title: Gonadal macrophage infiltration in congenital lipoid adrenal hyperplasia.
abstract: OBJECTIVE
  Congenital lipoid adrenal hyperplasia (lipoid CAH) results in impairment of adrenal and gonadal steroidogenesis caused by STAR mutations. Our previous study revealed upregulation of genes associated with inflammatory or immune response and macrophage infiltration in the adrenal cortex of Star-knockout mice. This study aimed at investigating macrophage infiltration in the gonads from human patients with lipoid CAH.
  
  
  METHODS
  This study includes seven patients with lipoid CAH who underwent gonadectomy: two XX women (age, 22 and 40 years) and five XY boys (1 year). Two women with ovarian cysts (32 and 40 years) and six boys with autopsy or tumor (1 year) were examined as controls. Immunohistochemical analysis of their gonads was performed to determine steroidogenic cells by NR5A1 or CYP17A1 and macrophages by IBA1 or CD68.
  
  
  RESULTS
  An increased number of macrophages infiltrated into the ovaries of lipoid CAH and consisted of two subpopulations: one scattered within and around a layer of theca cells of maturing follicles and the other massively aggregated in the stroma. Abundant cytoplasmic lipid droplets were observed not only in the theca cells but also in the stromal macrophages. There was no significant difference in the number of macrophages in the testicular interstitium between lipoid CAH (95% confidence interval (95% CI: 19.3-47.7 per 0.2mm(2)) and controls (95% CI: 13.3-25.8 per 0.2mm(2)) (P=0.10).
  
  
  CONCLUSIONS
  These results demonstrate that macrophages infiltrate the ovaries of lipoid CAH, where the theca cells and the stromal macrophages have abundant cytoplasmic lipid droplets.
authors.affiliation: Department of PediatricsKeio University School of Medicine, Tokyo, Japan tishii@1992.jukuin.keio.ac.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Ishii
authors.affiliation: Department of Pathology and Laboratory MedicineTokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Fukuzawa
authors.affiliation: Department of PediatricsKeio University School of Medicine, Tokyo, Japan Department of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Muroya
authors.affiliation: Department of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Adachi
authors.affiliation: Department of PediatricsGraduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ihara
authors.affiliation: Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Igaki
authors.affiliation: Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Hasegawa
authors.affiliation: Department of PediatricsSaitama Municipal Hospital, Saitama, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of PediatricsKeio University School of Medicine, Tokyo, Japan.
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Mitsui
authors.affiliation: Department of PediatricsKeio University School of Medicine, Tokyo, Japan.
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Hasegawa
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000473:pathology*; D000328:Adult; D058490:Disorder of Sex Development, 46,XY / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008264:Macrophages / Q000473:pathology*; D008297:Male; D009919:Orchiectomy; D010052:Ovariectomy; D010053:Ovary / Q000473:pathology*; D013737:Testis / Q000473:pathology*; D055815:Young Adult