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Mantle zone

The mantle zone (or mantle) is the outer region of secondary lymphoid follicles in organs such as lymph nodes and spleen, forming the peripheral rim that surrounds the germinal center and consisting primarily of tightly packed small naïve B lymphocytes displaced from primary follicles during germinal center expansion.^[1]^[2] This zone provides a structural boundary for the actively proliferating B cells in the germinal center, housing quiescent B cells that exhibit intense basophilic staining due to their small cytoplasmic volume and heterochromatic nuclei, alongside follicular dendritic cells, occasional helper T lymphocytes, macrophages, and some memory B cells positive for CD20 but negative for CD10.^[2]^[3] Functionally, the mantle zone acts as a reservoir for antigen-naïve B cells that can undergo activation, maturing into antibody-secreting plasma cells retained within the lymph node or transforming into memory B cells that re-enter the systemic circulation to enable rapid immune responses upon re-exposure to antigens.^[1]^[3] In normal histology, these B cells are confined to follicular structures, but disruptions such as sheets of B cells extending beyond the mantle zone may signal pathological conditions like B-cell lymphomas.^[3]

Anatomy

Location within lymphoid organs

The mantle zone is defined as the outer ring of small lymphocytes that encircles the germinal center within secondary lymphoid follicles.^[4] This structure is a key component of secondary lymphoid tissues, where it forms a peripheral layer surrounding the central germinal center.^[3] In lymph nodes, the mantle zone is located in the cortex, where it surrounds germinal centers in secondary follicles and is positioned adjacent to the paracortex (T-cell-rich area) and distant from the medulla.^[4] The mantle zone often appears oval-shaped, with its broadest region oriented toward the subcapsular sinus, which receives lymph from afferent lymphatic vessels, facilitating proximity to sites of antigen entry.^[4] Grossly, lymph nodes containing these structures are bean-shaped organs measuring approximately 0.2 to 2 cm in length, distributed throughout the body along lymphatic pathways.^[5] Within the spleen, the mantle zone encircles germinal centers in the white pulp, forming part of the lymphoid follicles adjacent to the central arteriole and perifollicular marginal zone, without the pronounced asymmetry seen in lymph nodes.^[4] The mantle zone is also present in mucosa-associated lymphoid tissue (MALT), such as in Peyer's patches of the gut, where it surrounds germinal centers in secondary follicles and is typically broadest near the follicle-associated epithelium, aligning with mucosal antigen exposure sites.^[4]

Structural organization

The mantle zone constitutes a distinct layer within secondary lymphoid follicles, forming a dense, concentric cuff of tightly packed small lymphocytes that encircles the central germinal center. This structural arrangement arises from the primary follicle, where the mantle zone represents the entire lymphoid nodule composed of resting B cells; upon antigenic stimulation, rapid proliferation within the emerging germinal center displaces these cells outward, establishing the characteristic rim-like organization. The mantle zone serves primarily as a reservoir for naïve B cells, maintaining spatial separation from the more dynamic germinal center.^[1]^[6]^[7] In the spleen and certain lymph nodes, such as mesenteric nodes, the mantle zone interfaces externally with the marginal zone, creating a tripartite follicular architecture comprising the germinal center, mantle zone, and marginal zone. Expansion of the germinal center during immune responses further compresses and repositions the mantle zone peripherally, altering its relative thickness and contour while preserving its role as a bounding layer. This dynamic interplay ensures compartmentalization within the follicle, with the mantle zone typically appearing as a narrow, uniform band under histological examination.^[1]^[8]^[6] Structural variations in the mantle zone occur across lymphoid organs, reflecting differences in organ architecture and function. In lymph nodes, the mantle zone forms a relatively consistent, encircling sheath around the germinal center, often with a poorly developed marginal zone except in specific sites. By contrast, in the spleen, the mantle zone is integrated into eccentric lymphoid follicles adjacent to the periarteriolar lymphoid sheath—a T-cell-rich region surrounding the central arteriole—resulting in a more irregular shape and positioning within the white pulp. The splenic marginal zone, more prominently developed than in lymph nodes, borders the mantle zone at the interface with the red pulp, enhancing the organ's filtering capacity.^[1]^[8]^[9]

