J. Diebold

Further phenotypic evidence that nodular, lymphocyte-predominant Hodgkin's disease is a large B-cell lymphoma in evolution.

Five cases of nodular, lymphocyte predominant Hodgkins disease (nLP HD), in which an association with (n = 3) and transformation to (n = 2) large cell lymphoma (LCL) were found, were studied with monoclonal antibodies against B-, T-, and Reed-Sternberg (R-S) cell-associated antigens and epithelial membrane antigen (EMA) on paraffin sections. Both lymphocytic (L) and histiocytic (H) cells of nLP HD and lymphoma cells of LCL expressed multiple B-cell-associated antigens (detected by LN-l/CDw75, L26, MB2, DBB.42, DBA.44, DND.53, DNA.7 antibodies) but did not react with antibodies against T-cell-associated (MTl, UCHLl/ CD45RO) (one exception for CD45RO in LCL) and R-S cell-associated (Leu-Ml/CD15, Ber-H2/CD30) antigens. EMA was expressed by L and H cells in all cases and conserved in LCL cells, emphasizing the frequent expression of EMA by the diagnostic cells of nLP HD. An antibody (BNH9) against blood group-related antigens (H and Y oligosaccharide antigens) that does not normally react with lymphoid cells was found to be reactive with few L and H cells in two of five and most LCL cells in four of five cases. The finding might be indicative of abnormal activation of lymphoid cells. The data reinforce current implications that nLP HD is a B-cell malignancy in evolution and that it is not truly representative of Hodgkins disease in terms of biological and clinical behavior.

Bone marrow manifestations of infections and systemic diseases observed in bone marrow trephine biopsy

Bone marrow modifications resulting from infections and systemic diseases can be studied by analysis of morphology and aetiology. Two types of lesions or modifications can be observed, those occurring in the connective tissue comprising inflammatory processes, acute and chronic, as well as immune reactions, and those involving the normal haematopoietic cell lines, with possible hyperplastic or aplastic changes in one or more cell lines. The main lesions are described (oedema, haemorrhage, necrosis, suppuration, granulomas, lymphoid nodules and hyperplasia, immunoblastic or plasmacytic hyperplasia), as well as the main aetiologies. In association, the three main haematopoietic cell lines show hyperplasia, hypoplasia, aplasia of one or all of the cell lines, sometimes with dysmyelopoiesis. The stroma and vessel reactions comprise myelofibrosis, gelatinous transformation or amyloid deposits.

LAV-like viral particles in lymph node germinal centers in patients with the persstent lymphadenopathy syndrome and the acquired immunodeficiency syndrome-related complex: An ultrastructural study of 30 cases

The detection of LAV- or HTLV III-type viral particles in lymph node germinal centers from patients with the persistent lymphadenopathy syndrome (LAS) or the acquired immunodeficiency syndrome (AIDS)-related complex (ARC) is an important diagnostic factor in the prodromal stages of AIDS. These particles, the morphology of which is defined, are situated solely in the extracellular spaces delimited by cytoplasmic extensions of the dendritic reticular cells. Often few in number, they were found in 26 of the 30 lymph nodes studied, selected uniquely on the basis of light microscopic criteria (predominantly follicular lymphoid hyperplasia). The four negative nodes contained no, or fewer than two, germinal centers in the samples taken for ultrastructural study. The diagnosis of the LAS or the ARC was always confirmed clinically and biologically. Thus, lymph node biopsy and the corresponding ultrastructural study are important steps in the diagnosis of AIDS.

Lymph Node Modification in Patients with the Acquired Immunodeficiency Syndrome (AIDS) or with AIDS Related Complex (ARC): A Histological, Immuno-Histopathological and Ultrastructural Study of 45 Cases

The authors present the results of a histopathological study on the lymph-nodes taken from 45 subjects suffering from either an AIDS or from a chronic adenopathy corresponding to the definition of AIDS related complex (ARC). The various aspects observed were classed as type I to type IV. The lymph-node modifications observed in the 29 patients with an ARC could be divided into three principle groups: an extensive follicular hyperplasia associated with other elementary lesions or type IA (25 lymph-nodes from 23 patients); changes resembling a multicentric Castleman syndrome or type IB (1 case); angioimmunoblastic-like (AIL) lesions or type II (2 cases) and an association of lesions of type II (7 lymph-nodes from 6 patients). During AIDS, the adenopathy usually disappears, and the small lymph-nodes removed, especially on autopsy, show an extensive lymphoid depletion (type III) with systematic sclerosis (15 lymph-nodes from 14 patients). When adenopathy persists, it is due to infections complications (tuberculosis, cryptococcosis, avian mycobacteriosis and Whipples disease like lesions). Of the 10 patients in whom a Kaposis sarcoma was observed, only 6 showed lymph-node involvement, or type IV. The different histopathological lesions seem to appear according to an evolving succession, proven by certain association of lesions and by successive biopsies. In our series, 17% of subjects with an ARC evolved to AIDS. Lymph-node biopsy allows a possible ARC to be implicated on the association of the following simple lesions: follicular hyperplasia with partial or total destruction of the perifollicular lymphocytic cisterna, infiltration of the germinative centres by streams of small lymphocytes, evolving to an aspect of a burst germinative centre and various sinusal reactions with, in particular, the presence of neutrophilic polynuclear cells. The biopsy also allows the forms with bad prognosis to be recognized: those with AIL-like aspect or multicentric Castleman-like syndrome, which seems to represent a particular evolutive form. Finally, it also detects, in certain cases, the localization of a Kaposi syndrome, signalling the passage to AIDS. The immunopathological studies present a double interest. Firstly, they offer arguments in favour of the diagnosis: increase in the number of T8 lymphocytes in the germinative centres with the formation of small clusters and disruption of the network of dendritic reticular cells, and the inversion of the T4/T8 ratio in the extra-follicular cortical regions, by either a decrease in T4 lymphocytes or by an increase in T8 lymphocytes.(ABSTRACT TRUNCATED AT 400 WORDS)

Intravascular large B-cell lymphoma with bone marrow involvement at presentation and haemophagocytic syndrome: two Western cases in favour of a specific variant.

