Lymphoid Aggregates That Resemble Tertiary Lymphoid Organs Define a Specific Pathological Subset in Metal-on-Metal Hip Replacements

摘要: Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) has been used to describe the histological associated with metal-on-metal (M-M) bearings. We tested hypothesis that lymphoid aggregates, ALVAL lesions resemble tertiary organs (TLOs). Histopathological changes were examined in periprosthetic tissue of 62 M-M hip replacements requiring revision surgery, particular emphasis on characteristics and pattern lymphocytic infiltrate. Immunofluorescence immunohistochemistry study classical features TLOs cases where large organized follicles present. Synchrotron X-ray fluorescence (XRF) measurements undertaken detect localisation implant derived ions/particles within samples. Based type infiltrates, three different categories recognised; diffuse aggregates (51%), T cell (20%), organised (29%). Further investigation tissues showed these recapitulate many cells B into discrete areas, presence follicular dendritic cells, acquisition high endothelial venule like phenotype by blood vessels, expression chemokines plasma cells. Co-localisation implant-derived metals was observed. These findings suggest addition well described general foreign body reaction mediated macrophages a IV hypersensitivity response, an under-recognized immunological metal wear debris involving formation occurs distinct subset patients implants.