Malignant Lymphoid Infiltrates Research Articles

Subcutaneous panniculitis like T - cell lymphoma: Case series report

Subcutaneous Panniculitis-like T-cell lymphoma (SPTCL) is characterized by malignant lymphoid cell infiltration within the lobules of panniculitis. Diagnosis of SPTCL requires distinguish from primary cutaneous c/d T-cell lymphoma, peripheral T-cell lymphoma, and lupus panniculitis. We reported 4 cases with the diagnosis of SPTCL. Five patients were admitted to the hospital with skin lesions (erythema nodosum, skin thickening, skin ulcers) accompanied by persistent fever. Skin biopsies of them have infiltrative images of septal adipose tissue inflammation, immunohistochemical staining were positive for CD3, CD4, CD8, high Ki index. SPTCL is mainly based on biopsy. If SPTCL is diagnosed early, the prognosis is good.

S3489 The Uncommon Acute Abdomen: Enteropathy-Associated T-Cell Lymphoma Revealed by Jejunal Perforation

Introduction: Long-standing Celiac disease that is untreated or refractory to gluten-free diet can have dire consequences. Among these, Enteropathy-associated T-cell Lymphoma (EATL) is a rare form of non-Hodgkin’s intestinal lymphoma that carries a poor prognosis with high mortality. This neoplasm can manifest as complicated small bowel disease such as obstruction or perforation. We present a patient with Celiac Disease presenting with an acute abdomen found to have jejunal perforation due to EATL. Case Description/Methods: A 51-year-old male with history of biopsy-confirmed Celiac Disease (CD) presented for severe abdominal pain. Vital signs were stable and laboratory findings showed leukocytosis and lactic acidosis. Abdominal CT revealed closed loop obstruction and pneumatosis with hollow viscus perforation. He was taken to the OR for urgent exploratory laparotomy where purulent fluid and a perforation in the mid-jejunum was discovered. Subsequent jejunal resection with primary anastomosis was performed. Post-operative course was complicated by ileus and urinary retention but ultimately made full recovery. Biopsy of the resected jejunum revealed malignant lymphoid infiltrate in a background of mild villous blunting, increased intraepithelial lymphocytes, ulceration, perforation, and acute serositis consistent with EATL. Follow-up endoscopy was consistent with known CD, but otherwise unremarkable. T-cell receptor rearrangement study and bone marrow biopsy were negative. He was initiated on BV-CHP chemotherapy and achieved complete remission after 6 cycles. After induction, he opted for consolidation (BEAM) chemotherapy followed by autologous bone marrow transplant. Unfortunately, this treatment course was complicated by septic shock with multi-organ failure and ultimately decision was made for comfort care. (Figure) Discussion: Strict gluten-free diet (GFD) is the primary prevention of EATL in CD. Non-compliance to GFD has been shown to significantly increase risk of developing EATL. Small bowel perforation is a rare, but well-documented complication of EATL that must be recognized in CD patients presenting with acute abdomen. Current treatment of EATL with chemotherapy and autologous bone marrow transplant has shown promising improvement in survival rates and reduced mortality rate. For CD patients, strict adherence to GFD with close clinical monitoring is of utmost importance to improve quality of life, minimize progression of EATL, and prevent necessity of risky advanced interventions as highlighted in our case.Figure 1.: Axial view of Abdominal CT showing perforation of small bowel.

Duodenal monomorphic epitheliotropic intestinal T cell lymphoma along with unpredictable intestinal Epstein-Barr virus infection; a rare newly redefined entity in a rare site and review of literature

Introduction: Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), previously known as type II enteropathy associated T-cell lymphoma (EATL), was redefined by the WHO (2016) as separate entity from the celiac disease-associated lymphoma. It is an extremely rare and highly aggressive peripheral T-cell lymphoma. It mainly involves jejunum and ileum and rarely duodenum. Case Presentation: This was a 38-year-old male patient presented by daily vomiting related to meals for 8 months along with generalized colicky abdominal pain associated with constipation and marked weight loss. Upper endoscopy showed large ulcerated mass at the third part of the duodenum. Histopathological examination showed the diffuse malignant lymphoid infiltrate with morphology and immunophenotyping consistent with MEITL associated with unpredictable Epstein-Barr virus (EBV) in intestinal epithelial cells. The patient underwent five cycles of chemotherapy (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) followed by duodenectomy. Conclusion: This case represents a rare newly redefined lymphoma entity in a rare site associated with unpredictable non-neoplastic epithelial EBV infection, which proved to be oncogenic agent involved in various hematopoietic and other neoplasms with unclear relationship to the development of this MEITL.

