Günter Burg

Hodgkin's disease followed by lymphomatoid papulosis. Immunophenotypic evidence for a close relationship between lymphomatoid papulosis and Hodgkin's disease.

The clinical association of lymphomatoid papulosis and Hodgkins disease and the striking morphologic similarity of atypical cells in lymphomatoid papulosis to Reed-Sternberg cells in Hodgkins disease suggest that lymphomatoid papulosis and Hodgkins disease are related. To test this possibility we studied the antigenic profile of Reed-Sternberg cells in the lymph nodes and of atypical cells in cutaneous lesions of lymphomatoid papulosis in two patients with Hodgkins disease and lymphomatoid papulosis. In paraffin sections both cell types expressed CD30, CD45 T cell-restricted antigens, and occasionally CD15 antigens. They were negative for CD45 B cell-restricted antigens and for lysozyme. In cutaneous lymphomatoid papulosis lesions a similar immunologic profile of the atypical cells was found; that is, they were positive for CD30, CD2, CD3, and CD25 but negative for B cell and macrophage antigens. The similarity of the immunophenotype of Reed-Sternberg cells in lymph nodes affected by Hodgkins disease and the immunophenotype of atypical cells of lymphomatoid papulosis lesions in the same patients suggests that the malignant cells in both conditions are derived from activated T cells and that they are closely related if not identical.

Trends in allergic contact sensitization

A standard patch test series was tested for 7 years (1977–1983) in a total of 11,962 patients. The annual frequency of positive reactions to the compounds tested was assessed for the total and for males and females separately. During the observation period, there were significant increases in positive reactions in the total group from 6.2% to 12.7% for nickel sulphate. from 5,3% lo 7.0% fur balsam of Peru and from 3.8% to 6.5% for potassium dichromate, reflecting significant changes in both sexes. The frequency of positive reactions to wool alcohols, formaldehyde, neomycin sulphate, paraben mix and gentamycin sulphate significantly increased, while that of positive reactions to clioquinol, mercuric chloride arid turpentine peroxide significantly decreased in cither males or females, sometimes leading to significantly changes in the total group.

Das entzündliche Infiltrat bei Psoriasis vulgaris

SummaryIn 6 patients with proriasis vulgaris the enzyme patterns of the inflammatory infiltrate were investigated during the psoriasis-morphogenesis (phase I–IV according to Braun-Falco). 1.Enzymes of the energy-producing metabolism in areas of fully developed psoriasis lesions (phase IV) showed the following reactions:a)Glycolytic enzymes: very high activity;b)Citric-acid-cycle-enzymes: weak activity;c)Respiratory-chain-enzymes: moderate activity;d)Pentose-phosphate-shunt-enzymes: weak activity.The behaviour of these enzymes does not permit a reliable interpretation of metabolic activities and it is not possible to perform a differentiation of inflammatory cells in psoriasis vulgaris according to the enzyme pattern.2.However, cell-specific enzymes allow the differentiation of inflammatory cells in psoriasis vulgaris by cytochemical reactions. These cytochemical reactions permit a classification of the inflammatory infiltrates and an interpretation of the dynamics of cell-reaction in the course of psoriasis morphogenesis. Mastcells are well stained cytochemically by the naphthol-AS-d-chloracetatesterase-reaction; macrophages are positive by \ga-naphthylacetatesterase, by naphthol-AS-d-acetatesterase and by acid phosphatase according to Leder\3-but not by the technique of Spier and Martin. Neutrophile leucocytes are characterized by high activities of peroxydase and alcaline phosphatase and are well stained by naphthol-AS-d-chloracetatesterase with a typical cyclamen-red stain and are therefore different from the more brick-red reaction-product of the mastcells. Lymphocytes are cytochemically virtually negative. It is evident that macrophagocytic-mastocytic reactions are first in psoriasis-morphogenesis and later are followed on by lymphocytic-leucocytic reactions. A pathogenetic interpretation of the observed sequence of the inflammatory cells in the various phases of psoriatic morphogenesis at the present time is not yet possible.ZusammenfassungBei 6 Patienten mit Psoriasis vulgaris wurde das enzymchemische Verhalten des entzündlichen Infiltrates während der Psoriasismorphogenese (Phasen I–IV nach Braun-Falco) untersucht. 1.Dabei zeigten die Enzyme des energieliefernden Stoffwechsels in Bereichen vollausgebildeter Psoriasis (Phase IV) folgende Reaktionsausfälle:a)Enzyme der Glykolyse: sehr starke Aktivität;b)Enzyme des Citronensäurecyclus: schwache Aktivität;c)Atmungskettenenzyme: deutliche Aktivität;d)Enzyme des Pentose-Phosphatshunts: geringe Aktivität.Der Ausfall dieser Enzyme erlaubt weder eine zuverlässige metabolische Deutung, noch ist er zur zellanalytischen Beurteilung des entzündlichen Infiltrates bei Psoriasis vulgaris geeignet.2.Mit Hilfe zellspezifischer Enzyme ist eine cytochemische Differenzierung der bei Psoriasis vulgaris beteiligten Entz\:undungszellen m\:oglich. Neben einer Beurtilung der Zusammensetzungen des entz\:undlichen Infiltrates erlauben diese cytochemischen Reaktionsausfälle auch eine Aussage \:uber die Dynamik der cellulären Reaktion im Verlauf der Psoriasismorphogenese. Zur cytochemischen Darstellung der Mastzellen ist die Naphthol-AS-d-Chloracetatesterase-Reaktion besonders geeignet. Die Makrophagen sind gekennzeichnet durch eine stark positive Reaktion auf \ga-Naphthylesterase, Naphthol-AS-d-Acetatesterase sowie der sauren Phosphatase nach Leder \3- nicht jedoch nach der Methode von Spier u. Martin. Die neutrophilen Leukocyten sind durch einen hohen Gehalt an Peroxydase und alkalischer Phosphatase gekennzeichnet und heben sich mit der Naphthol-AS-d-Chloracetatesterase-Reaktion durch ihre cyclamenrote Färbung von dem mehr ziegelroten Reaktionsprodukt der Mastzellen ab. Die Lymphocyten besitzen kein zellspezifisches Enzymprofil. Es ist auffällig, daß die makrophagocytär-mastocytäre Reaktion am Beginn der Psoriasismorphogenese steht und erst später gefolgt wird von der lymphocytär-leukocytären Reaktion. Eine pathogenetische Interpretation der beobachteten Aufeinanderfolge der Entzündungszellen in den einzelnen Entwicklungsphasen während der psoriatischen Morphogenese erscheint zur Zeit noch problematisch.

