Atsuo Mikata

Some problems on the histopathological diagnosis of non-Hodgkin's malignant lymphoma -- a proposal of a new type.

A new classification for non‐Hodgkins malignant lymphoma is proposed as the one suited for the Lymphomas in Japan, which is to provide a new subtype “pleomorphic” for those more or less rapid‐growing lymphomas of peripheral T‐cell nature, along with another subtype lymphoblastic, after Nathwani et al. for those of central T‐cell nature. The proposal is based on the result of the investigation by the Study Group for Histopathological Diagnosis on Malignant Lymphoma that (1) the presence of a significant number of T‐cell lymphomas with peculiar “pleomorphism” is responsible for the very low reproducibility rate of histopathological diagnosis on the diffuse, mixed L&H type of Rappaport classification, and (2) the relative incidence of lymphoms of peripheral T‐cell nature including the so‐called adult T‐cell leukemia is much higher in Japan than in the Western countries.

Permeability of postcapillary venules of the lymph node. An electron microscopic study.

Abstract Thorium dioxide and India ink were injected into the tail vein or the footpads of mice and, at various intervals after injection, popliteal lymph nodes were examined with light and electron microscopes. Observation was mostly focused on the postcapillary venule (PCV) of the lymph node. Intravenoulsy injected thorium dioxide particles crossed the vascular wall of the PCV mainly through the intercellular space between the tall endothelial cells. Thorium dioxide particles were frequently present in relatively large quantity around the lymphocytes which were in the process of emigration. Carbon particles were transferred mostly through intracellular pinocytotic process. The PCV endothelium had more active phagocytic capacity than usual vascular endothelium when a large dose of carbon was injected. With subcutaneous injection of thorium dioxide solution, absorptive pathway was found to be intracellular. The increased permeability of the PCV is due to the presence of large endothelial gaps, which provide suitable pathway for both lymphocytic emigration and colloidal transport, as well as rheological and endothelial characteristics of this vessel. Absorption of molecules from the lymphoid parenchyma directly into the PCV is also suggested.

Multiple pulmonary hyalinizing granulomas associated with systemic idiopathic fibrosis.

A 41 year‐old man with progressive nodular infiltration of the lung of about 2 years’duration died of cardiac and respiratory failure. Autopsy revealed bilateral multiple pulmonary hyalinizing granulomas (PHGs) diagnosed on the basis of the characteristic dense hyaline collagen bundles with nonspecific inflammatory infiltration. Constrictive pericarditis, retroperitoneal fibrosis, mediastinal fibrosis, fibrous thickening of the peritoneal and pleural surfaces, and fibrosis of soft tissue of the neck, flank, and hepatic hilar region were present, therefore, a diagnosis of systemic idiopathic fibrosis was made. The patient had anti thyroglobulin and anti‐thyroid microsomal antibodies and lymphocytic thyroiditis. The inflammatory process of PHG of the present case was active and the clinical course was progressive. PHG seems to be a lesion belonging to the systemic idiopathic fibrosis complex. Immunologic abnormalities may be related to PHG and systemic idiopathic fibrosis.

Mesenchymal chondrosarcoma--a case report with an ultrastructural study and review of Japanese literatures.

A case of mesenchymal chondrosarcoma occurring in the left maxilla of a 30‐year‐old Japanese male was reported. Electron microscopic observation confirmed transition of undifferentiated cells to chondrocytes and calcification in similar manner as previously described with physiological processes. Matrix vesicles were thought to be the cytoplasmic products of tumor chondrocytes. Electron‐dense finely granular deposits resembling the organic matrix of cartilagenous calcification were seen within the intercellular matrix. Matrix vesicles were also closely related to these deposits. Japanese cases of this rare tumor were reviewed and 8 cases, Including the present case as 6th among them, were accepted. Clinical characteristics were similar to those of a series reported by SALVADOR et al.

Treatment of Non-Hodgkin Lymphomas in the Nasal Cavities and Paranasal Sinuses a Failure Analysis

Twenty-five patients with sinonasal lymphoma were treated mainly with irradiation. All were non-Hodgkin lymphomas of diffuse type. Twenty patients had stage IA, 2 had stage IB, 1 stage IIA, 1 stage IIIA, and 1 stage IVA disease. Relapse developed in 16 (64%) of the 25 patients, with a failure rate of 64 per cent in the stage I patients (14/22). Most patients with failures had distant spread of the disease with or without local recurrence. Only one patient had local recurrence alone at the first relapse. Histologic classification according to the new working formulation seemed to be a reliable prognostic indicator for relapse: failure rates for low, intermediate, and high grade lymphomas were 0 per cent (0/2), 46 per cent (6/13), and 100 per cent (10/10), respectively. Computed tomography was valuable for planning of radiation therapy and for follow-up.

