Tadaaki Eimoto

HISTIOCYTIC NECROTIZING LYMPHADENITIS

The lymph nodes from 10 cases of histiocytic necrotizing lymphadenitis (HNL), 3 cases of necrotizing lymphadenitis with follicular hyperplasia (NLFH), and 11 cases of various types of lymphadenitis (abscess‐forming, tuberculous, Piringer‐type, “viral”, and nonspecific lymphadenitides) were comparatively studied. The NLFH, clinically representing a milder form of collagen disease, showed necrotizing lesions similar to those of HNL but with follicular hyperplasia, more plasma cells, and scattered neutrophils; the latter features closely resemble those of some lymph nodes in systemic lupus erythematosus (SLE). Ultrastructurally, HNL and NLFH both showed coagul‐ative necroses of individual lymphocytes, the macrophages with large cellular debris, prominent immunoblasts, and cytoplasmic inclusions such as frequent tubuloreticular structures (TRS) and “intracytoplasmic rodlets” (ICR). The necrotic modality in abscess‐forming and tuberculous lymphadenitides was different and the macrophages contained smaller debris. The immunoblasts were less prominent in “viral” lymphadenitis and much less in the others. While TRS were present in may cases of other lymphadenitides as well, they were positive in a much smaller number of cells only; the ICR were found exclusively in HNL and NLFH. These findings suggest a relationship between HNL and NLFH; they may form a spectrum of hyperimmune reaction that includes fSLE as an extreme manifestation.

Immunohistological study of histiocytic necrotizing lymphadenitis

Immunohistological study of 18 cases of histiocytic necrotizing lymphadenitis (HNL) demonstrated numerous helper/inducer cells (OKT-4) and suppressor/cytotoxic cells (OKT-8) with activation (Tac) and proliferation (OKT-9) markers, and histiocytes (lysozyme, α-1 antichymotrypsin, OK-M1) in the affected areas. However, B cells (B-1), NK cells (Leu-7 and Leu-11), complement proteins and receptor (C4 and C3d receptor), and neutrophils (chloroacetate esterase) were scanty or absent in these foci. Activity of NK cells was also decreased in the peripheral blood of 2 cases examined. The results suggest that HNL might be induced by the abnormal T cell-histiocyte response against some causative agents which induce a similar reaction of delayed hypersensitivity type.

Ultrastructure of adult T-cell leukemia/lymphoma.

SummaryEighteen cases of adult T-cell leukemia/lymphoma (ATLL) in Japan were analyzed by electron microscopy and compared with 5 cases of B-lymphoma and well-established groups of T-lymphomas (4 cases of T-lymphoblastic lymphoma and 2 cases of Sézary syndrome). Five hundred cells in each case, categorized ultrastructurally as to the cellular size and nuclear shape, showed an essentially pleomorphic cellular distribution in ATLL in remarkable contrast with the monomorphism of B-“histiocytic”, B-well-differentiated lymphocytic, and T-lymphoblastic lymphomas. Some B-lymphomas and Sézary syndrome also showed pleomorphism. Cases of ATLL were classified according to the predominant cells and degree of nuclear irregularity, which delineated a spectrum of node-based, peripheral T-cell neoplasms probably encompassing T-immunoblastic sarcoma, T-zone lymphoma, as well as multilobated T-cell lymphoma. The characteristic fine structure of ATLL, in comparison with that of B-lymphomas, included slight to marked nuclear irregularity with convoluted-shape predominance, a speckled chromatin pattern of the large cells, prominent lysosomes, and glycogen accumulation in addition to the difference in cellular distribution. Although T-lymphoblastic lymphoma and Sézary syndrome shared some of these features, the ultrastructural differentiation of ATLL from them seems to be possible.

Gastric pseudolymphoma with monotypic cytoplasmic immunoglobulin

Two cases of hyperplastic lymphoid lesion of the stomach with cytoplasmic immunoglobulin of monotypic pattern are presented. Both patients were young, and the postgastrectomy course was uneventful for 38 and 76 months, respectively. The lesion had been diagnosed as pseudolymphoma based on the presence of hyperplastic follicles with germinal center and mixed infiltration of plasma cells and mature lymphocytes with no significant cytologic atypia. However, the immunoperoxidase method showed monotypic cytoplasmic immunoglobulin; lambda/IgM in one case and lambda/IgG in the other. The staining pattern of germinal centers was also monotypic in one, but polytypic in the other. These cases suggest the presence of monoclonal but reactive lymphoid hyperplasia, i.e., monoclonal‐type pseudolymphoma in the stomach. On the other hand, this type of lesion has to be carefully followed for the possible development of malignant lymphoma.

Adult T-cell leukemia/lymphoma in Taiwan a clinicopathologic observation

The retrovirus‐associated adult T‐cell leukemia/lymphoma (ATL) has not been previously documented in Taiwan. Five cases identified recently by the authors are reported. Three of the patients were women, and their ages ranged from 36 to 60 years. The most important diagnostic clue was the observation of polylobated lymphoid cells in the peripheral blood. Other variably observed significant features included hypercalcemia, cutaneous eruptions, osteolytic bone lesion, hepatomegaly, and lymphadenopathy. Surface marker studies revealed that the leukemic or lymphoma cells were T‐helper cells. Histopathologic examination revealed one case of pleomorphic type and three cases of medium‐sized cell type. No tissue was available for study in one case. The diagnosis of ATL was confirmed by the indirect immunofluorescence test on MT‐1 cell for antibodies to adult T‐cell leukemia virus‐associated antigen (ATLA). Three patients were dead within 6 months, and two patients had been in clinical remission for 7 and 10 months, respectively. These two latter cases were similar to the so‐called smoldering type of ATL. Two descendents among nine relatives of the patients were also positive for anti‐ATLA (22%). Two husbands were negative. Four of the five patients lived in the same county in northeastern coastal Taiwan, which suggested a possible clustering of ATL in that region.

