Abstract
Background In endemic areas, lymphangiectasia is the fundamental alteration to live Wuchereria bancrofti adult worms which, in adult males, are usually found in the lymphatic vessels of the spermatic cord; accordingly, hydrocele/filaricele is the most common clinical manifestation of bancroftian filariasis. The pathogenic role of the lymphatic endothelial cells (LECs) and the status of mesothelial cells (MCs) samples of the parietal layer (PL) of the tunica vaginalis testis were examined. Methods The PL of thirty-two patients, excised for different reasons, was examined by histology and immunohistochemistry using the D2-40 monoclonal antibody for identification of LECs and CK-7 antibody for recognition of mesothelial cells (MCs). Results The most important findings were (a) marked lymphangiectasia, especially in hydroceles with minor evolution time; (b) the first report of lymphatic stomata and submesothelial lacunae in filarial acute hydrocele; (c) the likely participation of LECs in filarial granuloma; (d) the potential phenotypic transition of LECs into myofibroblasts in severe chylocele; and (e) mesothelial reactive hyperplasia, a hallmark of filaricele, varying in intensity from mild to severe, sometimes mimicking a mesothelial neoplasia. Conclusion The data suggest that LECs have an active role in the pathogenesis of bancroftian hydrocele and, possibly, in other clinical forms of lymphatic filariasis.
Highlights
Lymphatic vessels (LVs) have historically been viewed as inert drainage system for fluid and immune cells, but this merely passive concept is increasingly being revised as new functions of lymphatic endothelial cells (LECs) are identified
The following groups were characterized: (1) control (4 cases): symptomless individuals from which living adult worms (AWs) nonsensitive to antifilarial treatment were removed [17,18,19,20]; (2) patients with dead AWs in the parietal layer (PL) (1 case); (3) acute filarial hydrocele (3 cases): patients with fluid accumulation in the tunica vaginalis cavity which appears within a few days after a nodule formation and resolves spontaneously up to 18 months [11]; (4) filaricele (20 cases): patients with chronic accumulation in the tunica vaginalis cavity of fluid composed of a combination, in different proportion, of transudate and nonmilky lymph from ruptured dilated lymphatic vessels [12]
The cases of this group were distributed in grades according to the intensity of the mesothelial cells (MCs) hyperplasia: grade 0: MCs confined to the free surface; grade 1: MCs present in the submesothelial and not surpassing a third of the wall thickness; grade 2: MCs reach two-thirds of the wall; and grade 3: MCs are found in whole thickness of the wall; and (5) chylocele (4 cases): patients with chronic accumulation in the tunica vaginalis cavity of milky fluid as a result of lymph rich in chylomicrons from ruptured dilated lymphatic vessels [12]
Summary
Lymphatic vessels (LVs) have historically been viewed as inert drainage system for fluid and immune cells, but this merely passive concept is increasingly being revised as new functions of lymphatic endothelial cells (LECs) are identified. They have been shown to play active roles in controlling their transport functions and in directly communicating with immune cells to modulate their immediate and downstream function. The pathogenic role of the lymphatic endothelial cells (LECs) and the status of mesothelial cells (MCs) samples of the parietal layer (PL) of the tunica vaginalis testis were examined. The data suggest that LECs have an active role in the pathogenesis of bancroftian hydrocele and, possibly, in other clinical forms of lymphatic filariasis
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