Zur Histochemie der Capillaren bei Psoriasis vulgaris

SummaryIn 6 patients with psoriasis and in 5 controls endothelial cells of the capillaries have been investigated histochemically. The papillary capillaries in psoriasis show a typical but appearently non-specific enzyme pattern without differences to the normal skin. In psoriatics the normal skin, border zone and psoriatic lesion showed no demonstrable alterations enzymatically. The glycolytic activity in the endothelial cells of the capillaries was relatively high, while mitochondrial enzymes of the citric acid cycle and the respiratory chain demonstrated relatively low enzymatic activity. Enzymes of the phosphate cycle as well as the glycerine aldehyde dehydrogenase histochemically were of low activity, too.However, multilocalized NADPH- and NADH-donating enzymes reacted stronger as well as certain hydrolytic enzymes (alkaline phosphatase, 5-nucleotidase, adenosintrophosphatase, leucinaminopeptidase, acid phosphatase [Leder]). The latter proved to be especially applicable for the morphological demonstration of the capillaries.ZusammenfassungBei 6 Patienten mit Psoriasis vulgaris und 5 Personen, bei denen klinisch und anamnestisch kein Anhalt für Psoriasis vulgaris bestand, wurde das histoenzymatische Verhalten der Capillar-Endothelien verglichen.Dabei zeigte sich, daß die papillären Capillaren bei Psoriasispatienten ein typisches, wenn auch offenbar nicht spezifisches Enzymmuster besitzen, das sich nicht grundsätzlich von dem Enzymmuster der Capillar-Endothelien normaler Haut unterscheidet. So konnten in klinisch normaler Haut, in der Übergangszone und im Psoriasisherd hinsichtlich der nachgewiesenen Enzymaktivitäten große Abweichungen nicht erfaßt werden.Dabei war auffällig, daß die Capillar-Endothelien eine relativ hohe glykolytische Aktivität besitzen, während die vorwiegend mitochondrialgebundenen Enzyme des Citronensäurecyclus und der Atmungskette eine vergleichsweise geringe Aktivität erkennen ließen. Auch Enzyme des Pentosephosphatcyclus sowie Glycerinaldehyd-Dehydrogenase waren nur in schwacher Aktivität nachweisbar. Demgegenüber zeigten “zweiörtige” NADPH- und NADH-liefernde Enzyme eine stärkere Aktivität. Auffällig war der starke Reaktionsausfall bestimmter hydrolytischer Enzyme (alk. Phosphatase, 5-Nucleotidase, Adenosintriphosphatase, Leucinaminopeptidase, saure Phosphatase nach Leder). Letztere sind daher auch zu Untersuchungen des morphologischen Verhaltens von Capillaren besonders geeignet.

