Human immunodeficiency virus-1 (HIV-1) infection is a fatal retroviral infection that may first present clinically as enlargement of the lymphoid tissues of Waldeyer's ring. These tissues are a major site of viral replication. The presence of the virus in these tissues causes a unique constellation of diagnostic histopathologic features, including florid follicular hyperplasia, follicle lysis, and productively HIV-1-infected multinucleated giant cells of probable dendritic cell origin. Serologic evaluation is confirmatory of HIV infection. With the recent advances in antiretroviral chemotherapy, the early institution of which may significantly prolong life and disease-free interval, the recognition of the clinical and pathologic parameters of HIV-related enlargement of Waldeyer's ring tissues is essential.
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References
1.
FauciAS. The human immunodeficiency virus: Infectivity and mechanisms of pathogenesis. Science1988; 239: 617–22.
2.
LaneHFauciA.. Immunologic abnormalities in the acquired immunodeficiency syndrome. Annu Rev Immunol1985; 3: 477–500.
3.
BrynesRKChanWCSpiraTJEwingEPJrChandlerFW. Value of lymph node biopsy in unexplained lymphadenopathy in homosexual men. JAMA1983; 250: 1313–7.
4.
EwingEPChandlerFWSpiraTJBrynesRKChanWC. Primary lymph node pathology in AIDS and AIDS-related lymphadenopathy. Arch Pathol Lab Med1985; 109: 977–81.
5.
IoachimHLLemerCWTapperML. The lymphoid lesions associated with the acquired immunodeficiency syndrome. Am J Surg Pathol1983; 7: 543–53.
6.
WoodOS. The immunohistology of lymph nodes in HIV infection: A review. In: RotterdamH, ed. Progress in AIDS pathology. Philadelphia, Pa: Field and Wood, 1990: 25–32.
7.
BarzanLCarboneATirelliU. Nasopharyngeal lymphatic tissue in patients infected with human immuno-deficiency virus: A prospective clinicopathologic study. Arch Otolaryngol Head Neck Surg1990; 116: 928–31.
8.
ShahabIOsborneBMButlerJJ. Nasopharyngeal lymphoid tissue masses in patients with human immunodeficiency virus-1: Histologic findings and clinical correlation. Cancer1994; 74: 3083–8.
9.
SternJCLinPTLucenteFE. Benign nasopharyngeal masses and human immunodeficiency virus infection. Arch Otolaryngol Head Neck Surg1990; 116: 206–8.
10.
WenigBMThompsonLDRFrankelSS. Lymphoid changes of the nasopharynx and tonsils that are indicative of human immunodeficiency virus infection: A clinicopathologic study of 12 cases. Am J Surg Pathol1996; 20: 572–87.
11.
ChaudhryRAkhtarSLucenteFEKimDS. Large oral ulcers leading to destruction of the tonsils in patients with AIDS. Otolaryngol Head Neck Surg1996; 114: 474–8.
12.
BurkeAPBensonWRibasJL. Postmortem localization of HIV-1 RNA by in situ hybridization in lymphoid tissues of intravenous drug addicts who died unexpectedly. Am J Pathol1993; 142: 1701–13.
13.
FrankelSSWenigBMBurkeAP. Active HIV-1 replication in dendritic cells and syncytia at the mucosal surface of the pharyngeal tonsil (adenoids). Science1996; 272: 115–7.
14.
EmbertsonJZupancicMRibasJL. Massive covert infection of helper T lymphocytes and macrophages by HIV during the incubation period of AIDS. Nature1993; 362: 359–62.
15.
HarperMEMarselleLMGallRCWong-StaalF.Detection of lymphocytes ‘expressing human T-lymphotropic virus type III in lymph nodes and peripheral blood from infected individuals by in situ hybridization. Proc Natl Acad Sci USA1986; 83: 772–6.
16.
EsserRvon BriesenHBruggerW. Secretory repertoire of HIV-infected human monocytes/macrophages. Pathobiology1991; 59: 219–22.
17.
HoDDRotaTRHirschMS. Infection of monocyte/ macrophage by human T lymphotropic virus type III. J Clin Invest1986; 77: 1712–5.
LanghoffETermilligerEFBosHJ. Replication of human immunodeficiency virus type 1 in primary dendritic cell cultures. Proc Natl Acad Sci U S A1991; 88: 7998–8002.
20.
BurkeAPAndersonDBensonW. Localization of human immunodeficiency virus 1 RNA in thymic tissues from asymptomatic drug addicts. Arch Pathol Lab Med1995; 119: 36–41.
21.
BurkeAPAndersonDMannanP. Systemic lymphadenopathy histology in human immunodeficiency virus-1-seropositi ve addicts without apparent acquired immunodeficiency syndrome. Hum Pathol1994; 25: 248–56.
22.
ChadburnAMetrokaCMouradianJ.Progressive lymph node histology and its prognostic value in patients with acquired immunodeficiency syndrome and AIDS-related complex. Hum Pathol1989; 20: 579–87.
23.
ÖstÅBaroniCDBiberfeldP. Lymphadenopathy in HIV infection: Histological classification and staging. Acta Pathol Microbiol Immunol Scand (Suppl) 1989(suppl 8): 7–15.