Undifferentiated carcinoma of the lung with osteoclast-like giant cells

We treated a patient with undifferentiated carcinoma of the lung, with osteoclast-like giant cells resembling those of the giant cell tumor of bone. The clinical and morphologic characteristics of this case are documented, and the literature concerning this type of tumor is reviewed. The tumor differed histologically from the pleomorphic carcinoma, which occurs most commonly in the lung, and showed diverse pleomorphic manifestation with benign looking osteoclast-like multinucleated cells and bizarre giant cells. In addition, and undifferentiated carcinoma with a sarcoma-like appearance containing small areas of papillary adenocarcinoma was evident in the tumor.

Case Report: Concomitant Association of Thyroid Sarcoidosis and Hashimoto’s Thyroiditis

A female patient had sarcoidosis of the thyroid and Hashimotos thyroiditis. This seems to be the first report in which these two histological conditions were concomitantly present.

NON‐HODGKIN'S LYMPHOMA IN NORTHWESTERN KYUSHU ISLAND OF JAPAN

Ninety cases of node‐based non‐Hodgkins lymphoma in northwestern Kyushu, Japan were classified according to the Japanese Lymphoma Study Group (LSG) and the immunological as well as clinicopathological studies were performed. There were 6 cases of small cell type, 23 of medium‐sized cell type, 25 of large cell type, 20 of pleomorphic type, 10 of lymphoblastic type and 6 cases of specific lymphomatous lesions (Lennerts lymphoma and T‐cell lymphoma with angioimmunoblastic lymphadenopathy‐Iike pattern). Immunologically, the T‐cell character was predominant in pleomorphic type (100%), specific lymphomatous lesions (100%), medium‐sized cell type (80%) and large cell type (60%). Clinically, leukemic manifestation was frequently encountered in all histological types except for large cell type. The leukemic cells in pleomorphic type and T‐medium‐sized cell type were polymorphic, similar to those of adult T‐cell leukemia. Skin lesions were found chiefly in leukemic cases of pleomorphic and T‐medium‐sized cell types, and non‐leuke‐mic cases of T‐large cell type. The worst prognosis was observed in the pleomorphic type, especially of leukemic form. These results support the proposal of pleomorphic type as a distinct entity in prospecting the immunological subtype, clinical manifestations, and survival. In addition, T‐medium‐sized cell and pleomorphic types, having common clinicopathological characteristics, may be categorized as one group. On the other hand, T‐large cell type seems to be composed of heterogenous groups of the peripheral T‐cell tumor, although some cases overlap with pleomorphic type.

Presence of HTLV‐I proviral DNA in patients with adult T‐Cell leukemia/lymphoma in Taiwan

Human T‐lymphotropic virus‐I (HTLV‐I) proviral DNA was demonstrated in the leukemic cells of two newly identified cases of adult T‐cell leukemia/lymphoma (ATL) in Taiwan by the Southern blot hybridization method. Therefore, the ATL cases diagnosed clinicopathologically in Taiwan were, for the first time, documented to be definitely related to HTLV‐I.

PAPILLARY CARCINOMA OF THE THYROID

Twenty‐one papillary thyroid carcinomas (PTCs), grouped into predominantly papillary (14 cases), predominantly follicular (5 cases), and extremely follicular, i.e., follicular variant (2 cases) types, were studied in comparison with three cases each of follicular lesions including follicular carcinoma, follicular adenoma, adenomatous goiter and Graves’disease. Histochemical, im‐munoperoxidase, and electron microscopic analyses demonstrated no remarkable differences between the predominantly papillary and predominantly follicular PTCs, but the presence of common characteristics distinct from those of the follicular lesions. These two types of PTCs showed less glycogen, more mucoid material, more epidermal keratin, less thyroid hormone with relative predominance of T3 over T4, and more interdigitating reticulum cells (IDCs) than most of the follicular lesions. Ultrastructurally, the tumor cells of these PTCs had markedly irregular nuclei, a vesicular chromatin pattern, and small basally located lysosomes, in contrast with the cells in the follicular lesions which had smooth round nuclei, more heterochromatin, and apical or dispersed lysosomes of various sizes. The follicular variant PTCs showed some mixed features, such as glycogen in the follicular portion and mucoid material in metastatic papillary foci, positive keratin and IDCs but greater amounts of thyroid hormone, and a rather intermediate type of ultrastructure with only mildly irregular but vesicular nuclei and large apical as well as small basal lysosomes. These findings cytologically support the WHO definition of papillary carcinoma that includes tumors with variable mixtures of papillary and follicular patterns. However, separate consideration may be necessary with regard to the follicular variant. ACTA PATHOL. JPN. 37: 1563‐1579, 1987.