Histology

Cellular composition

The mantle zone is predominantly populated by small, naïve B lymphocytes that express the pan-B-cell markers CD19 and CD20, along with surface immunoglobulins IgM and IgD. These cells constitute a tightly packed, homogeneous layer surrounding the germinal center in secondary follicles or forming the bulk of primary follicles.^[1]^[4] T cells and other leukocytes are minimal or absent, comprising only a sprinkling within this predominantly B-cell compartment.^[10] This population consists of resting, unstimulated B cells that express the Tcl-1 oncogene at high levels, distinguishing them from more differentiated B-cell subsets.^[11] Plasma cells and activated B cells are notably absent, reflecting the quiescent nature of the mantle zone. Proliferation is low, with minimal Ki-67 positivity among these cells.^[4] Quantitatively, the mantle zone accounts for the majority of the follicle volume in primary follicles, where it forms the primary lymphoid structure, but its relative proportion diminishes in secondary follicles due to the expansion of the germinal center. In brief contrast, germinal center B cells display greater heterogeneity and activation compared to the uniform naïve population in the mantle zone.^[1]

Microscopic features

Under light microscopy, the mantle zone presents as a distinct dark-staining rim encircling the lighter germinal center of secondary lymphoid follicles, attributable to the dense aggregation of small lymphocytes featuring compact, clumped chromatin within their nuclei.^[12] This appearance arises from the tightly packed arrangement of naive B cells, which dominate the zone and contribute to its uniform, high-density profile.^[1] Hematoxylin and eosin (H&E) staining highlights the mantle zone's small lymphocytes, which possess scant cytoplasm, round to slightly irregular nuclei, and heterochromatic nuclei that stain intensely, creating a sharp visual contrast with the pale, expansive germinal center composed of larger, more active B cells.^[13] These features facilitate the identification of the mantle zone as a peripheral cuff in reactive lymphoid tissue. Immunohistochemistry reveals strong BCL-2 positivity in the normal mantle zone B cells, reflecting their resistance to apoptosis, while cyclin D1 expression is absent in this tissue, distinguishing it from certain neoplastic conditions.^[14]^[15] Electron microscopy demonstrates the mantle zone's ultrastructural characteristics, including compactly arranged lymphocytes with minimal intervening extracellular matrix, underscoring the zone's role as a densely organized reservoir of resting B cells.^[16] Unlike the adjacent marginal zone, which exhibits lighter staining and cells with more abundant cytoplasm, the mantle zone maintains a uniformly tight cellular packing.^[1]

Function

Role in B-cell maturation

The mantle zone serves as the primary site for recirculating naïve B cells, which express surface IgM and IgD, to encounter antigens in secondary lymphoid organs such as lymph nodes and spleen. These naïve B cells continuously migrate through the mantle zone of primary follicles, scanning for foreign antigens presented on the surface of follicular dendritic cells (FDCs) or delivered via subcapsular sinus macrophages. Upon initial antigen recognition via the B cell receptor (BCR), low-affinity interactions trigger early activation signals, including BCR clustering and downstream signaling pathways like NF-κB activation, prompting the B cells to migrate to the T-B cell border for cognate T cell help before returning to the follicle to initiate germinal center formation.^[17]^[18] In early humoral immunity, activation of naïve B cells encountered in the mantle zone can lead to differentiation into short-lived plasmablasts that produce low-affinity IgM antibodies extrafollicularly, providing rapid but unmutated responses to pathogens before affinity maturation occurs. These IgM responses are typically T cell-independent or require minimal T cell help, contributing to immediate defense against blood-borne antigens.^[17] The mantle zone integrates with somatic hypermutation processes at the mantle-germinal center interface, where activated naïve B cells originating from the mantle zone seed the nascent germinal center upon activation. At this boundary, B cells with appropriate antigen affinity receive survival signals from FDCs and T follicular helper cells, initiating entry into the germinal center for somatic hypermutation and affinity-based selection.^[6]^[19]

Lymphocyte reservoir and recirculation

The mantle zone serves as a quiescent reservoir of recirculating naïve B cells, which express high levels of IgM and IgD and position themselves surrounding the germinal center within lymphoid follicles.^[4] These cells continuously enter secondary lymphoid organs, such as lymph nodes, through high endothelial venules in response to chemokines CCL19 and CCL21 via the receptor CCR7, enabling efficient scanning for antigens.80059-8) Conversely, egress from these organs occurs through afferent lymphatics and into the bloodstream, mediated by sphingosine-1-phosphate receptor 1 (S1P1), which senses the S1P gradient in efferent lymph and blood to promote exit while counteracting retention signals within the tissue.^[20] This dynamic recirculation maintains B-cell homeostasis and diversity, with a continuous influx of newly generated naïve B cells from the bone marrow replenishing the peripheral pool to compensate for natural turnover and ensure a broad antigen receptor repertoire for immune surveillance.^[21] The efflux back to circulation allows these cells to transit through multiple lymphoid sites, optimizing the chances of encountering specific antigens without permanent sequestration.^[22] Upon antigen encounter, naïve B cells in the mantle zone upregulate CCR7 and migrate toward the T-cell zone at the follicle boundary, leading to their recruitment into nascent germinal centers and resulting in temporary depletion of the mantle zone population as activated cells commit to the response.^[23] With advancing age, the prominence of the mantle zone diminishes due to a progressive reduction in naïve B-cell numbers in peripheral blood and lymphoid tissues, stemming from declining bone marrow output and altered homeostasis, which impairs the reservoir's capacity to sustain recirculation and diversity.^[24]