T-cell receptor antibodies expression in benign and malignant cutaneous lymphoid infiltrates in comparison with T-cell receptor gene rearrangement and its diagnostic utility in borderline cases

IntroductionCutaneous T-cell lymphoid infiltrate can represent reactive lesion or a malignant T-cell lymphoma. However, clinical and histopathological appearance can overlap in both groups with a risk of misdiagnosis. Aberrant expression of T-cell markers is not always applicable and T-cell receptor (TCR) gene rearrangement is not always accessible and diagnosis in borderline cases can be challenging. AimsSeveral types of TCR antibodies are currently available with limited knowledge of their expression in different cutaneous lymphoid infiltrates. Aim of the study is a comparison of expression of TCR antibodies in benign and malignant lymphoid infiltrates and their utility in borderline cases. MethodsRepresentative cases of reactive and malignant lymphoproliferations were collected. Separate group of lesions with borderline morphology was selected for comparison. Immunohistochemical expression of TCR-V-betaF1 (TCRBF1), TCR-C-beta1 (TCRJOVI.1), TCR gamma/delta (TCRGD) and TCR delta (TCRD) was performed in all cases. TCR gene rearrangement evaluation was performed in all cases using PCR BIOMED-2 assay. ResultsBenign lymphoid infiltrates were all negative in TCRD and TCRGD. Expression of TCRJOVI.1 was seen in 3/10 cases and TCRBF1 in one. T-cell lymphomas were positive for TCRBF1 and TCRGD in 60% and 30% of cases respectively. TCR gene rearrangement was confirmed in 90% of lymphoma cases. All benign lesions were polyclonal. Morphologically borderline lesions showed expression of TCRBF1 in 6/10 cases and TCR gene rearrangement in 4/10 cases. Re-evaluation of the cases and clinical correlation led to the change of the diagnosis and confirmation of T-cell lymphoma in 4/10 cases. ConclusionsExpression of TCRBF1 and TCR-gene rearrangement was significantly associated with malignant infiltrates. TCRBF1 positivity in borderline cutaneous lymphoproliferations can raise the suspicion of malignancy but confirmation by TCR gene rearrangement and careful clinical correlation is still advisable.

Response to brentuximab vedotin by CD30 expression: Results from five trials in PTCL, CTCL, and B-cell lymphomas.

7543 Background: Brentuximab vedotin (BV), an antibody-drug conjugate targeting CD30, has been evaluated in multiple trials in patients (pts) with peripheral T-cell lymphoma (PTCL), cutaneous T-cell lymphoma (CTCL), or B-cell lymphoma. We examined the ability of CD30 expression level to predict response to BV across these patient populations. Methods: Data were integrated from 275 pts with PTCL, CTCL, and B-cell lymphoma treated with BV from 5 prospective clinical trials. Study SGN35-012 evaluated BV plus rituximab or BV monotherapy in pts with relapsed/refractory non-Hodgkin lymphoma. The ALCANZA study compared BV to physician’s choice of methotrexate or bexarotene in pts with mycosis fungoides (MF) or primary cutaneous anaplastic large cell lymphoma (pcALCL). Three investigator-sponsored trials evaluated BV monotherapy in pts with relapsed PTCL, MF, and pcALCL (35-IST-030, 35-IST-001, 35-IST-002). Exploratory analyses were conducted to examine the relationship between CD30 expression and objective response rate (ORR) for pts with CD30 expression ≥10%, <10%, or undetectable (0%) by IHC (malignant cells or lymphoid infiltrate; local review). Results: 143 pts had tumors with CD30 <10%, including 58/143 with undetectable CD30. Activity with BV was observed at all levels of CD30 expression, including CD30=0 (Table). Analysis of the interaction between CD30 and duration of response is ongoing and will be presented in the final poster. ORR by CD30 expression, n/N (%). Clinical trial information: NCT01421667, NCT02588651, NCT01578499, NCT01352520, NCT01396070. Conclusions: CD30 expression levels ≥10%, <10%, or undetectable did not predict response to BV in a range of CD30-expressing lymphomas: Clinical responses occurred in pts with CD30 low and CD30 undetectable lymphomas. Limitations of IHC, the dynamic nature and heterogeneity of cell-surface CD30 expression, and multiple mechanisms of action of BV may all contribute to this observation.[Table: see text]

