; D000098902:CD163 Antigen
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D000098902:CD163 Antigen; D011956:Receptors, Cell Surface; D020959:Polyethylene; D015040:Zirconium; C488050:PGM1 protein, human; D010733:Phosphoglucomutase; C028541:zirconium oxide