Novel Intra-Adrenal Secondary Lymphoid Follicle Formation
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Novel Intra-Adrenal Secondary Lymphoid Follicle Formation Victor E. Nava & Carlos Torres-Cabala
Published online: 8 September 2013 # Springer Science+Business Media New York 2013
Dear Editor: Ectopic lymphoid organogenesis, a part of the immune response to antigen, has, to our knowledge, not been reported in normal adrenal tissue [1], incidentally removed adrenal glands [2], or associated with pheochromocytomas. A 42-year-old female with multiple endocrine neoplasia 2A, and without clinical history of chronic infection, autoimmune disease, or lymphoproliferative disorder, developed bilateral pheochromocytomas and underwent bilateral adrenalectomy. Incidentally, a secondary lymphoid follicle was found in the medulla of the right adrenal away from tumor. The lymphoid follicle showed well-developed polarized architecture with reactive germinal center, mantle, and marginal zone, as demonstrated by normal morphology (Fig. 1, hematoxylineosin, ×20) and immunohistochemistry (Fig. 1, CD3 and CD20, ×20, and data not shown). Special stains for microorganisms (Acid–Fast, Gomori–Methenamine, and
V. E. Nava (*) : C. Torres-Cabala Department of Pathology, Mid-Atlantic Permanente Medical Group, Kaiser Permanente, Rockville, MD, USA 20852 e-mail: [email protected] C. Torres-Cabala e-mail: [email protected] V. E. Nava : C. Torres-Cabala Department of Pathology, MD Anderson Cancer Center,, The University of Texas, Houston, TX, USA
Fig. 1 Lymphoid follicle showing well-developed polarized architecture with reactive germinal center, mantle, and marginal zone, as demonstrated by normal morphology (hematoxylin–eosin, ×20) and immunohistochemistry (CD3 and CD20, ×20)
Warthin–Starry) were negative (data not shown). The normal histology of adrenal medulla commonly includes small perivascular accumulations of lymphocytes and/or plasma cells. The reported topographically unique secondary follicle formation, is probably not specifically related to pheochromocytoma, and contributes to the histological variants of nonneoplastic adrenal gland. Immunity to circulating tumor antigens could have contributed to this phenomenon [3]. Alternatively, ectopic germinal center formation primed by defective lymphatic drainage adjacent to tumor occurred, as recently proposed [4]. In summary, a novel adrenal site for lymphoid neo-organogenesis is described.
Endocr Pathol (2013) 24:248–249
References 1. Sternberg SS. Histology for pathologists. 2nd ed. Philadelphia: Lipponcott-Raven, 1997. 2. Buurman H, Saeger W. Abnormalities in incidentally removed adrenal glands. Endocr Pathol 17(3):277–82, 2006.
249 3. de Chaisemartin L, Goc J, Damotte D, Validire P, Magdeleinat P, Alifano M, Cremer I, Fridman WH, Sautès-Fridman C, Dieu-Nosjean MC. Characterization of chemokines and adhesion molecules associated with T cell presence in tertiary lymphoid structures in human lung cancer. Cancer Res 71(20):6391–9, 2011. 4. Thaunat O, Keriaschiki D, Nicoletti A. Is defective lymphatic drainage a trigger for lymphoid neogenesis? Trends Immunol 10:441–5, 2006.
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