Job D. Elema

The significance of intracytoplasmic proteins in Reed-Sternberg cells.

Lymphoid tissue of 42 patients with Hodgkins disease was studied with immunohistological techniques on the light microscopic and ultrastructural level. The presence of IgG in some Reed‐Sternberg (R‐S) cells was confirmed, and in addition serial sections and a double staining technique revealed that these cells also contained both kappa and lambda light chains. Furthermore two serum proteins, human serum albumin and alpha‐1‐antitrypsin, were demonstrated in the same positive R‐S cells. The ultrastructural localization of the immunoglobulin and of human serum albumin was not related to any protein synthesizing organelle or to structures related to endocytosis. It is suggested that the presence of immunoglobulin in R‐S cells is the result of a disturbance of the cell wall integrity with subsequent nonspecific diffusion of immunoglobulin and other serum proteins into the cell. The presence of IgG therefore can not be taken as an argument for a B‐cell origin of R‐S cells. Possible mechanisms for the cell wall damage are discussed. Cancer 42:1793–1803, 1978.

ACRODERMATITIS CHRONICA ATROPHICANS - A LIGHT AND ELECTRON-MICROSCOPIC STUDY

Degeneration of the elastica and collagen fibres in skin biopsies from patients with acrodermatitis chronica atrophicans was studied with light and electron microscopy. Elastic fibres were involved in the infiltrative stage while the elastin plexus was still present. In the atrophic phase, only fragments of elastic and oxytalan fibres were seen and the elaunin plexus was absent. Some collagen fibres were surrounded by osmiophilic material. In all biopsies, myelin sheaths were collapsed without axon structures. Spirochetes could be demonstrated in 69% of the biopsies and were most numerous in infiltrative and nodular lesions. The loss of elasticity of the skin in the atrophic phase may be caused by the destruction of both elastic and elastin fibres.

The Use of Monoclonal Antibodies for the Pathological Diagnosis of Lung Cancer

The diagnosis of lung cancer is made by light microscopic, histological and cytological criteria. The use of electronmicroscopy enables a further refinement of these morphological criteria. In this chapter the potential of immunohistology as an additional tool for phenotyping lung cancer in biopsies is discussed. Immunohistology characterizes lung cancer on the ground of its expression of specific, lung cancer associated, antigens.

Alkaline phosphatase positive lymphomas: a morphologic, immunologic, and enzymehistochemical study.

Among 87 cases of different non‐Hodgkin lymphomas studied with morphologic, enzymehistochemical, and immunologic techniques, ten were found with a positive alkaline phosphatase staining reaction of the cell membranes. The ages of the seven adult patients included in this report varied between 48–85 years. Studies of cell suspensions or cryostat sections demonstrated the presence of monoclonal membrane immunoglobulins indicating a B‐cell origin of these lymphomas. Investigation of peripheral blood of six patients revealed the presence of a corresponding monoclonal lymphocyte population in four. According to Rappaports classification, lymphoblastic, poorly differentiated, and well‐differentiated lymphocytic as well as histiocytic lymphoma were encountered. According to the “Kiel” classification, most lymphomas were classified in the group of follicle‐center cell tumors. The clinical course of the patients was variable. Non‐Hodgkin lymphomas with alkaline phosphatase positive staining do not constitute a separate entity.

Gastrointestinal toxicity of chemotherapy and the influence of hyperalimentation.

The effect of combination chemotherapy on human small intestinal morphology and disaccharidase activities and their relation with clinical and chemical (fecal wet weight and K‐excretion) parameters for gastrointestinal toxicity were evaluated in patients with disseminated malignant melanoma receiving enteral normoalimentation (NA). Also evaluated were the supposed protective effects on gastrointestinal toxicity of enteral hyperalimentation (HA) with an elemental diet. After chemotherapy, a comparable decrease in villus height, total mucosal height, and mitotic index was found in jejuna biopsy specimens of both groups. However, in the NA group, the crypt depth decreased (in contrast to the HA group), whereas the disaccharidase activities in the HA group deteriorated to lower values than in the NA group. The authors found no correlation between disaccharidase levels and mucosal morphology, nor was there a correlation between these variables, fecal parameters and clinical diarrhea, suggesting that diarrhea occurring after chemotherapy was not due to loss of mucosal tissue or decrease in enzyme activities. A protective effect of HA with an elemental diet on gastrointestinal toxicity could not be established.

Alkaline Phosphatase Positive Lymphomas and Lymphocytes

During an enzymehistochemical and immunological study of 50 cases of non-Hodgkin lymphoma 5 appeared to have alkaline phosphatase staining of the neoplastic cell membranes (Fig.1). According to Rappaport these should be classified as lymphocytic, poorly differentiated. Some had a mixed character with small, intermediate and large lymphocytes (Fig.2) and a vaguely nodular structure. Others were diffuse and consisted nearly entirely of large lymphocytes with many mitoses and a starry sky pattern (Fig.3). These lymphomas are not prepresented in the classification of Lukes and in the Kiel classification. Probably they should be classified as large cleaved cells or as linnphoblastic “unclassified”.

Fatal infection with Borrelia burgdorferi by involvement of the cardiac conducting system

The cardiac conducting system of a patient with fatal cardiac involvement byB. burgdorferi showed necrosis of associated muscle fibers in the sinoatrial node with lymphoplasmacytic infiltrate and focal edema. Lymphocytic infiltrate was also found around the atrioventricular node and in the penetrating bundle and branching bundle. Fibrosis in the left bundle branch apparently resulted in nearly complete discontinuation of the fibers. Peripheral neural and muscular tissue also showed signs of inflammation. Spirochetes were demonstrated in the branching bundle and between the muscular fibers of the right atrium. Peripheral neural and muscular tissue showed signs of disseminated Lyme borreliosis.