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However, follicular thymic hyperplasia (FTH) associated with RA (FTH\u2010RA) is generally not considered a lymphoproliferative disorder. To investigate the pathogenesis of FTH\u2010RA, we examined 12 cases of FTH involving thymic enlargement, four of FTH involving RA and eight of FTH involving myasthenia gravis (MG). Increased numbers and larger germinal center (GC) size were observed in FTH\u2010RA group. The percentage of distorted GCs was 13.3% in FTH\u2010RA group and 3.25% in FTH associated with MG (FTH\u2010MG) group. A greater meshwork of follicular dendritic cells was observed in the GCs of FTH\u2010RA group. Positive indices of CD27<jats:sup>+<\/jats:sup> cells and PD\u20101<jats:sup>+<\/jats:sup> cells per GC in FTH\u2010RA group were significantly higher than those in FTH\u2010MG group, though positive indices of CD68<jats:sup>+<\/jats:sup> cells and CD163<jats:sup>+<\/jats:sup> cells were similar. Myoid cell proliferation, as evaluated by \u03b1\u2010SMA, tenascin\u2010C, and l\u2010caldesmon expression, was significantly increased in the FTH\u2010RA group compared with the FTH\u2010MG group. These results suggest that FTH should be considered in patients with RA treated with methotrexate. The pathogenesis of FTH\u2010RA includes GC expansion and increased numbers of memory B cells, follicular helper T cells, and myoid cells, indicating humoral immunity activation.<\/jats:p>","DOI":"10.1111\/pin.13212","type":"journal-article","created":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T11:57:03Z","timestamp":1644580623000},"page":"252-260","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Pathogenesis of follicular thymic hyperplasia associated with rheumatoid arthritis"],"prefix":"10.1111","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8035-791X","authenticated-orcid":false,"given":"Rintaro","family":"Ohe","sequence":"first","affiliation":[{"name":"Department of Pathology, Faculty of Medicine Yamagata University  Yamagata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suran","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of 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