Morphological and Immunohistochemical Features of Secondary Immune Organs (Regional Lymph Nodes and Spleen) in Acute Secondary Peritonitis
Received: 2026-03-26
Published: 2026-06-29
Abstract
Aim. To characterize morphological and immunohistochemical (IHC) features of mesenteric lymph nodes and spleen in fatal acute secondary peritonitis, using age-matched non-septic tissue as a qualitative reference.
Materials and Methods. Autopsy-based cross-sectional study at the Republican Pathological Anatomy Center (2018–2023). Mesenteric lymph nodes and spleen were examined from 131 adults (18–45 years) who died of acute secondary peritonitis, alongside 15 age-matched non-septic controls (acute myocardial infarction, no systemic inflammation) that served as a qualitative reference. Specimens were fixed in 10% buffered formalin, embedded in paraffin, and stained with hematoxylin-eosin (H&E); 33 lymph node specimens underwent IHC for CD3, CD4, CD20 and CD68, and 32 spleen specimens for CD8, CD68 and Ki-67, with DAB detection. Results are expressed as counts, percentages with 95% confidence intervals (Wilson score method), or mean ± standard deviation (M ± SD).
Results. Within 24–72 hours, both organs showed secondary lymphoid collapse: germinal-center depletion, marginal-zone denudation, T- and B-lymphocyte migration toward inflamed foci, reticulocyte and macrophage proliferation, and interstitial edema. In lymph nodes, CD68 macrophage positivity occurred in 27/33 cases (81.8%; 95% CI 65.6–91.4%); CD3/CD4 T-lymphocytes were low/absent in 21/33 (63.6%) and 12/33 (36.4%) cases; CD20 B-lymphocytes were reduced/absent in 32/33 (97.0%). In spleen, CD8 T-lymphocyte depletion was moderately positive in 27/32 cases (84.4%; 95% CI 68.2–93.1%); Ki-67 proliferation index was 16.21 ± 1.06%, indicating insufficient regeneration.
Conclusion. Acute secondary peritonitis produces time-dependent structural and immunophenotypic collapse in lymph nodes and spleen, with T- and B-lymphocyte depletion and compensatory macrophage hyperplasia.
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List of references
-
Sartelli M, Catena F, Abu-Zidan FM, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 2017;12:22. https://doi.org/10.1186/s130 17-017-0132-7.
-
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. https://doi.org/10.1001/jama.2016.0287.
-
Hotchkiss RS, Swanson PE, Freeman BD, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med. 1999;27(7):1230-1251. https://doi.org/10.1097/00003246-1 99907000-00002.
-
Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol. 2013;13(12):862-874. https://doi.org/10.1038/nri3552.
-
Felmet KA, Hall MW, Clark RSB, Jaffe R, Carcillo JA. Prolonged lymphopenia, lymphoid depletion, and hypoprolactinemia in children with nosocomial sepsis and multiple organ failure. J Immunol. 2005;174(6):3765-3772. https://doi.org/10.4049/jimmunol.174.6.3765.
-
De Waele JJ. Intra-abdominal hypertension and abdominal compartment syndrome. Curr Opin Crit Care. 2022;28(6):695-701. https://doi.org/10.1097/MCC.0000000000000991.
-
Di Franco S, Alfieri A, Fiore M, et al. A literature overview of secondary peritonitis due to carbapenem-resistant Enterobacterales (CRE) in intensive care unit (ICU) patients. Antibiotics (Basel). 2022;11(10):1347. https://doi.org/10.3390/antibiotics11101347.
-
De Simone B, Coccolini F, Catena F, et al. Benefits of WSES guidelines application for the management of intra-abdominal infections. World J Emerg Surg. 2015;10:18. https://doi.org/10.1186/s13017-015-001 3-x.
-
Pei F, Gu B, Miao SM, Guan XD, Wu JF. Clinical practice of sepsis-induced immunosuppres-sion: Current immunotherapy and future options. Chin J Traumatol. 2023;27(2):63-70. https://doi.org/10.1016/j.cjtee.2023.11.001.
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