Immunohistochemical analysis of arterial wall cellular infiltration in Buerger's disease (endarteritis obliterans)

Purpose: The diagnosis of Buerger's disease has depended on clinical sympto ms and angiographic findings, whereas pathologic findings are considered to be of secondary importance. Arteries from patients with Buerger's tissue w ere analyzed histologically, including immunophenotyping of the infiltratin g cells, to elucidate the nature of Buerger's disease as a vasculitis. Methods: Thirty-three specimens from nine patients, in whom Buerger's disea se was diagnosed on the basis of our clinical and angiographic criteria bet ween 1980 and 1995 at Nagoya University Hospital, were studied. Immunohisto chemical studies were performed on paraffin-embedded tissue with a labeled streptoavidin-biotin method. Results: The general architecture of vessel walls was well preserved regard less of the stage of disease, and cell infiltration was observed mainly in the thrombus and the intima. Among infiltrating cells, CD3(+) T cells great ly outnumbered CD20(+) B cells. CD68(+) macrophages or S-100(+) dendritic c ells were detected, especially in the intima during acute and subacute stag es. All cases except one showed infiltration by the human leukocyte antigen -D region (HLA-DR) antigen-bearing macrophages and dendritic cells in the i ntima. Immunoglobulins G, A, and M (IgG, IgA, IgM) and complement factors 3 d and 4c (C3d, C4c) were deposited along the internal elastic lamina. Conclusion: Buerger's disease is strictly an endarteritis that is introduce d by T-cell mediated cellular immunity and by B-cell mediated humoral immun ity associated with activation of macrophages or dendritic cells in the int ima.