Immunostaining in Atypical Fibroxanthoma of the Skin

We have studied 12 cases of cutaneous atypical fibroxanthoma using immunohistochemistry to demonstrate lysozyme, alpha-1-antitrypsin, S-100-protein, receptors for peanut agglutinin, and intermediate filaments. Results were compared with immunostaining in 24 cases of other so-called fibrohistiocytic tumours. In addition 2 cases of atypical fibroxanthoma and 6 cases of fibrohistiocytic tumours were stained by monoclonal antibodies specific for the monocyte cell lineage (Ki-M1, Ki-M2, Ki-M6, Ki-M7, Ki-M8, OKM-1 and Leu-M1) and double-stained by monocyte-markers and Ki-67. The immunophenotype of atypical fibroxanthoma was rather similar to the marker profile found in malignant fibrous histiocytoma. All atypical fibroxanthomas were positive for vimentin and negative for epithelial markers. Monocyte lineage-specific determinants could be demonstrated in varying amounts in cells suggestive of being reactive. In contrast proliferating--Ki-67 positive--cells did not express monocyte/macrophage related antigens in atypical fibroxanthoma and malignant fibrous histiocytoma both. As to the histogenesis of these tumours our findings speak in favour of a derivation from primitive mesenchymal cells rather than from histiocytes.

Lymphomatoid Papulosis:A Cutaneous T Cell Pseudolymphoma?

It was the purpose of this study to further define the nature of the dermal infiltrates in lymphomatoid papulosis (LP) means of enzyme cytochemistry (acid phosphatase and esterase), immunology (rosetting techniques, immunoperoxidase technique on cryostat sections), and by semithin and ultrathin sections. The studies performed on biopsy samples with clinically and histologically typical LP indicated that most lymphoid cells display markers for T-lymphocytes, which were helper T-cells in the one case studied with monoclonal antibodies. Regarding the typical benign self-involutive clinical course, LP is considered to be a cutaneous pseudolymphoma of T-cell type.

Recent advances in the understanding of cutaneous lymphoma.

Three hundred and sixteen patients with cutaneous lymphoreticular proliferations were studied using enzyme‐cytochemical and immunological techniques. Cell typing was performed using enzyme histochemistry, whilst B‐cell and T‐cell differentiation was achieved using surface markers, resetting and other techniques. These findings were then correlated with histopathology and cytomorphology.

Significance of non-lymphoid ('accessory') cells in malignant lymphomas and pseudolymphomas of the skin.

We investigated the co‐distribution of lymphocyte subpopulations and non‐lymphoid ‘accessory’ cells in 35 cases of cutaneous lymphoproliferative diseases (T‐cell lymphoma, 10 cases; B‐cell lymphoma, 17 cases; pseudolymphoma, 8 cases) using immunohistochemical methods. T‐zone histiocytes and particularly Langerhans cells were abundant in all cutaneous T‐cell lymphomas, but were also found in B‐cell lymphomas. T‐zone histiocytes were associated with T‐lymphocytes, especially T‐helper cells, but not with T‐suppressor cells. Dendritic reticulum cells were essentially confined to well differentiated germinal centres. Macrophages occurred in both lymphomas and pseudolymphomas without definite relationship with either B‐ or T ‐cells. In malignant lymphomas of high grade malignancy, macrophages represented the only non‐lymphoid cell type.

Differentiation Between Pseudolymphomas and Malignant B Cell Lymphomas of the Skin

A vast spectrum of synonymas has been used for the designation of pseudolymphomas of the skin including the following: sarkoid Spiegler-Fendt (Darier 1910), benign lymphocytoma (Kaufmann-Wolf 1921), lymphadenosis benigna cutis (Bafverstedt 1943), cutaneous lymphoid hyperplasia (Caro and Helwig 1969), and others (Kresbach and Kerl 1978; Kerl and Kresbach 1979).

Patterns of Cutaneous Lymphomas

During recent years there has been much progress in interpreting the histo- and cytomorphology of lymphoreticular proliferations by means of enzyme cytochemical (cell typing by hydrolytic enzymes) and