Ribosome-lamella complex of the lymphocytes in a case of plasmacytic lymphadenopathy with polyclonal hypergammaglobulinemia.

A case of lymphoid hyperplasia with prominent plasmacytic proliferation histologically and with polyclonal hypergammaglobulinemia and anemia clinically was reported. This condition in a 54-year-old Japanese male was probably a type of plasma cell dyscrasia similar to a plasma cell variant of Castlemans disease. About 19% of apparently nonatypical lymphocytes in the biopsy material of this case were found to have ribosome-lamella complexes (RLC) similar to those previously described in patients with hairy cell leukemia and some other hematologic disorders. An intimate association with the rough endoplasmic reticulum of these structures suggested aberrant protein synthesis by B-lymphocytes.

Prognostic factors of stage I and II non-hodgkin's lymphomas of the head and neck: the value of the working formulation and need for chemotherapy

From 1966 through 1984, 142 patients with early stage non-Hodgkins lymphoma of the head and neck were treated. Histologic slides were reviewed and reclassified according to Rappaports classification and the Working Formulation. Patients were clinically staged; 82 Stage I, and 60 Stage II. Five-year freedom from relapse was 53% for Stage I and 48% for Stage II patients with no statistically significant difference. No patients with favorable histologies of Rappaports classification or low grade malignancy of the Working Formulation relapsed. By univariate analyses, stage, primary site, the Working Formulation, Rappaports classification, extent of radiation field, radiation dose, tumor bulkiness and addition of multiple-agent chemotherapy seemed to be prognostic factors for predicting relapse. Multivariate regression analyses (MVA) showed primary site and multiple-agent chemotherapy were independent prognostic factors. Tumor bulkiness provided marginal prognostic significance. Waldeyers ring lymphomas fared better than nodal or extralymphatic lymphomas; it seems necessary to report Waldeyers ring lymphomas independently from nodal or extralymphatic lymphomas. Patients receiving more than 3 chemotherapeutic agents had better prognosis than those receiving 3 or less agents, or no chemotherapy. Pathologic grade was another prognostic factor when the Working Formulation was used in MVA. When Rappaports classification was used, division of unfavorable histologies into histiocytic and non-histiocytic groups provided only marginal significance in MVA. We conclude that Stage I-II non-Hodgkins lymphomas of the head and neck with favorable histologies of Rappaports classification or low grade malignancy of the Working Formulation be treated with radiation therapy only; and patients with other histologies should be treated with multiple-agent chemotherapy and radiation therapy.

HISTOPATHOLOGICAL STUDY OF SIX CASES OF CASTLEMAN'S TUMOR

A histopathological analysis of six cases of Castlemans tumor by means of light and electron microscope was performed, with a review of literature. All cases were hyaline‐vascular type as described by Keller et al. The morphology of lymphoid follicles in the lesions varied according to the presence or non‐presence of the germinal center which was from large active to emaciated hyalinized. The lymphoid follicle was essentially similar to that of normal lymph node undergoing some reactive process. Depending on the observation of serial sections, the lesions had lymphatic sinuses around the blood vessels in the tumor parenchyma, some of which were proved to be connected to the abortive marginal sinuses.

ENZYME HISTOCHEMISTRY OF NON‐HODGKIN'S LYMPHOMAS

Fifty‐two cases of non‐Hodgkins lymphomas were studied with enzyme histochemical methods. Forty‐four cases of these were also investigated for surface markers with immunological techniques, and results of histochemical, routine histological and immunological observations were correlated. Twenty‐one of 27 B‐cell lymphomas showed prominent ATPase activity, while all 13 T‐cell lymphomas, except one case, did not show such activity. Nodular lymphomas, though of B‐cell nature, were often negative for ATPase and it remained negative after diffuse evolution in some. Four of 7 AlPase positive lymphomas were of B‐cell origin. Dot‐like localized AcPase and β‐glucuronidase activity characterized T‐cell lymphomas while 5 T‐cell PDL, including lymphoblastic type with double markers, showed localized esterase activity. Enzyme histochemical characteristics of lymphomas were fairly honest reflection of those of various functional units in the normal lymph nodes. Enzyme histochemical methods appeared to be a useful tool for the study of lymphomas.

Plexiform neurofibromatosis of the ileum in an infant

An infant is reported in whom severe malabsorptive symptoms developed shortly after birth associated with intermittent episodes of intestinal obstruction. Plexiform neurofibromatosis involving the terminal ileum was found at laparotomy at the age of 6 mo. The infant died from gastrointestinal functional impairment at the age of 1 yr.