LYMPH-NODE HYALINISATION IN RHEUMATOID-ARTHRITIS AND SYSTEMIC-SCLEROSIS

Aims-To review the histological features of lymph nodes excised from s even patients with rheumatoid arthritis and one with systemic sclerosi s. Methods-Lymph nodes excised from seven patients with rheumatoid art hritis and one patient with systemic sclerosis over a 10 year period w ere examined using the stains haematoxylin and eosin, periodic acid Sc hiff (PAS), Masson-trichrome, and Congo red for amyloid. Results-Of th e seven nodes examined from the cases of rheumatoid arthritis, three s howed definite reactive follicular hyperplasia with a prominence of pl asma cells in the interfollicular areas, two showed subtotal replaceme nt of the node by numerous sarcoid like granulomata, and one contained a large central area of necrosis with a surrounding palisade of histi ocytes. In all six cases, focal areas of PAS positive eosinophilic hya line material were present, which did not stain with Congo red. In som e cases this hyaline material was focally calcified. In the seventh pa tient with rheumatoid arthritis the excised lymph node was almost tota lly replaced by similar PAS positive hyaline material which showed ext ensive areas of calcification. The lymph node removed from the patient with systemic sclerosis similarly showed almost total replacement by PAS positive hyaline material. Conclusion-In all cases the nodes conta ined PAS positive extracellular hyaline material to a greater or lesse r degree. The lymph nodes from two of the patients with rheumatoid art hritis contained numerous sarcoid like granulomata, further indicating a possible between sarcoidosis and arthritis. Pathologists and clinic ans should include rheumatoid arthritis and systemic sclerosis in thei r differential diagnosis of lymph node hyalinisation of unknown aetiol ogy.