Carl J. O'Hara

Peripheral/post-thymic T-cell lymphomas: a spectrum of disease. Clinical, pathologic, and immunologic features of 78 cases.

The clinical, pathologic, and immunologic features of 78 cases of peripheral/post‐thymic T‐cell lymphomas are described. These neoplasms were extremely heterogenous and were classified as small lymphocytic, mixed small and large cell, large cell, lymphoepithelioid cell, angiocentric, and adult T‐cell leukemia/lymphoma type. Some cases revealed angioimmunoblastic or Hodgkins‐like features. These neoplasms mainly affected older adults (mean age, 57 years; median age, 60 years). Lymphadenopathy represented the most frequent clinical presentation, although most patients demonstrated both nodal (87%) and extranodal involvement (77%) during the course of disease. Sites of extranodal disease included skin/soft tissue, spleen, lung, liver, bone, gastrointestinal tract, central nervous system, peripheral blood, nasopharynx, and retrovaginal tissue. Splenomegaly at presentation was most frequently observed in lymphoepithelioid cell lymphomas. Angiocentric lymphomas involved lung. A mediastinal presentation was typically observed in young adults and associated with a poor prognosis. Patients with gastrointestinal lymphomas presented with bleeding and/or malabsorption. B symptoms were present in most cases (65%). Hypercalcemia occurred in four patients. Phenotypic studies of T‐cell antigens demonstrated the loss of one or more pan‐T‐cell markers in eight of 47 cases evaluated. Assessment of T‐cell subsets revealed a helper/inducer phenotype for nearly all immunoreactive cases. For the overall series, 32 patients died of disease (median survival time, 11.5 mo). There was a statistical difference between the combined groups of small lymphocytic and lymphoepithelioid cell types as compared with mixed and large cell types, with a poorer survival for the latter group. Angiocentric and adult T‐cell leukemia/lymphoma were associated with poor survival. This series of T‐cell lymphomas further documents the marked heterogeneity of this group of neoplasms as well as the poor prognosis observed for certain histologic types.

Virologic studies in a case of transfusion-associated AIDS.

The authors present the case of a 60-year old woman who developed acquired immunedeficiency syndrome (AIDS) 43 months after a blood transfusion. The blood donor was identified as a sexually active homosexual man who frequently used intravenous drugs. Although he was asymptomatic, physical examination revealed generalized lymphadenopathy of cervical, axillary, and inguinal areas. 47 months after his blood donation, the donor underwent lymph node biopsy which revealed follicular hyperplasia. He was seropositive for antibodies to human T-lymphotropic virus type III (HTLV-III) and had serologic evidence of prior infection with cytomegalovirus, Epstein-Barr virus, and hepatitis B virus. On the other hand, he had a normal total lymphocyte count and normal T-cell subsets. Striking was the difference between the seropositivity of the high-risk donor and the seronegativity of the patient with transfusion-associated AIDS with respect to cytomegalovirus, Epstein-Barr virus, and hepatitis B virus. The demonstration of apparent transmission of HTLV-III by blood transfusion and the inability to detect evidence of infection with other viruses strongly indicate a primary etiologic role for this virus in the pathogenesis of AIDS. The high-risk blood donor continues to be an asymptomatic carrier of HTLV-III. The authors are currently comparing the HTLV-III isolates obtained from the blood donor with the HTLV-III-related RNA sequences detected in the spleen of the patient in order to determine whether molecular changes occurred after transmission of the virus that might be related to the development of AIDS.

