Cases Of Large Cell Lymphoma Research Articles

Large cell lymphoma with initial presentation in the bone marrow.

This report describes 14 cases of large cell lymphoma with initial presentation as marrow involvement in the absence of peripheral lymphadenopathy. The disease affected mainly the middle-aged and elderly, with male predominance. Most patients presented with swinging fever and peripheral blood cytopenia. Reactive hemophagocytic syndrome was a common finding, causing significant morbidity and mortality. Peripheral lymphadenopathy was absent (by case selection), but involvement of the liver, spleen and paraaortic lymph nodes could be demonstrated in some cases. However, in some patients, the involvement was apparently restricted to the bone marrow. Involvement of the bone marrow was often subtle, and could be missed on causal examination. Immunohistochemical studies on eight cases showed that four exhibited a B-cell phenotype, three a T-cell phenotype and one a non-T non-B phenotype. The prognosis was poor, with survival being measured in days to weeks in most patients.

小児Ｎｏｎ‐Ｈｏｄｇｋｉｎ’ｓ Ｌｙｍｐｈｏｍａ２６例の臨床病理学的検討

Twenty six cases diagnosed as Non-Hodgkin's lymphoma in patients under 15 years of age between 1980 and 1989 were reviewed and reclassified histopathologically and immunohistochemically.There were 21 boys and 5 girls with a mean age of 9.0 years. Major primary sites were head and neck (50.0%) and abdomen (23.0%). Non-localized type (stage III and IV) were 76.9% of the patients and localized type (stage I and II) were 23.1% at the time of diagnosis according to the Murphy's classification.Histopathologically, 26 cases divided into three major subtypes: lymphoblastic type (30.8%), large cell type (34.6%), and Burkitt type (30.8%).Immunohistochemically, it was demonstrated that 13 cases of 26 cases were T cell origin and 11 cases were B cell origin. There was no case of non-T non-B.In lymphoblastic type and Burkitt type, histology was found to correlate strongly with immunophenotype and biologic behavior, but in the cases of large cell type they were heterogeneous.In 9 cases of large cell lymphoma, 4 cases were T cell lymphoma, 2 cases were B cell lymphoma and 3 cases were Ki-1 positive lympoma.Complete remission was obtained in 23 of 26 cases (88.5%), 100% in lymphoblastic type, 75.0% in large cell type and 87.5% in Burkitt type. Two-year-survival rate was 100% in lymphoblastic type, 56.3% in large cell type and 83.3% in Burkitt type. Seven-year-survival rate was 75.0%, 56.3%, and 83.3%, respectively. Large cell type lymphomas had the worst prognosis.

Nodular paragranuloma can transform into high-grade malignant lymphoma of B type.

A follow-up study of 537 cases of Hodgkin's disease, lymphocyte predominance type, nodular--designated as nodular paragranuloma (NP)--found simultaneous presence of (n = 11) or subsequent transition into (n = 3) a large cell lymphoma (LCL) in 14 cases. Morphologically, the LCLs were classified in ten cases as centroblastic lymphoma (malignant lymphoma, diffuse, large cell, non-cleaved cell), in three cases as immunoblastic lymphoma (malignant lymphoma, large cell, immunoblastic), and in one case as large cell anaplastic lymphoma. Eleven of the 14 LCLs were studied immunohistologically. Five cases showed a monotypic immunoglobulin (Ig) pattern, seven were positive to the monoclonal B-cell marker Ki-B3, and three showed both monotypic Ig and Ki-B3 positivity. With anti-Ig and Ki-B3, nine of the 11 LCLs could be classified as B-cell non-Hodgkin's lymphoma. Only one case of LCL exhibited the typical phenotype of Hodgkin cells, ie, positivity to anti-CD15 (3C4) and anti-CD30 (Ber-H2). A retrospective follow-up study of these secondary LCLs of B type revealed a longer survival time than that of primary B-type LCLs and other secondary LCLs. These findings indicate that B-type LCL is the most common outcome when NP progresses into a lesion of higher malignancy and provide further evidence of a close relationship of NP to the B-cell system. They also suggest that it would be clinically relevant to distinguish between cases of B-type LCLs secondary to NP and cases of LCLs without association with NP. This implies that signs of a preexisting NP should be looked for when a B-type LCL is diagnosed.

Clinical, ultrastructural immunohistochemical and DNA content analysis of lymphomas having features of interdigitating reticulum cells

Interdigitating reticulum cells (IRC) are dendritic, nonphagocytic histiocytes found in thymus-dependent areas of lymphoid tissues. We report two cases of large cell lymphoma having features of IRC in patients 13 and 17 years old. In each case the diagnosis was suggested by light and electron microscopic features, positive immunoperoxidase staining for S-100 protein, and additional immunoperoxidase findings. Both patients presented with aggressive lymphomas and were treated with intensive combination chemotherapy. Each patient achieved a complete clinical remission, then rapidly relapsed and died with disseminated disease 3 and 9 months after presentation. Novel findings included strong staining of specimens with an antibody to epithelial membrane antigen, staining of one specimen with peanut agglutinin in the pattern previously described in normal IRC, and a DNA content analysis that showed aneuploid stem cell lines in both patients.

