Yoshiyuki Kurabayashi

Primary malignant lymphoma of the intestine: Clinicopathologic and immunohistochemical studies of 39 cases

Clinicopathologic and immunohistochemical features in 39 cases of primary intestinal non‐Hodgkins lymphoma (NHL) in Japanese patients were studied. Only resection materials in stage IE and IIE‐1 were included in this study because of the certainty that the intestine was the primary site of the lymphoma. The updated Kiel classification was used to classify NHL Histologically, only two cases (5.1%) were follicular lymphomas, and the others were diffuse lymphomas. Twenty‐eight patients (71.8%) had high‐grade NHL and 11 (28.2%) had low‐grade NHL. Twenty (71.4%) of the 28 high‐grade NHL were centroblastic lymphomas, and 14 (70.0%) of these 20 cases of centroblastic lymphoma were the polymorphic variant. Ten (90.9%) of the 11 low‐grade NHL were low‐grade mucosa‐associated lymphoid tissue (MALT) lymphomas. Macroscopically, 18 patients had polypoid masses, 17 ulcerative tumors and four had diffusely infiltrating NHL. Seven of the 10 low‐grade MALT lymphomas were polypoid masses. Immunohistochemically, 35 lesions (89.7%) were of the B cell phenotype and three (7.7%) were of the T cell phenotype. In the remaining case, the cell lineage could not be determined. No lesions were considered to be Of histio‐cytic origin. The 5 year survival rate for high‐grade B cell lymphomas was poorer than for low‐grade B cell lymphomas, and the present study indicated that the histological grade of the intestinal B cell lymphomas was a prognostically significant factor.

Malignant lymphoma of Waldeyer's ring. A histological and immunohistochemical study.

The histopathological and immunohistological features of non‐Hodgkins lymphoma limited to the Waldeyers ring were studied in 22 Japanese patients using a panel of T‐ and B‐cell markers on paraffin‐embedded sections. All cases showed a diffuse growth pattern. Twenty cases were B‐cell lymphomas and two were T‐cell lymphomas. In contrast to the primary malignant lymphomas of the nasal cavity and paranasal sinuses, in which T‐cell neoplasms are more frequently seen, the majority of the primary Waldeyers ring lymphomas were B‐cell neoplasms. Sixteen of the 20 cases of B‐cell lymphoma were centroblastic lymphomas, and the monomorphic variant comprised the majority of these; the other three B‐cell lymphomas were immunocytomas. Two of the T‐cell lymphomas showed morphological features of angiocentric lymphomas.

Suppurative Lesions without Prominent Epithelioid Cell Response in Abscess-forming Granulomatous Lymphadenitis

To clarify the clinicopathological significance of the suppurative lesions without an epithelioid granulomatous response (SLs without Ep) in lymph nodes and their relationship to abscess-forming granulomatous lymphadenitis (AGL) and cat scratch disease (CSD), 10 cases were assessed clinicopathologically and immunohistologically. SLs without Ep were located in the subcapsular sinus, paracortical area and medullary cords, but not in the germinal centers. The microabscesses were surrounded by collections of monocytoid B-lymphocytes (MBLs), histiocytes without epithelioid features, neutrophils, small lymphocytes and small numbers of plasma cells. The majority of the MBLs seen in the SLs without Ep were of the large cell type. The histological triad of toxoplasmic lymphadenitis, i.e., reactive follicular hyperplasia, small clusters of epithelioid cells and aggregates of MBLs, were also seen in all cases. Some of the clinical and pathological findings in our 10 cases were characteristic of CSD, i.e., (1) cat exposure before the lymphadenopathy was in four of the 10 cases, (2) occurrence in autumn and winter months in all cases, (3) typical suppurative granulomas surrounded by palisaded epithelioid cells were in four of the 10 cases, and (4) Warthin-Starry silver stain-positive bacteria were detected in seven of the 10 cases. The results of our study suggest that SLs without Ep are an early stage of CSD.

Malignant lymphomas of the nasal cavity and paranasal sinuses. A clinicopathologic and immunohistochemical study.