Role of Immunostaining in Detecting Extra-Pattern and Subtle Lymphomatous Infiltration in Bone Marrow Biopsies of NHL Patients

Introduction: Immunohistochemistry (IHC) enables the examination of a greater number of trephine biopsy levels and is helpful in determining additional scattered malignant cells. The aim of this study is to detect extra-pattern and subtle lymphomatous infiltration in bone marrow biopsies using CD20 and CD3 immunostaining. Patients and Methods: This study was conducted on 100 newly diagnosed Non Hodgkin Lymphoma (NHL) patients. Their bone marrow trephine biopsies were assessed on routine histology [Hematoxylin and Eosin (H & E)], and were further subjected to IHC using CD20 and CD3. Results: Pattern of involvement by H & E was highlighted by IHC. It showed additional interstitial pattern in 9 cases, parasinusoidal streaks in one case and highlighted a patchy pattern in another case with interstitial involvement on H & E. IHC also detected subtle infiltrations on additional 5.5% cases compared with histology alone. It helped in differentiating reactive (12 cases) and malignant lymphoid infiltration (33 cases). Conclusion: CD20 and CD3 immunostaining performed routinely on bone marrow trephine biopsies has the ability to reveal extra-pattern of infiltration and improve detection of subtle lymphoid involvement. A combined procedure identifying several distinctive features, in particular histotopography and IHC, provides a promising way of discriminating reactive from neoplastic lymphoid infiltrates in bone marrow trephine biopsies.

P343 The electrophysiologic features of neurolymphomatosis

Background Neurolymphomatosis is defined as a malignant lymphoid infiltration of the peripheral nervous system. However, few studies revealed the clinical and electrophysiological features of neurolymphomatosis. The objective of this study is to investigate the clinical and electrophysiological features of neurolymphomatosis. Method We found eleven patients (six male and five female) with following two conditions from medical records at Severance hospital from January 2004 to February 2016: (i) patients with pathologically confirmed lymphoma or leukemia, and (ii) patient with the evidence of malignant cell infiltration of peripheral nervous system in imaging studies. We retrospectively analyzed eleven patients with neurolymphomatosis. Results The median age of neurologic symptom onset was 53 years (range, 36–70 years). Among eleven patients with neurolymphomatosis, ten had non-Hodgkin’s lymphoma and the most common subtype was diffuse large B-cell lymphoma and the other patient had acute lymphoblastic leukemia. Eight patients were expired and their mean survival time is eight months (range, 1–23 months) after the diagnosis of neurolymphomatosis. Neurologic deficits were presented as first clinical presentation of lymphoma in five (46%) patients and as relapse or progression of a previous hematologic malignancy in six (54%) patients. Patients frequently demonstrated cranial nerve involvement (six patients; 55%) and severe pain (ten patients; 91%). 18FDG-PET/CT scan excellently revealed abnormality in ten (91%) of eleven patients and malignant lymphoid cells usually infiltrated from root and/or plexus to distal peripheral nerve. Nerve conduction study (NCS) revealed partial conduction block in ten nerves and simple axonal degeneration in 26 nerves. The mean interval from neurologic symptom onset to test was significantly longer in nerves with simple axonal degeneration than that in the nerves with partial conduction block. All nerves demonstrated simple axonal degeneration in the test more than 25 days after symptom onset. Conclusions Partial conduction block on NCS may lead to misdiagnosis of neurolymphomatosis. However, if patients have progressive painful multiple mononeuropathies with cranial neuropathy, the possibility of neurolymphomatosis should be considered.