To report two cases of an unusual form of intravascular lymphoma, characterized by bone marrow involvement at presentation with haemophagocytic syndrome.

Sea-blue histiocyte syndrome in bone marrow secondary to total parenteral nutrition including fat-emulsion sources : a clinicopathologic study of seven cases

Bone marrow examination revealed a lipid‐laden histiocytosis in seven patients undergoing long‐term total parenteral nutrition necessitated by extensive short‐bowel surgical resection. Clinical abnormalities occurred during this treatment which required bone marrow examination. These included hepatosplenomegaly and peripheral blood cytopenia; the median time to the detection of these abnormalities was 64 months. u2003The most striking change within the bone marrow was the presence of many pigment‐laden histiocytes which had the typical morphology of sea‐blue histiocytes seen in the so‐called idiopathic sea‐blue histiocyte syndrome. The occurrence of sea‐blue histiocytosis in the bone marrow in association with long‐term parenteral nutrition for short‐bowel syndrome has not, to our knowledge, been reported previously and should now be considered in the differential diagnosis of bone marrow sea‐blue histiocytosis.

Herpes simplex virus lymphadenitis mimicking tumoral relapse in a patient with Hodgkin's disease in remission

A patient treated for Hodgkins disease and presenting 12 years later with a left inguinal lymphadenopathy mimicking a relapse is reported. Histopathological study disclosed large histiocytic granulomas in the sinuses. Some of these granulomas showed necrotic areas with numerous neutrophils. At the edge of the necrotic zones, cells of undetermined origin exhibited intra-nuclear inclusions typical of Herpes simplex virus. The diagnosis was confirmed by immunolabelling, revealing Herpes simplex viral antigens in frozen and paraffin sections, and by ultrastructural studies. The diagnostic value of the histological methodology and pathological changes and the significance of the disease, appearing in a patient treated for Hodgkins disease are discussed.

The detection of CD14 and CD16 in paraffin-embedded bone marrow biopsies is useful for the diagnosis of chronic myelomonocytic leukemia

Histopathological study of bone marrow biopsy (BMB) in chronic myelomonocytic leukemia (CMML) is often difficult and might benefit from an immunohistochemical approach. We immunostained 15 cases of CMML, focusing at two new antibodies staining for CD14 and CD16 on paraffin-embedded tissues. CD68 (KP1), CD68 (PG-M1), and CD163 were not differentially expressed between CMML and chronic myelogenous leukemia (CML). In CMML BMB, we found a significant increase in the number of CD14+ monocytes. This increase was made of dispersed cells in the interstitium, often exhibiting bilobated nuclei, and being difficult to differentiate from neutrophils. There was no expansion of CD16+ monocyte-like cells. However, we found a significant decrease in the number of granulocytes expressing CD16, MPO, and CD15 in CMML compared to CML and control BMB, probably related to dysgranulopoiesis. Indeed, BMB immunohistochemistry can be helpful in CMML by identifying both the monocyte expansion with CD14 and the dysgranulopoiesis with CD16.

Morphological variability of tumour cells in T-cell-rich B-cell lymphoma

T-cell-rich B-cell lymphoma (TCRBCL) is an unusual lymphoma which is difficult to diagnose. A majority of reactive T-cells and numerous histiocytes mask the few large neoplastic B-cells. Fourteen cases of TCRBCL were studied in order to identify the main histological and cytological features useful for this diagnosis. Neoplastic cells are atypical and sometimes difficult to classify. Several types are seen; they are mostly centroblasts, which represent more than 50% of the tumour cells but are sometimes multilobated, immunoblasts- or Reed-Sternberg-like cells. Interestingly, at least two, and often three, types of tumour cell are present in all the cases. Epithelioid cells and histiocytes are always found and are often numerous. Hypervascularization and fibrosis are present in the majority of cases, but without annular bands. Necrosis is absent. All tumour cells express CD20 but EMA is expressed in less than half the cases. In two cases, the association of a diffuse large B-cell lymphoma in one site and a TCRBCL in another suggests that TCRBCL may be considered as a peculiar pattern of a diffuse large B-cell lymphoma with a strong stroma reaction. TCRBCL may not represent a clinicopathological entity.

Ultrastructural study of 4 cases of Ki-1 positive large anaplastic cell malignant lymphoma

The ultrastructural morphology of 4 cases of large anaplastic cell malignant lymphoma (Ana ML) is reported. Three cases were primary Ana ML and one pleomorphic large T cell lymphoma with some Ki-1 positive cells. All were confirmed by immunohistochemistry on frozen and paraffin sections. The Ki-1 and EMA positive tumour cells had an abundant cytoplasm, with no differentiation and large pale nuclei with multiple compact or dispersed nucleoli. The morphology is that of an activated cell engaged in protein synthesis and/or in the mitotic cycle. These tumour cells resemble to the Hodgkins and monolobated Reed-Sternberg cells described in Hodgkins disease.