Development

Embryonic origins

The mantle zone originates from mesodermal-derived mesenchymal precursors during the second trimester of human gestation, coinciding with the emergence of lymph node anlagen as loose condensations of stromal cells surrounding primitive lymph sacs.^[25]^[26] These anlagen form around the 11th gestational week and are initially avascular clusters of undifferentiated mesenchymal cells expressing platelet-derived growth factor receptor alpha (PDGFRα), which serve as sites for subsequent lymphoid colonization.^[25]^[26] The initial formation of primary follicles, which constitute the precursors to the mantle zone, occurs through the colonization of these mesenchymal sites by hematopoietic stem cell (HSC)-derived progenitors originating from the fetal liver.^[25]^[27] Fetal liver HSCs generate lymphoid tissue inducer (LTi) cells, which are CD4+CD3- cells expressing interleukin-7 receptor alpha (IL-7Rα), that migrate into the anlagen starting around the 12th gestational week via integrin-mediated adhesion to vascular endothelium.^[28]^[25] These LTi cells cluster with stromal organizers, forming the structural basis of primary follicles composed of small, naive B lymphocytes that will delineate the mantle zone.^[28]^[29] Stromal organization within these developing follicles relies heavily on lymphotoxin-alpha (LTα) and IL-7 signaling pathways.^[26]^[30] IL-7 signaling sustains LTi cell survival and proliferation while inducing surface expression of LTα1β2 heterotrimers on these cells, which then bind to LTβ receptor (LTβR) on mesenchymal stromal cells to activate NF-κB-dependent transcription of chemokines (e.g., CXCL13) and adhesion molecules (e.g., VCAM-1, ICAM-1).^[26]^[30] This bidirectional interaction primes and matures stromal cells into lymphoid tissue organizer (LTo) phenotypes, enabling the aggregation of B cell progenitors into follicle-like structures that define the nascent mantle zone.^[26]^[31] The mantle zone first becomes discernible around weeks 16-20 of gestation as part of these primary follicles in the outer cortex of emerging lymph nodes, characterized by dense clusters of small B lymphocytes without germinal centers.^[25]^[32] These early structures mature further postnatally into secondary follicles featuring expanded germinal centers surrounded by a distinct mantle zone of recirculating naive B cells.^[25]

Postnatal changes

Following birth, the mantle zone undergoes significant expansion during infancy and early childhood, driven by frequent exposure to environmental antigens that stimulate the formation of secondary lymphoid follicles. Primary follicles, consisting of naive B cells in the mantle zone and established in utero, undergo rapid increase in number and size in response to antigenic challenges, peaking during childhood when immune system maturation is most active.^[1] This hypertrophy reflects the mantle zone's role as a reservoir for recirculating naive B cells, adapting to sustain ongoing immune surveillance.^[33] In adulthood and particularly in the elderly, the mantle zone exhibits gradual involution characterized by thinning and increased fibrosis, contributing to immunosenescence. Lymphocyte depletion leads to reduced B-cell density in the mantle zones, accompanied by collagen deposition and hyaline changes that disrupt follicular architecture and impair antigen-driven responses.^[1] These structural alterations correlate with diminished germinal center formation and overall lymphoid tissue regression, exacerbating age-related immune decline.^[33] Infections and vaccinations further influence mantle zone dynamics by inducing reactive hyperplasia, where antigen stimulation promotes transient hypertrophy of the mantle zone alongside follicular expansion. For instance, viral infections or immunization can elicit mantle cell proliferation as part of the adaptive immune response, though this is more pronounced in younger individuals with robust lymphoid reactivity.^[34] Such changes highlight the mantle zone's adaptability to immune challenges while tying into its function in B-cell recirculation to maintain zone integrity over time. Estrogen influences contribute to higher circulating B-cell numbers in females, supporting greater B-cell homeostasis compared to males.^[35]