Sucrase-isomaltase expression in chronic ulcerative colitis and dysplasia☆☆☆

Sucrase-isomaltase (SI) is a mucosal disaccharidase that is present in normal small intestine and fetal colon. It also has been noted in colonic adenomas and adenocarcinomas. We used a polyclonal antibody to human SI to investigate enzyme presence and utility in detecting dysplastic changes in chronic ulcerative colitis. Sections from 32 cases were reviewed for the presence or absence of active colitis and dysplasia. Immunostaining of these cases for SI was performed and the results were reported based on location of immunoreactivity (ie, membrane and cytoplasmic staining in superficial and crypt epithelial cells) and percentage of positivity. Of 81 sections examined, 48 were rated negative for dysplasia (23 inactive colitis, 20 active, and five probably negative) and 28 were rated positive (eight low grade and 20 high grade). Surface membrane staining of epithelial cells was noted in all 28 dysplastic slides and positive cases (sensitivity, 100%) but also in 29 of 48 negative sections (P less than .001). In contrast, cytoplasmic positivity was present in 25 of 28 dysplastic and in only two of 48 negative slides (P less than .0001). The presence of cytoplasmic staining of SI in the superficial or crypt cells revealed a sensitivity of 92% and a specificity of 94%. There were five additional sections rated as indefinite for dysplasia (probably positive or unknown); two showed staining patterns typical of negative slides and three showed positive staining patterns. Of the 18 samples of transitional mucosa next to areas of dysplasia, surface membrane staining of SI was seen in all samples and cytoplasmic staining was seen in 15. We conclude that membrane staining of SI can be detected in inflammatory, regenerative, and dysplastic mucosa in ulcerative colitis. Cytoplasmic staining, however, correlates strongly with the presence of dysplastic change and may help in its detection.

The ultrastructural and immunohistochemical demonstration of viral particles in lymph nodes from human immunodeficiency virus-related and non-human immunodeficiency virus-related lymphadenopathy syndromes

Viral particles have been demonstrated by electron microscopy in lymph nodes from patients with acquired immune deficiency syndrome AIDS-related persistent generalized lymphadenopathy (PGL) syndrome. Immunohistochemical and in situ hybridization studies have identified these viruses as the human immunodeficiency virus (HIV). In this study, we examined 20 PGL lymph nodes and found viral particles in 18 cases. Immunohistochemical studies on these cases revealed positive staining for the HIV core protein P24 within germinal centers of secondary follicles. In addition we found viral particles, morphologically indistinguishable from those observed in PGL lymph nodes, in 13 of 15 non-HIV related reactive lymph nodes. Immunohistochemical staining of these lymph nodes for the P24 core protein was negative. None of the patients in this group had risk factors for developing AIDS and none exhibited clinical evidence of immune deficiency. We conclude that the viral particles observed in PGL lymph nodes are most likely HIV, but similar particles can be seen in reactive lymph nodes not associated with HIV infection. The discrete localization of these particles within germinal centers has been observed for other viruses and immune complexes and a possible mechanism of this antigen deposition is discussed.

Non-Hodgkin's lymphoma, multilobated B-cell type: report of nine cases with immunohistochemical and immunoultrastructural evidence for a follicular center cell derivation

The clinical, pathologic, and immunologic features in nine cases of non-Hodgkins lymphoma of the multilobated B-cell type are described. Clinical and phenotypic heterogeneity was observed in these B-cell neoplasms. A probable follicular center cell derivation for these cytologically unusual B-cell lymphomas is supported by antecedent histories of follicular center cell neoplasms in three cases; a focal nodular pattern in one case; the demonstration of peanut lectin (PNA) receptors, a marker for follicular center cells, on neoplastic multilobated B cells; and immunoultrastructural studies of nonneoplastic tonsillar cells that identified and characterized rare multilobated cells, immunoreactive for B1, B2, and Ia membrane antigens, a phenotype consistent with follicular center-type cells. Comparison of B- and T-cell multilobated lymphomas revealed that only immunologic studies accurately discriminated between these neoplasms.

Localization of tumor-associated glycoprotein DF3 in normal, inflammatory, and neoplastic lesions of the colon

Background. The expression of DF3 was assessed by a monoclonal antibody in normal, inflammatory, and neoplastic conditions in the large bowel.

Metastatic islet cell tumor with ACTH, gastrin, and glucagon secretion clinical and pathologic studies with multiple therapies

A patient with metastatic islet cell carcinoma demonstrated multiple clinical syndromes simultaneously with secretion of ACTH, gastrin, glucagon, and serotonin. Hepatic arterial embolization resulted in an initial decrease in all secretory products, which was sustained for glucagon and serotonin. Recrudescence of the Cushings and Zollinger‐Ellison syndrome was managed by surgical extirpation of the primary tumor and regional metastases as well as bilateral adrenalectomy. Electron microscopy and immunocytochemistry of the primary tumor and the metastatic lesions revealed (1) the presence of multiple types of granules within single cells and, (2) different patterns of secretory profiles in different tumor sites.