24.
PallesenGGerstoftJMathiesenL.. Stages of LAV/ HTLV lymphadenitis. I. Histological and immunohistological classification. Scand J Immunol1987; 25: 83–91.
25.
PileriSRivanoMTRaiseE. The value of lymph node biopsy in patients with acquired immuno-deficiency syndrome (AIDS) and the AIDS-related complex (ARC): A morphological and immunohistochemical study of 90 cases. Histopathology1986; 10: 1107–29.
26.
O'MurchadaMTWolfBCNeimanRS. The histologic features of hyperplastic lymphadenopathy in AIDS-related complex are nonspecific. Am J Surg Pathol1987; 11: 94–9.
27.
StanleyMWFrizzeraG.Diagnostic specificity of histologic features in lymph node biopsy specimens from patients at risk for the acquired immunodeficiency syndrome. Hum Pathol1986; 17: 1231–9.
28.
BudkaH.Multinucleated giant cells in brain: A hallmark of the acquired immune deficiency syndrome (AIDS). Acta Neuropathol (Berl)1986; 69: 353–8.
29.
SeilheanDDe GirolamiUHénanDHauwJJ. The neuropathology of AIDS: The Salpêtrière experience and review of the literature, 1981–1993. Adv Pathol Lab Med1994; 7: 221–57.
30.
SharerLRChoESEpsteinLG. Multinucleated giant cells and HTLV-III in AIDS encephalopathy. Hum Pathol1985; 16: 760.
31.
PantaleoGGraziosiCFauciAS. The immunopathogenesis of human immunodeficiency virus infection. N Engl J Med1993; 328: 327–35.
32.
BiberfeldPChaytKJMarselleLMBiberfeldGGalloRCHarperME. HTLV-III expression in infected lymph nodes and relevance to pathogenesis of lymphadenopathy. Am J Pathol1986; 125: 436–42.
33.
FoxCHTenner-RáczKRáczPFirpoAPizzoPAFauciAS. Lymphoid germinal centers are reservoirs of human immunodeficiency virus type 1 RNA. J Infect Dis1991; 164: 1051–7.
34.
RaczPTenner-RaczKSchmidtH.Follicular dendritic cells in HIV-induced lymphadenopathy and AIDS. Acta Pathol Microbiol Immunol Scand (Suppl) 1989(suppl 8): 16–23.
35.
SteinmanRM. The dendritic cell system and its role in immunogenicity. Annu Rev Immunol1991; 9: 271–96.
36.
RoittI.The anatomy of the immune response. In: RoittI, ed. Essential immunology. 8th ed.London, England: Blackwell Scientific Publications, 1994: 147–61.
37.
HartDNMcKenzieJL. Isolation and characterization of human tonsil dendritic cells. J Exp Med1988; 168: 157–70.
38.
MacAtoniaSELauRPattersonSPinchingAJKnightSC. Dendritic cell infection, depletion and dysfunction in HIV-infected individuals. Immunology1990; 71: 38–45.
39.
MacAtoniaSEGompelsMPinchingAJPattersonSKnightSC. Antigen presentation by macrophages but not by dendritic cells in human immunodeficiency virus (HIV) infection. Immunology1992; 75: 576–81.
40.
PattersonSKnightSC. Susceptibility of human peripheral blood dendritic cells to infection by human immunodeficiency virus. J Gen Virol1987; 68: 1177–81.
41.
PattersonSGrossJBedfordPKnightSC. Morphology and phenotype of dendritic cells from peripheral blood and their productive and non-productive infection with human immunodeficiency virus type 1. Immunology1991; 72: 361–7.
42.
PopeMBetjesMGHRomaniN. Conjugates of dendritic cells and memory T lymphocytes from skin facilitate productive infection with HIV-1. Cell1994; 78: 389–98.
43.
MillerCJMcGheeJRGardnerMB. Mucosal immunity, HIV transmission, and AIDS. Lab Invest1993; 68: 129–45.
44.
PomerantzRJde la MonteSMDoneganSP. Human immunodeficiency virus (HIV) infection of the uterine cervix. Ann Intem Med1988; 108: 321–7.
45.
FoxCHKotlerDTierneyAWilsonCSFauciAS. Detection of HIV-1 RNA in the lamina propria of patients with AIDS and gastrointestinal disease. J Infect Dis1989; 159; 467–71.
46.
HeiseCDandekarSKumarPDuplantierRDonovanRMHalstedCH. Human immunodeficiency virus infection of enterocytes and mononuclear cells in human jejunal mucosa. Gastroenterology1991; 100: 1521–7.
47.
NelsonJAReynolds-KohlerCMargarettenWWileyCAReeseCELevyJA. Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. Lancet1988; 1: 259–62.
48.
YahiNBaghdiguianSMoreauHFantiniJ.Galactosyl ceramide (or a closely related molecule) is the receptor for human immunodeficiency virus type 1 on human colon epithelial HT29 cells. J Virol1992; 66: 4848–54.
49.
BabaTTrichelAAnL. Infection and AIDS in adult macaques after nontraumatic oral exposure to cell free SIV. Science1996; 272: 184–8.