Pathology

Benign expansions

Reactive hyperplasia of the mantle zone occurs in various infections, leading to polyclonal expansion of B cells within this compartment. For instance, in Epstein-Barr virus (EBV) infection, such as infectious mononucleosis, lymph nodes display follicular and paracortical hyperplasia where mantle zones contribute to the overall reactive B-cell proliferation, maintaining a polyclonal pattern without clonal dominance.^[36] Similarly, in human immunodeficiency virus (HIV) infection, early-stage lymphadenopathy features florid follicular hyperplasia with attenuated mantle zones, reflecting a polyclonal immune response to viral antigens.^[37] Castleman disease, particularly the hyaline-vascular variant, prominently features benign mantle zone expansions. In this subtype, follicles exhibit regressed germinal centers surrounded by broad, concentric layers of small lymphocytes in the mantle zones, often displaying an "onion skin" pattern. Accompanying interfollicular vascular proliferation with hyalinized vessels further characterizes this reactive process, distinguishing it as a non-malignant lymphoproliferative disorder.^[38]^[39] Autoimmune disorders, including rheumatoid arthritis, can induce follicular hyperplasia with attenuated mantle zones due to persistent antigenic stimulation and chronic inflammation. Lymph nodes in these patients show enlarged follicles where the mantle zones appear narrowed amid interfollicular plasmacytosis, representing a reactive, polyclonal B-cell response.^[40]^[41] Diagnostic evaluation of these benign expansions relies on histologic preservation of nodal architecture, confirmation of polyclonal immunoglobulin expression via immunohistochemistry or molecular studies showing polyclonal B-cell receptor gene rearrangements, and lack of cyclin D1 overexpression or t(11;14) translocation, features absent in reactive conditions but typical of mantle cell neoplasms.^[42]^[43] In contrast to neoplastic patterns, these changes lack monoclonality and effacement of normal structures.

Neoplastic involvement

The mantle zone is primarily implicated in neoplastic processes through mantle cell lymphoma (MCL), a mature B-cell neoplasm originating from naïve B cells that normally reside in this region.^[44] MCL is characterized by the t(11;14)(q13;q32) chromosomal translocation, which juxtaposes the CCND1 gene on chromosome 11 with the immunoglobulin heavy chain locus on chromosome 14, leading to constitutive overexpression of cyclin D1 protein.^[45] This genetic hallmark drives cell cycle dysregulation and is present in nearly all cases of MCL.^[46] Histologically, MCL typically exhibits a diffuse or nodular growth pattern that expands or replaces the mantle zones surrounding reactive follicles, with neoplastic cells showing irregular nuclei and scant cytoplasm.^[45] MCL is subclassified into classic and blastoid variants based on morphology and clinical behavior. The classic subtype features small- to medium-sized lymphoid cells with irregular nuclear contours, resembling normal mantle zone B cells, and often presents with a mantle zone growth pattern in early stages.^[47] In contrast, the blastoid variant displays larger cells with finely dispersed chromatin and prominent nucleoli, mimicking lymphoblastic lymphoma, and is associated with more aggressive disease progression and poorer response to therapy.^[48] In situ mantle cell neoplasia represents a precursor lesion in which cyclin D1-positive neoplastic B cells are confined to the mantle zones of otherwise reactive lymphoid follicles, without architectural effacement or overt expansion.^[49] These lesions are often incidental findings in lymph nodes resected for unrelated reasons and harbor the t(11;14) translocation, indicating monoclonal expansion, but they typically follow an indolent course without progression to overt lymphoma in most cases.^[50] Rarely, the mantle zone may show involvement or mimicry in other B-cell lymphomas, such as spillover from follicular lymphoma where neoplastic follicles attenuate the surrounding mantle zones, or marginal zone lymphoma presenting with expansion that encroaches on mantle areas.^[51] These patterns can pose diagnostic challenges, requiring immunohistochemistry to distinguish from primary MCL.^[52] MCL accounts for approximately 5-6% of all non-Hodgkin lymphomas and generally follows an aggressive clinical course, with a median overall survival of approximately 8-10 years for aggressive cases despite intensive therapies, varying by subtype and treatment.^[45]^[53] Staging relies on the Mantle Cell International Prognostic Index (MIPI), which incorporates age, performance status, LDH levels, and white blood cell count to stratify patients into low-, intermediate-, and high-risk groups.^[54] SOX11 expression serves as a key prognostic marker, with nuclear positivity in 90-95% of cases indicating conventional aggressive MCL, while SOX11-negative tumors often exhibit indolent behavior and better outcomes.^[55]

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