Immunohistochemical Characterization Of Granulomatosis With Polyangiitis Exhibiting Spontaneous Regression
Masuta, Y., Komeda, Y., Sekai, I., Hara, A., Kurimoto, M., Yoshikawa, K., Otsuka, Y., Takada, R., Yoshikawa, T., Kamata, K., Minaga, K., Maenishi, O., Watanabe, T., & Kudo, M. (2024). Immunohistochemical characterization of granulomatosis with polyangiitis exhibiting spontaneous regression. Asian Pacific journal of allergy and immunology, 42(4), 415–419. https://doi.org/10.12932/AP-190221-1073
View Original Source →Abstract
BACKGROUND: Granulomatosis with polyangiitis (GPA) is characterized by granulomatous inflammation, vasculitis, and elevated levels of serum proteinase 3 (PR3)-anti-neutrophil cytoplasmic antibody (PR3-ANCA). OBJECTIVE: We tried to characterize immune cells accumulated into the lung lesions of a GPA patient exhibiting spontaneous regression. METHODS: Transbronchial lung biopsy (TBLB) samples were subjected to immunohistochemical analyses. RESULTS: Multiple lung nodules were detected by CT. TBLB showed granulomatous inflammation and small vessel vasculitis. This case was diagnosed as GPA based on pathological findings and elevation of PR-3 ANCA levels. Spontaneous disappearance of multiple lung nodules was observed in CT. CD3+ T cells and CD20+ B cells accumulated in the inflammatory lesions surrounding the vessels whereas granulomatous inflammation was mainly comprised of CD3+ T cells and CD68+ macrophages, but not B cells or myeloperoxidase+ neutrophils. CONCLUSIONS: We characterized immune cell compositions of the lung lesions of a patient with GPA exhibiting spontaneous regression.
Case Details
Disease Location
Lung
Personal Characteristics
24-year-old-man
Clinical Characteristics
Underwent whole-body CT as his annual blood examinations indicated mild anemia. Multiple nodules localized in the bilateral peripheral lungs were detected. Blood examinations revealed mild anemia and thrombocytosis. The serum concentrations of iron (fe) and ferritin were low. Elevations of total IGG and ige were observed. Pr3-anca was elevated. Fdg-PET revealed a marked uptake of fdg into bilateral lung nodules. Transbronchial lung biopsy (tblb) against the right s8 lung nodule was performed. Granulomatous inflammation, deposition of fibrinoid materials, stenosis of the vascular lumen, and infiltration of immune cells surrounding the small vessels were observed. Pathological findings were consistent with those of granulomatosis with polyangiitis (gpa). Inflammatory lesions surrounding the small vessels were characterized by infiltration of CD3+ t cells and CD20+ b cells. Granulomatous inflammatory lesions were characterized by infiltration of CD3+ t cells and CD68+ macrophages.
Remission Characteristics
Multiple lung nodules completely disappeared four months later in follow-up CT
Treatment & Mechanisms
Proposed Remission Mechanisms
Reduced exposure to environmental and infectious agents and drugs might have induced regression of gpa in this case.
Clinical Treatment
Biopsy
Non-Clinical Treatment
None reported