Membrane antigens of human bronchial epithelial cells identified by monoclonal antibodies

SummarySubpopulations of normal bronchial epithelial cells were identified using a series of murine monoclonal antibodies. These antibodies were used to stain intact bronchial epithelial cells in culture by indirect immunofluorescence. LAM 2 reacted with 80%, LAM 6 with 75%, LAM 7 with 60%, and LAM 8 with 5% of these cells. Sections of human bronchial epithelium were also stained with these antibodies by immunoperoxidase methods. LAM 2 was found to bind with 80%, LAM 6 with 65%, LAM 7 with 50%, and LAM 8 with less than 1% of bronchial epithelial cells. LAM 2 stained both columnar epithelial cells and basal cells; LAM 6 stained mainly basal cells and only a small proportion of columnar cells; LAM 7 showed specificity for basal cells; LAM 8 distinctly stained single cells in the basal cell layer. These antibodies were previously shown to react with the surface membrane of human lung carcinomas, ranging from the broad reactivity of LAM 2 with small cell and non-small cell lung cancers to the highly restricted reactivity of LAM 8 with small cell carcinomas of the lung. Thus, membrane antigens have been identified in bronchial epithelial cells by monoclonal antibodies which exhibit a similar range of cellular reactivity in vitro as in vivo. Inasmuch as these antibodies recognize subsets of cells which could not be easily distinguished by morphologic characteristics, these reagents may be useful in classifying bronchial epithelial cells.

Infiltration of the lower respiratory tract by helper/inducer T lymphocytes in HTLV-1-associated adult T-cell leukemia/lymphoma.

The human T-cell lymphotropic virus type 1 (HTLV-1) is the causative agent of adult T-cell leukemia/lymphoma (ATLL), a disorder in which peripheral blood and multiple organs are infiltrated by malignantly transformed T lymphocytes. We investigated the nature of pulmonary disease in a patient with serologic evidence of HTLV-1 infection. In this case, endobronchial biopsy specimens showed infiltration of the bronchial mucosa by pleomorphic cells exhibiting a high degree of nuclear irregularity. These cells were morphologically identical in appearance to malignant cells found in peripheral blood and infiltrating the dermis, expressed the OKT4/Leu3 phenotype and the receptor for interleukin 2, and, by analogy to gene rearrangement studies on leukemic blood cells, were monoclonal in origin. However, in situ hybridization of endobronchial biopsy specimens with full-length HTLV-1 probes failed to detect retroviral RNA or proviral DNA. These studies indicate that T lymphocytic involvement of the lower respiratory tract in HTLV-1-associated ATLL is characterized by expression of a malignant phenotype despite the inability to document actual cellular infection with this retrovirus by a molecular hybridization technique.

Chapter 30 Characterisation of small cell carcinoma surface membrane antigens by indirect immunofluorescence. Solid phase radioimmunoassay and immunoblotting

Abstract Five antibodies to surface membrane antigens of small cell lung carcinoma (SCLC), were selected by indirect immunofluorescence (IF). Their characteristics were compared to antibody LAM8. Antibody reactivity on a panel of lung tumour cell lines was determined by IF and by indirect solid phase radioimmunoassays (RIA). Biochemical characterisation of the antigens was done by RIA and immunoblotting. By IF antibodies SWA4, SWA20, SWA23, and LAM8 reacted selectively with 4/8 SCLC cell lines. By RIA this selectivity was lost for antibodies SWA4 and SWA23. Antibodies SWA21 and SWA22 reacted with all SCLC, weakly with one non-SCLC cell line and also stained leukocytes. RIA and immunoblotting experiments suggested antigens recognised by antibodies SWA4, SWA23 are identical to sGP90-135 identified by antibody LAM8 and suggest similarities of the antigens recognised by antibodies SWA21 and SWA22. In contrast, antibody SWA20 appeared to recognise a different membrane antigen. These results demonstrate that antibodies which recognise the same membrane antigen can differ considerably in their pattern of reactivity with cell lines depending on the method employed, and that the same pattern of cell line reactivity, even when examined over a large number of cell lines by different methods, does not necessarily establish the similarities of antigens.