Broadening the morphologic spectrum of bartonella henselae lymphadenitis: Analysis of 100 molecularly characterized cases

Christine E. Jabcuga, Long Jin, William R. Macon, Matthew T. Howard, Andre M. Oliveira, Rebecca King

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Bartonella henselae lymphadenitis, or cat-scratch lymphadenitis (CSL), is classically associated with stellate microabscesses, occasional giant cells, and extension of the inflammatory infiltrate into perinodal soft tissue. Availability of B. henselae molecular testing on tissue specimens has broadened our understanding of the morphologic variation in this disease. Here we sought to describe the histopathologic features of the largest series to date of molecularly proven CSL. B. henselae polymerase chain reaction-positive tissue specimens from 2010 to 2012 were identified, and hematoxylin and eosin slides were reviewed. A single-step 16S-23S rRNA-based polymerase chain reaction testing was used to identify B. henselae on formalinfixed, paraffin-embedded tissues. A total of 100 B. henselae- positive cases were identified. The median age of the patients was 26.5 years (range, 1 to 69 y). Ninety-two percent of cases presented in lymph nodes, with 66% of these occurring above the diaphragm, most commonly in the cervical chain. Of 100 cases, 57 had classical CSL features of necrotizing granulomas with microabscesses, with or without surrounding palisading histiocytes. In contrast, 43/100 cases lacked the prototypical microabscesses of CSL including: 23 cases (53.5%) with features of fungal/mycobacterial lymphadenitis, 6 (14%) cases with features of Kikuchi lymphadenitis, and 4 cases (9.3%) with the classic histologic triad of toxoplasma lymphadenitis. In summary, B. henselae lymphadenitis may lack the typical microabscesses in almost half of cases and may closely mimic other reactive, especially infectious, lymphadenopathies. Given the lack of specificity of many of these features, a low threshold for B. henselae molecular testing on tissue is warranted in the appropriate clinical context.

Original languageEnglish (US)
Pages (from-to)342-347
Number of pages6
JournalAmerican Journal of Surgical Pathology
Volume40
Issue number3
DOIs
StatePublished - 2016

Fingerprint

Bartonella henselae
Lymphadenitis
Cats
Polymerase Chain Reaction
Histiocytes
Toxoplasma
Giant Cells
Hematoxylin
Eosine Yellowish-(YS)
Diaphragm
Granuloma
Paraffin
Lymph Nodes

Keywords

  • Bartonella henselae
  • Cat-scratch disease
  • Polymerase chain reaction
  • Reactive lymphadenitis

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Broadening the morphologic spectrum of bartonella henselae lymphadenitis : Analysis of 100 molecularly characterized cases. / Jabcuga, Christine E.; Jin, Long; Macon, William R.; Howard, Matthew T.; Oliveira, Andre M.; King, Rebecca.

In: American Journal of Surgical Pathology, Vol. 40, No. 3, 2016, p. 342-347.

Research output: Contribution to journalArticle

Jabcuga, Christine E. ; Jin, Long ; Macon, William R. ; Howard, Matthew T. ; Oliveira, Andre M. ; King, Rebecca. / Broadening the morphologic spectrum of bartonella henselae lymphadenitis : Analysis of 100 molecularly characterized cases. In: American Journal of Surgical Pathology. 2016 ; Vol. 40, No. 3. pp. 342-347.
@article{69603d8e98cd4dc48d2cb186a78b3eea,
title = "Broadening the morphologic spectrum of bartonella henselae lymphadenitis: Analysis of 100 molecularly characterized cases",
abstract = "Bartonella henselae lymphadenitis, or cat-scratch lymphadenitis (CSL), is classically associated with stellate microabscesses, occasional giant cells, and extension of the inflammatory infiltrate into perinodal soft tissue. Availability of B. henselae molecular testing on tissue specimens has broadened our understanding of the morphologic variation in this disease. Here we sought to describe the histopathologic features of the largest series to date of molecularly proven CSL. B. henselae polymerase chain reaction-positive tissue specimens from 2010 to 2012 were identified, and hematoxylin and eosin slides were reviewed. A single-step 16S-23S rRNA-based polymerase chain reaction testing was used to identify B. henselae on formalinfixed, paraffin-embedded tissues. A total of 100 B. henselae- positive cases were identified. The median age of the patients was 26.5 years (range, 1 to 69 y). Ninety-two percent of cases presented in lymph nodes, with 66{\%} of these occurring above the diaphragm, most commonly in the cervical chain. Of 100 cases, 57 had classical CSL features of necrotizing granulomas with microabscesses, with or without surrounding palisading histiocytes. In contrast, 43/100 cases lacked the prototypical microabscesses of CSL including: 23 cases (53.5{\%}) with features of fungal/mycobacterial lymphadenitis, 6 (14{\%}) cases with features of Kikuchi lymphadenitis, and 4 cases (9.3{\%}) with the classic histologic triad of toxoplasma lymphadenitis. In summary, B. henselae lymphadenitis may lack the typical microabscesses in almost half of cases and may closely mimic other reactive, especially infectious, lymphadenopathies. Given the lack of specificity of many of these features, a low threshold for B. henselae molecular testing on tissue is warranted in the appropriate clinical context.",
keywords = "Bartonella henselae, Cat-scratch disease, Polymerase chain reaction, Reactive lymphadenitis",
author = "Jabcuga, {Christine E.} and Long Jin and Macon, {William R.} and Howard, {Matthew T.} and Oliveira, {Andre M.} and Rebecca King",
year = "2016",
doi = "10.1097/PAS.0000000000000552",
language = "English (US)",
volume = "40",
pages = "342--347",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Broadening the morphologic spectrum of bartonella henselae lymphadenitis