Computed tomography in the evaluation of lymphoma of the uterine cervix

Primary involvement of the uterine cervix is a rare presentation of extranodal lymphoma. The clinical and computed tomography findings are described in four patients ranging from 23 to 74 years of age. All presented with vaginal bleeding. Computed tomography findings were similar to those of other primary pelvic neoplasms, with diffuse uterine enlargement and lobular contour alteration often mimicking fibroids. Lymphadenopathy was not observed in comparison to secondary lymphoma of the female genitalia. All patients had excisional biopsies. One patient had an initial TAH and BSO. Histology was varied with one case of large cell lymphoma, one of diffuse histiocytic, one of unclassifiable poorly differentiated lymphoma, and one of nodular poorly differentiated lymphocytic lymphoma that was finally classified as granulocytic sarcoma. Disease extent could be assessed by computed tomography and aided treatment planning. In conclusion, computed tomography was found to be useful in the evaluation of uterine lymphoma. Although the findings are not specific, the local tumor extent can be evaluated at the same time as other sites of potential involvement.

Malignant Lymphomas Exhibiting Positive Immunohistochemical Staining for Neuron Specdic Enolase

AbstractImmunohistochemical staining for neuron specific enolase, an enzyme expressed primarily by neural and neuroendocrine tissues, has been used to augment routine light microscopy in the distinction of neuroendocrine tumors (such as oat cell and Merkel cell carcinomas) from malignant lymphomas. While using this marker in our diagnostic work, we encountered four strongly neuron specific enolase positive neoplasms that were shown on further evaluation to be large-cell lymphomas. We then retrospectively stained formalin-fixed, paraffin-embedded sections of twenty-two cases of large-cell lymphoma for neuron specific enolase and identified another two neuron specific enolase positive lymphomas. This report summarizes the features of these six neuron specific enolase positive lymphomas. (The J of Histotechnol 11: 37, 1988.)

Expression of a cell-cycle-associated nuclear antigen (Ki-67) in cutaneous lymphoid infiltrates.

Cryostat sections of skin biopsies from 83 patients with benign or malignant cutaneous lymphoid infiltrates were examined immunohistologically for reactivity with Ki-67 (a monoclonal antibody recognizing a nuclear antigen expressed by cycling cells) using the APAAP immunoalkaline phosphatase labeling method and a double immunoperoxidase/alkaline phosphatase staining technique. Ki-67-positive neoplastic lymphocytes were plentiful in all large-cell lymphoma cases and in one-third of the small-cell lymphomas. Some benign disorders (patch test biopsies, cutaneous lymphocytoma, lichen planus) also contained many Ki-67-positive lymphocytes. These data indicate the value of using Ki-67 to assess the proliferative capacities of the lymphoid cells in cutaneous infiltrates. Use of this technique in the future may have important prognostic and therapeutic implications in the management of cutaneous lymphoid malignancies.

The undifferentiated malignant neoplasm. Identification of lymphoma arising in skeletal muscle by immunohistochemical analysis

The undifferentiated malignant neoplasm presents a significant problem in the intelligent selection of therapy. Because of advances in chemotherapy, there are cancers that are effectively palliated, and sometimes cured if appropriately treated. Characterization of tumors by immunohistochemical stains drastically reduces the incidence of "undifferentiated" diagnoses and will optimize patient management, as illustrated by two cases of large-cell lymphoma arising in skeletal muscle.

Analysis of large-cell lymphomas using monoclonal and heterologous antibodies.

Fifteen cases of large-cell lymphoma, diagnosed as centroblastic (5), B-immunoblastic (5) or true histiocytic (5). lymphoma and one case of malignant histiocytosis were studied with monoclonal antibodies. Each diagnosis was based on morphological as well as marker studies. A panel of monoclonal and heterologous antibodies against T lymphocyte differentiation antigens (Leul, Leu2a, Leu3a, OKT4, OKT8, TA1), B lymphocyte subsets (BA1, BA2, HLA-DR, alpha C3b receptor antiserum, surface immunoglobulins), the common acute lymphoblastic leukaemia antigen (CALLA), monocytes/macrophages (OKM1, anti-human monocyte 1, TA1, Mac1, HLA-DR, anti-C3b receptor), myeloid cells (VIM-D5, elastase, OKM1) and the cells of the Langerhans cell/interdigitating reticulum cell series (OKT6, NA1/34). The results show a specific staining pattern for true histiocytic lymphoma (histiocytic sarcoma). Centroblastic and B-immunoblastic lymphomas showed gradual differences with mostly strong staining for HLA-DR and weak with anti C3b receptor for B-immunoblastic lymphomas in contrast to centroblastic lymphomas. Staining with BA1 and BA2 indicated immunological heterogeneity in these lymphomas. The number of admixed cells was usually low with few B cells and a shift in the ratio helper/inducer to suppressor/cytotoxic T cells in favour of the suppressor/cytotoxic subset.