Is There Any Association between Intestinal Lymphoma and Coeliac-Like Disease in Prosimians? The Case of the Ring-Tailed Lemur (<i>Lemur catta</i>)

Non-human primate species are considered as good models for human cancer research. Despite the relevant phylogenetic position of prosimians, few reports of neoplastic diseases have been described in these species. The current study investigated implication of an intestinal T-cell lymphoma in a 5-year-old female ring-tailed lemur (Lemur catta) hosted at Parco Natura Viva, an Italian zoological garden. First, a sub-occlusive thickening of the small bowel was found. Histologically, the lesion was caused by a malignant lymphoid infiltrate that was homogeneously CD3+. Moreover, inflammatory patterns peripheral to the lesion suggested a coeliac disease similar to that reported in human. A huge malignant lymphoid infiltrate was present also in the liver and spleen. Overall, the case suggests an etiopathological relationship between coeliac-like disease and intestinal T-lymphoma, as reported in several human studies. Findings from this study are useful to improve our knowledge on the occurrence of the T-lymphoma as well as to improve the husbandry and dietary protocol of prosimians in zoos.

Socioeconomic and demographic factors contributing to outcomes in patients with primary lymphoma of bone

BackgroundPrimary lymphoma of bone (PLB) is a rare disease, comprising a malignant lymphoid infiltrate of bone. The goal of this study was to identify socioeconomic, demographic, and anatomic factors as prognostic indicators of survival for this disease using the Surveillance, Epidemiology, and End Results (SEER) database. MethodsThe SEER database was used to identify a study population of 692 patients diagnosed with PLB in the United States from 1989 to 2003. Survival was analyzed using the Kaplan–Meier method, with effects of potential prognostic factors on survival analyzed using the log-rank test. Multivariable analysis was performed by Cox proportional hazards regression. ResultsThe overall 5-year survival rate was 49.6%, with a 10-year survival rate of 30.2%. Median overall survival was 4.9 years (95% CI: 3.9, 6.1). In multivariable analysis, age (p<0.0001), marital status (p=0.006), and appendicular vs. axial tumor location (p=0.004) were found to be independent predictors of survival. ConclusionsThis population-based study of PLB identified age, marital status, and tumor location as independent indicators of prognosis. This finding supports the clinical suspicion that an appendicular tumor location confers a better prognosis than an axial tumor location.

AB1071 Primary bone non hodking’s lymphoma: Presentation of 5 cases

BackgroundPrimary bone lymphoma (PBL) has been described as a malignant lymphoid bone infiltration, with or without cortical invasion and/or soft tissue extension, without visceral involvement nor distantlymph nodes. PBL constitutes...

Clinicopathologic Features, Prognosis, and Therapeutic Responses in Patients with Granulomatous Mycosis Fungoides: A Single Center Experience From Memorial Sloan Kettering Cancer Center.