T2 - Analysis of 100 molecularly characterized cases

AU - Jabcuga, Christine E.

AU - Jin, Long

AU - Macon, William R.

AU - Howard, Matthew T.

AU - Oliveira, Andre M.

AU - King, Rebecca

PY - 2016

Y1 - 2016

N2 - Bartonella henselae lymphadenitis, or cat-scratch lymphadenitis (CSL), is classically associated with stellate microabscesses, occasional giant cells, and extension of the inflammatory infiltrate into perinodal soft tissue. Availability of B. henselae molecular testing on tissue specimens has broadened our understanding of the morphologic variation in this disease. Here we sought to describe the histopathologic features of the largest series to date of molecularly proven CSL. B. henselae polymerase chain reaction-positive tissue specimens from 2010 to 2012 were identified, and hematoxylin and eosin slides were reviewed. A single-step 16S-23S rRNA-based polymerase chain reaction testing was used to identify B. henselae on formalinfixed, paraffin-embedded tissues. A total of 100 B. henselae- positive cases were identified. The median age of the patients was 26.5 years (range, 1 to 69 y). Ninety-two percent of cases presented in lymph nodes, with 66% of these occurring above the diaphragm, most commonly in the cervical chain. Of 100 cases, 57 had classical CSL features of necrotizing granulomas with microabscesses, with or without surrounding palisading histiocytes. In contrast, 43/100 cases lacked the prototypical microabscesses of CSL including: 23 cases (53.5%) with features of fungal/mycobacterial lymphadenitis, 6 (14%) cases with features of Kikuchi lymphadenitis, and 4 cases (9.3%) with the classic histologic triad of toxoplasma lymphadenitis. In summary, B. henselae lymphadenitis may lack the typical microabscesses in almost half of cases and may closely mimic other reactive, especially infectious, lymphadenopathies. Given the lack of specificity of many of these features, a low threshold for B. henselae molecular testing on tissue is warranted in the appropriate clinical context.

AB - Bartonella henselae lymphadenitis, or cat-scratch lymphadenitis (CSL), is classically associated with stellate microabscesses, occasional giant cells, and extension of the inflammatory infiltrate into perinodal soft tissue. Availability of B. henselae molecular testing on tissue specimens has broadened our understanding of the morphologic variation in this disease. Here we sought to describe the histopathologic features of the largest series to date of molecularly proven CSL. B. henselae polymerase chain reaction-positive tissue specimens from 2010 to 2012 were identified, and hematoxylin and eosin slides were reviewed. A single-step 16S-23S rRNA-based polymerase chain reaction testing was used to identify B. henselae on formalinfixed, paraffin-embedded tissues. A total of 100 B. henselae- positive cases were identified. The median age of the patients was 26.5 years (range, 1 to 69 y). Ninety-two percent of cases presented in lymph nodes, with 66% of these occurring above the diaphragm, most commonly in the cervical chain. Of 100 cases, 57 had classical CSL features of necrotizing granulomas with microabscesses, with or without surrounding palisading histiocytes. In contrast, 43/100 cases lacked the prototypical microabscesses of CSL including: 23 cases (53.5%) with features of fungal/mycobacterial lymphadenitis, 6 (14%) cases with features of Kikuchi lymphadenitis, and 4 cases (9.3%) with the classic histologic triad of toxoplasma lymphadenitis. In summary, B. henselae lymphadenitis may lack the typical microabscesses in almost half of cases and may closely mimic other reactive, especially infectious, lymphadenopathies. Given the lack of specificity of many of these features, a low threshold for B. henselae molecular testing on tissue is warranted in the appropriate clinical context.

KW - Bartonella henselae

KW - Cat-scratch disease

KW - Polymerase chain reaction

KW - Reactive lymphadenitis

UR - http://www.scopus.com/inward/record.url?scp=84959174677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959174677&partnerID=8YFLogxK

U2 - 10.1097/PAS.0000000000000552

DO - 10.1097/PAS.0000000000000552

M3 - Article

C2 - 26551620

AN - SCOPUS:84959174677

VL - 40

SP - 342

EP - 347

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 3

ER -