Jiro Maeda

UCHL1‐positive extranodal lymphoma resembling multiple lymphomatous polyposis of the gastrointestinal tract

Histopathologic and immunohistochemical studies were done on paraffin sections from a patient with alimentary tract lymphoma resembling multiple lymphomatous polyposis of the gastrointestinal tract (MLP). Diffuse, but not follicular, proliferation of medium‐sized lymphoid cells was noted in the polypoid lesions of the alimentary tract, peripancreatic lymph nodes, spleen, liver, and bone marrow. These cells possessed a T‐cell‐related antigen (UCHL1), but were negative for the B‐cell‐related and myeloid cell‐related antigens examined. Because neoplastic cells in MLP are usually of B‐cell origin, the current case will provide important information on the relation between phenotypes and morphologic patterns of proliferation.

Hodgkin's disease in hairy cell leukemia: Phenotypic characterization of neoplastic cells

A case of Hodgkins disease (HD) in a patient with long‐standing hairy cell leukemia (HCL) is reported. The diagnosis of HCL was confirmed by clinical features (chronic illness with marked splenomegaly) and hematopathologic findings (increase of characteristic hairy cells with tartrate‐resistant acid phophatase activity in peripheral blood and bone marrow). Cervical lymphadenopathy first appeared 6 years after the diagnosis of HCL, and histologic features of the node were characteristic of HD. As it was possible that the neoplastic cells of both lesions might have originated from a single clone, their phenotypic features were defined. The hairy cells were found to bear surface immunoglobulin, receptors for complement components, leukocyte common antigen, and antigen defined by LN‐1 monoclonal antibody, whereas lymph node lesion was characterized as HD because the Reed‐Sternberg‐like cells were positive for Leu M1 antigen, lysozyme, alpha‐1‐antitrypsin, and nonspecific cross‐reacting antigen. Since there was no evidence indicating a common clonal origin, it is more likely to consider that both lesions are derived from different clones.

Lymph node involvement in chronic neutrophilic leukemia. An immunohistochemical study.

An immunohistochemical study was performed on autopsy material from a patient with chronic neutrophilic leukaemia (CNL) using antibodies against various cell lineage-related antigens. Proliferation of immature neutrophils with occasional clusters of erythroblasts and megakaryocytes were noted in the retroperiotoneal lymph nodes, spleen, and kidneys as well as in the bone marrow. Predominance of immature neutrophils in the lymph nodes suggested the emergence of a blast crisis, although there was no increase of blasts in the peripheral blood. Since immature myeloid cells are difficult to distinguish from malignant lymphoid cells on tissue sections, we suggest that immunohistochemical identification of cell lineage-related molecules on these cells is necessary for the more accurate interpretation of lymph node lesions in myeloid neoplasms.

IMMUNOBLASTIC LYMPHADENOPATHY-LIKE T-CELL LYMPHOMA WITH MULTIPLE CUTANEOUS AND VISCERAL INVOLVEMENTS

Morphologic and immunological findings found in a patient with immunoblastic lymphadenopathy (IBL)‐like T‐cell lymphoma (IBL‐T) are presented. Though the initial clinical features were suggestive of IBL, multiple cutaneous and visceral tumors appeared later in his course. The cutaneous lesion is considered to be unique, because the neoplastic T cells with suppressor/cytotoxic (S/C) phenotype showed focal epidermotropism, resulting in necrosis and ulceration of the overlying epidermis. An interesting feature in IBL‐T is the frequent association of polyclonal hypergammaglobulinemia, yet the neoplastic T cells show S/C phenotype. Since la‐like antigen was expressed on the neoplastic T cells, it is stressed that antigen‐presenting and contrasuppressor cells should also be included in the cell populations which have a possibility to be a normal counterpart of IBL‐T.

Autopsy findings in a Japanese patient with acquired immunodeficiency syndrome.

A 37‐year‐old Japanese man was diagnosed as having acquired immunodeficiency syndrome (AIDS) on the basis of a homosexual history, generalized lymphadenopathy, marked decrease of helper/inducer T cells in the peripheral blood, and positive serum antibody (antibodies) against human immunodeficiency virus (human T‐lymphotropic virus type III/lymph‐adenopathy‐associated virus). Autopsy showed severe depletion of lymphocytes in the lymphoid organs including the systemic lymph nodes, spleen, and gut‐associated lymphoid tissue. Pneumocystis carinii pneumonia and adrenal cytomegalovirus infection (‘necrotizing adrenalitis’) were identified, but there was no neoplasm. Postmortem findings in AIDS were reviewed in the literature. ACT A PATHOL. JPN. 37: 1797–1809, 1987.

Monoclonal IgM-secreting neoplasms. Clinical and morphologic heterogeneity.

Two patients with monoclonal IgM‐secreting neoplasms are presented. Though both patients could be diagnosed as Waldenströms macroglobulinemia, the clinicopathologic features were quite contrastive. Most neoplastic cells in Case 1 showed lymphocytic morphology with rather leukemic process, while those in Case 2 were highly polymorphic with solid proliferation. The clinical and morphologic heterogeneity in these cases and cases in the literature is discussed, and the possible requirement to establish a system for the subclassification of IgM‐secreting neoplasms is insisted.

Apolipoprotein E in high-density lipoprotein in patients with old cerebral infarction.

Mahley らは高比重リポ蛋白質 (以下HDL) の抗動脈硬化作用にはHDL-with apo Eが重要な役割を果していると提唱したが, Bittolo Bon らは心筋硬塞生存者のHDLの apo E (以下HDL-E) が有意に低濃度であることを示して, この説を臨床面から支持した. ところで陳旧性脳硬塞患者 (以下OCI) のHDL-Eについての報告はないようである. そこで, OCIを対象に免疫固定電気泳動法を応用して開発した定量法でHDL-Eを測定した. 対照との比較で, OCIのHDLのコレステロール (以下HDL-C) と apo A-Iは低く, apo B, apo B/apo A-I (以下B/A-I) および atherogenic index (以下A.I.) は高い. そしてOCIのHDL-Eは, その濃度も全 apo Eに対する比 (以下HDL-E比) も, HDLの蛋白質や脂質に対する相対含量比も対照より有意に低くて, Bittolo Bon らの成績に一致した. この成績から, apo Eが異常に減少したHDLではその抗動脈硬化機能が減弱している可能性が示唆された. さらに新たな知見として, HDL-E比と動脈硬化の risk factor の指標とされているB/A-IやA.I.との間に負の相関関係が, negative-risk factor の指標とされているHDL-Cや apo A-Iとの間に相関関係が認められた. また, HDL-E比と apo Bとの間に負の相関関係をみいだしたことから, HDL-with apo Eが低比重リポ蛋白質 (以下LDL) レセプターに競合結合する結果, 高LDL血症を惹起するかも知れないという危惧は解消した. 以上から, HDL-E比が臨床的な negative-atherogenic index として有用であることが示唆された.