Abstract 2643 Background:Granulomatous mycosis fungoides (GMF) is a variant of MF/cutaneous T-cell lymphoma characterized by a prominent granulomatous infiltrate in addition to the malignant lymphoid infiltrate. The diagnosis of GMF remains challenging due to variable clinical and histopathologic features. The significance of granuloma formation in CTCL is unclear and whether patients with GMF have a distinct prognosis compared to patients with classic type of MF is controversial. Data are scarce and long term results are not available. Objectives:To evaluate the clinical, histopathologic, prognostic significance and therapeutic responses of patients with GMF and to compare results to age and stage-matched patients with classic type of MF. Methods:A single center retrospective case-case study was performed at Memorial Sloan-Kettering Cancer Center of 430 patients with a diagnosis of MF between January 1981 and April 2012. Available histopathology slides were reviewed for the presence of granulomas or histiocytes comprising ≥ 25% of the atypical lymphoid infiltrate. Each identified case was matched with two classic MF cases via age and TNMB stage. For each case meeting criteria, the medical records, photographs, and histopathology slides were reviewed. Results:Twenty-seven patients with GMF were identified representing 6.3% of all MF patients at our center. Patient demographics were similar between the GMF group and case-control classic MF group, with a male-to-female ratio of 2.1:1 and a median age of 57. Most GMF patients (69%) present at early stages (IA-IIA). Patients with GMF had a longer onset of disease prior to diagnosis (median, 4.5 years vs 3.0 years). Skin manifestations of granulomatous MF showed a great variability, but were not distinguishable from those of classic MF. Histological findings showed an atypical predominantly CD4+ lymphocytic infiltrate with either granuloma formation or histiocytes with giant cells. TCR rearrangement was positive in 70% of cases. Features of GMF were present at initial diagnosis in 17 patients. In 10 patients, granulomatous infiltrates appeared at an average of 5.4 years after MF diagnosis. Secondary malignancies developed in 38% of patients with GMF compared to 23% of patients in the case-control classic MF group. Among the GMF patients, there was a trend towards fewer CRs to any treatment (38% vs 54%; p = 0.21); fewer PRs or CRs with topical therapy (57% vs 83%; p = 0.002) and with UV-light therapy (62% vs 90%; p = 0.008). Significantly more GMF patients received systemic therapy (66.7%) compared to classic MF patients (32.7%; p = 0.006). They also required a longer time to achieve best response (median 35 months vs 9 months, p = 0.002) compared to the control group. Disease progression to higher stage was seen in 46% of cases in the GMF group compared to 30% of cases in the classic MF group (p = 0.23). The 5-year and 10-year progression-free survival rates were significantly lower in the GMF group (59% and 33%, respectively) compared to the control group (84% and 56%, respectively; p = 0.02). However, the 5-year and 10-year overall survival rates were similar between GMF (86% and 72%, respectively) and classic MF patients (85% and 85%; p = 0.54). Conclusion:Our study presents the largest series on GMF in the United States. Most patients with GMF show similar clinical features when compared to patients with conventional MF. The clinical features do not reflect the histologic findings of granulomas. More frequent disease progression and poorer response to skin-directed therapies are seen in GMF patients compared to classic MF; however, overall survival is not significantly different. The majority of GMF patients present with granulomatous features at initial diagnosis and in subsequent biopsies suggesting that this entity has a unique relationship with its microenvironment. Disclosures:No relevant conflicts of interest to declare.

Transformation of vulvar pseudolymphoma (lymphoma‐like lesion) into a marginal zone B‐cell lymphoma of labium majus

Lymphomas arising in the female genital tract are extremely uncommon. Diffuse large B-cell lymphoma and follicular lymphoma are the most common types. We describe the case of an 80-year-old woman with a recurrent lesion in the vulva initially diagnosed as a lymphoma-like lesion and evolving 7 years later into a marginal zone B-cell lymphoma (lymphoplasmacytic lymphoma). Diagnosis was based on the monotypic pattern of the plasmacellular component and the clonal rearrangement of immunoglobulin heavy chain genes. No previous cases of vulvar marginal zone B-cell lymphoma arising in the context of a persistent lymphoma-like lesion have been reported. We highlight the importance of differentiating benign from malignant lymphoid infiltrates in the vulva.

Bone marrow trephines containing lymphoid aggregates from patients with rheumatoid and other autoimmune disorders frequently show clonal B-cell infiltrates

In bone marrow trephines, morphological and immunohistochemical criteria may not be sufficient to discriminate reactive from malignant lymphoid infiltrates. The aim of this study was to determine whether the detection of clonal immunoglobulin heavy chain (IGH) gene rearrangements is a reliable and specific marker for malignant B-cell clones in bone marrow biopsies. Bone marrow trephines with infiltration by different types of low-grade B-cell non-Hodgkin lymphoma (n = 32), reactive lymphoid hyperplasia (n = 18), and reactive lymphoid aggregates (n = 15), including 5 patients with rheumatoid or other autoimmune disorders, were analyzed by morphology, immunohistochemistry, IGH gene rearrangement (polymerase chain reaction), and DNA sequence analysis in selected cases. In 22 (68.8%) of 32 patients with B-cell non-Hodgkin lymphoma, a clonal IGH gene rearrangement was detected. Of the reactive cases, 1 of 18 patients with lymphoid hyperplasia demonstrated clonality, and 9 (60%) of 15 patients with reactive lymphoid aggregates gave a clonal result (GeneScan analysis). DNA sequence analysis was performed in 7 of the latter patients confirming clonality in 6. Four of the patients with B-cell clonality had an autoimmune disorder. None of these patients developed a malignant lymphoma during follow-up. Thus, the molecular detection of a clonal rearrangement of the IGH gene may support the diagnosis of a malignant lymphoma infiltrating the bone marrow. However, morphologically and immunohistochemically benign lymphoid aggregates might also harbor B-cell clones especially in patients with autoimmune disorders. Therefore, the detection of clonality has to be interpreted with utmost care and does not qualify for the unequivocal diagnosis of a malignant B-cell lymphoma.

