Since we recently discussed tattoo inks that elicit type 4 immune responses, I thought I'd mention another interesting phenomenon that arises from tattooing:
A patient presented with a lump in the right armpit that had been there for 6 months. After investigation, there could be no conclusion made about the cause of the lump. This necessitated an excision biopsy. The resulting H&E stained sample is shown above. Beyond some hyperplasia, the only noticeable defect was a black "discoloration". Immediately, it was suspected that the black spots were metastases of malignant melanoma (which is notorious for its dark pigmentation). However, after more vigorous examination and a specific, stain-based testing, they determined that this was not a melanoma. In fact, this black color was due to a tattoo that the patient had gotten 30 years previously. It has been well documented that tattoo inks end up in spleen and lymph tissue. However, it had not previously been reported that such an old tattoo could cause enlargement of a lymph node (it had been assumed that such an effect occurs within the immediate timeframe of recieving the tattoo).
Presumably, the presence of tattoo inks in immune tissues is due to uptake in the skin by antigen presenting cells which then migrate to the lymph nodes or spleen. It is interesting to note that tattoos are not only sometimes the victims of attack by the immune system within the skin, but can also cause some interesting pathology within tissues of the immune system. Since tattoo inks are not regulated, its frightening to wonder what sort of unintended chemistry might find its way into some of your body's most important defensive tissues.
That said, I'll probably still get a tattoo when I pass my comprehensive exam.
CM Jack, A Adwani and H Krishnan. Tattoo pigment in an axillary lymph node simulating metastatic malignant melanoma. International Seminars in Surgical Oncology. 2005, 2:28
What?!? This phenomenon is surprisingly interesting…I knew I never got a tattoo for good reasons! So from what I’ve come across, presumably, ink particles are moved into the deeper dermis over time due to mobile phagocytic cells causing the tattoo to look bluish and faded. Older tattoos show that the ink deep in the dermis, and also found in local lymph nodes since AP cells migrate to lymph nodes to present their antigens. So what about reoccurring attacks on the local area which the tattoo is located? Could someone have multiple flare-ups as a consequence of the permanent ink residing at layers of the dermis?
ReplyDeleteBelow is an article on treating allergic reaction in tattoos. Pretty cool-they show a before and after picture..
ReplyDeleteLysa- regarding your question about the recurring attacks on the tattoo- this man had a two year history of allergic reaction to the red ink in his tattoo! They tried to treat the reaction with steroid ointments but it didn't work so they ended up doing a laser treatment.
Interestingly, the article states that allergic reaction to tattoos sometimes occurs after their removal because the ink is mainly intracellular and laser treatment causes the ink to become extracellular which allows it to be recognized by the immune system as foreign.
"Successful treatment of an allergic reaction in a red tattoo with the Nd-YAG laser "
R. Dave MS, FRCSEd, Clinical Research Fellow
P. J. Mahaffey FRCS, FRCSEd, Consultant Plastic Surgeon
Bedford Laser Treatment Centre, Bedford Hospital, Kempston
Road, Bedford MK42 9D J, UK.
Wow. That is amazing. And scary. A friend of mine has crazy allergies (she's allergic to most foods, almost all plants, etc, etc...) and has already had cases of enlarged lymph nodes in her lung and arm. She also has two tattoos on her back. I will definitely be showing this to her.
ReplyDeleteGlad it didn't sway your personal decision tho. That made me smile. :)
I think the interesting point of the pathology is that the ink was taken to the lymph node and spleen but actually didn’t get to the point of attacking the local site. So immune response was stopped somewhere. Because in order to complete immunological pathway, all system has to be activated in the cascade, and it might be an example of difficulty of achieving immune response also.
ReplyDeleteIt is also interesting that the nodes were developed very slowly. I wonder if that was stimulation of the immune response (through the dendritic cells) or some kind of attraction between the ink and lymph nodes through slow diffusion of ink to the blood stream.
I think its interesting that, this is a pretty unregulated field!
ReplyDelete