The clinicopathologic and immunohistological features of 20 Japanese patients with non‐Hodgkins lymphomas (NHLs) limited to the sinonasal area were studied using a broad panel of T‐ and B cell markers on paraffin‐embedded and fresh frozen tissue. All cases showed a diffuse growth pattern. Nine cases were B cell lymphomas (immunoblas‐tic n = 4, centroblastic n = 3, immunocytoma n = l, centrocytic n = l), and nine were T‐cell lymphomas (pleomorphic medium and large cell n = 8, angioimmuno‐blastic n = 1). In two cases, the cell lineage could not be determined. No morphologic features of angiocentric/an‐giodestructive lymphoproliferative lesions or lymphoepithe‐lial lesions in ductal or glandular epithelium were seen in our series. Eight (89%) of the nine T‐ cell tumors and four(44%) of the nine B ‐ cell neoplasms involved both the nasal cavity and paranasal sinuses. Six of the nine T ‐ cell neoplasms showed a clinical presentation of rhinitis, whereas all of the B ‐ cell neoplasms showed tumor masses in the nasal cavity and/or paranasal sinuses. The two‐year survival rate for T cell lymphomas was poorer than that for B‐cell lymphomas. The five‐year survival of patients with NHLs involving both the nasal cavity and paranasal sinuses was also poorer than that of patients in whom NHLs were limited to the nasal cavity. Acta Pathol Jpn 42:333–338, 1992.

Centroblastic and centroblastic-centrocytic lymphomas associated with prominent epithelioid granulomatous response without plasma cell differentiation: a clinicopathologic study of 12 cases.

To clarify the clinicopathologic features of B-cell lymphoma associated with prominent epithelioid granulomatous responses other than immunocytomas, 12 patients were studied. There were six men and six women. The lymphoma generally affected elderly patients (median age, 58.5 years) and was mostly nodal in origin. Seven of the 12 patients had a localized lesion (stage I or II), and five had an advanced lesion (stage III or IV). Histologically, four patients showed a follicular growth pattern and eight a diffuse growth pattern. Based on the updated Kiel classification, nine patients showed centroblastic lymphomas, and three showed centroblastic-centrocytic lymphomas. The epithelioid cells were accumulated in large, poorly demarcated masses. Trabecular fibrosis compartmentalized in the lymph nodes, producing a vague nodular pattern in low-power fields. Immunohistochemical studies of the tumor cells revealed positive membrane staining with L26 in all 12 patients and with LN-1 antibody in 9 of 10 patients. Expression of the bcl-2 protein was present in all seven patients tested. Genotypic investigation exhibited germline configuration of the immunoglobulin heavy chain gene, the T-cell receptor beta-chain gene and the bcl-2 gene in all three patients investigated. By in situ hybridization, Epstein-Barr virus genomes were detected in only a few tumor cells in three of the patients tested. This study indicated that most, if not all, of the B-cell lymphomas with prominent epithelioid granulomatous responses other than immunocytoma were of follicular center cell origin.

Imprint cytology of cat scratch disease

The cytologic features of cat scratch disease (CSD) from eight cases in imprint smears are presented. All patients were clinicopathologically diagnosed as CSD as follows: 1) a history of animal exposure was recorded 2 to 4 weeks before lymphadenopathy; 2) the disease occurred in the autumn and winter months; 3) a characteristic histopathology in the biopsied lymph node specimens was observed; and 4) Warthin‐Starry silver stain‐positive bacteria were detected in four of the seven cases examined. The characteristic cytologic finding was the presence of confluent epithelioid cells with nearby and central scatterjng of neutrophils against a background of polymorphic inflammatory cells. Furthermore, a varying number of medium‐sized to large lymphoid cells with an appearance suggestive of monocytoid B lymphocytes (MBLs) were noted to be associated with the epithelioid cells. These cytologic findings closely paralleled the histologic patterns of epithelioid cell granulomas, with and without MBLs, which we have previously reported are probably associated with the disease.