Fine Needle Aspiration Cytology and Flow Cytometry in the Diagnosis and Subclassification of Non-Hodgkin’s Lymphoma Based on the World Health Organization Classification

To determine the usefulness of fine needle aspiration cytology (FNAC) in combination with flow cytometry on the new World Health Organization (WHO) classification of malignant lymphoma.Smears and flow cytometry reports of patients who underwent both methods at the same time were independently examined. Both methods were classified according to the new WHO classification of malignant lymphoma.A group of 131 smears were examined. In 89 cases exact diagnosis was made by cytomorphology. Twenty-five cases were not classified exactly or were classified incorrectly, resulting in a sensitivity of 96.4% and a specificity of 85%. With flow cytometry, only 30 of 131 patients could be classified exactly, resulting in a sensitivity of 27% and specificity of 100%, respectively. The combination of methods showed a sensitivity of 85% and specificity of 100%.The combination of FNAC and flow cytometry obtained by FNAC can distinguish between benign and malignant lymphoid infiltrates and support a diagnosis of lymphoma.

Diagnostic value of combining immunostaining for CD3 and nuclear morphometry in mycosis fungoides

Background:Mycosis fungoides (MF) is the most common skin lymphoid neoplasm. In initial stages, differential diagnosis of MF from other benign dermal lymphoid infiltrates (BDLI) may be impossible on morphological basis...

Sensitivity of an immunoglobulin heavy chain gene polymerase chain reaction primer system for routine diagnosis of lymphomas

Aims Polymerase chain reaction (PCR) and length fragment analyses of the immunoglobulin heavy chain (IgH) gene are useful tools for clonality assessment in malignant Bcell-lymphomas and reactive lymphoid infiltrates. The present investigation analyzes the sensitivity of an IgH gene consensus primer multiplex PCR system for the detection of clonality for routine diagnosis in 109 lymphomas during a period of 3 years (2003–2005) at the Institut of Pathology Klinikum Darmstadt.

MMP-9 in B-cell chronic lymphocytic leukemia is up-regulated by α4β1 integrin or CXCR4 engagement via distinct signaling pathways, localizes to podosomes, and is involved in cell invasion and migration

AbstractB-cell chronic lymphocytic leukemia (B-CLL) progression is determined by malignant cell extravasation and lymphoid tissue infiltration. We have studied the role and regulation of matrix metalloproteinase-9 (MMP-9) in B-CLL cell migration and invasion. Adhesion of B-CLL cells to the fibronectin fragment FN-H89, VCAM-1, or TNF-α–activated human umbilical vein endothelial cells (HUVECs) up-regulated MMP-9 production, measured by gelatin zymography. This effect was mediated by α4β1 integrin and required PI3-K/Akt signaling. The chemokine CXCL12 also up-regulated MMP-9, independently of α4β1 and involving ERK1/2 but not Akt activity. Accordingly, α4β1 engagement activated the PI3-K/Akt/NF-κB pathway, while CXCL12/CXCR4 interaction activated ERK1/2/c-Fos signaling. Anti–MMP-9 antibodies, the MMP-9 inhibitor TIMP-1, or transfection with 3 different MMP-9 siRNAs significantly blocked migration through Matrigel or HUVECs. Cell-associated MMP-9 was mainly at the membrane and contained the proactive and mature forms. Moreover, B-CLL cells formed podosomes upon adhesion to FN-H89, VCAM-1, or fibronectin; MMP-9 localized to podosomes in a PI3-K–dependent manner and degraded a fibronectin/gelatin matrix. Our results are the first to show that MMP-9 is physiologically regulated by α4β1 integrin and CXCL12 and plays a key role in cell invasion and transendothelial migration, thus contributing to B-CLL progression. MMP-9 could therefore constitute a target for treatment of this malignancy.

Lymphoid tumor in the orbit: malignant or benign? MRI, histomorphological and molecular genetic analysis of eight cases

Differentiation between benign and malignant lymphoid infiltrates of the conjunctiva and the orbit is difficult even on the basis of histopathological appearance. We describe eight cases with low-grade malignant lymphoma, mucosa-associated lesion tissue (MALT) lymphoma. Laboratory analysis was done using microscopy, immunophenotyping and gene rearrangement using the Southern blot technique. DNA-rearrangement analysis allows a very precise determination of the benign and malignant lymphoid infiltrates of the ocular region. Our MRI findings show that these tumors can also generally be distinguished by their signal intensity on T2-weighted images. These findings might explain the favorable prognosis for MALT lymphoma of the conjunctiva and the orbit, and the absence of any recurrence in follow-ups ranging from 6 months to 9 years.

Hepatic cytotoxic T‐cell infiltrates in patients with peripheral T‐cell proliferative diseases/lymphomas: Clinicopathological and molecular analysis

Seventy patients with various types of peripheral T-cell proliferative disease/lymphoma who manifested with prolonged fever, weight loss, anemia, lymphadenopathy, hepatosplenomegaly and elevated serum levels of alkaline phosphatase and/or lactate dehydrogenase were evaluated. Histopathological examination of the livers revealed T-cell infiltration into the hepatic sinusoids and portal tracts. The morphology of the infiltrated T cells varied from mature small lymphocytes to malignant lymphoid cells. The liver pathology was classified into four groups on the basis of cellular atypia. Group A and group B showed mature lymphoid cell infiltration; however, only group B had multiple large areas of hepatocellular necrosis. Group C showed atypical lymphoid cell infiltration and in group D malignant lymphoid cell infiltrates were demonstrated. The majority of the antigenic phenotypes of these T-cell infiltrates were CD3+, CD4-, CD8+, CD20-, CD45RO+, CD56-, CD57-, TIA-1+ and betaF1-. Epstein-Barr virus RNA in the nuclei of the infiltrated T cells was recorded in 38.6% of the patients and was more common in groups C and D. Patients in groups B, C and D had a very poor prognosis, median survival was only 1 month, whereas median survival in group A patients was 36 months. Chemotherapy was not effective in improving survival. Monoclonal band/s of T-cell receptors (TCR) beta and/or gamma gene rearrangements were detected in 88.6% of patients, and DNA-sequence analysis showed high identity to the human TCR germline gene.

Extranodal Hodgkin's lymphoma of the oral soft tissue

Cervical lymphadenopathy is the most common head and neck presentation for Hodgkin's lymphoma (HL). Although uncommon, extranodal HL observed at the time of diagnosis is well documented and is typically associated with generalized disease and a consequence of local spread from adjacent lymph nodes. Extranodal HL of the upper aerodigestive tract soft tissue is extremely rare, but has been reported to involve the oral cavity, oropharynx, nasopharynx, and larynx. Two cases of extranodal HL of the oral soft tissue are being reported. A 32-year-old male presented with a 5.0-cm ulcerated lateral palatal swelling and a history of recently diagnosed HL. Clinical impression was palatal abscess, r/o HL. Diagnosis on biopsy was malignant lymphoid infiltrate, consistent with HL. The patient was determined to have stage IV HL, with involvement of the low pelvic area, oral cavity, and cervical lymph node chain. A second case of extranodal HL of the oral soft tissue was identified in a 70-year-old female as a swelling of the floor of the mouth. Clinical impression was mucocele, r/o salivary gland tumor. The biopsy specimen was diagnosed on routine microscopy as consistent with lymphocyte-predominant HL. The diagnosis was confirmed by immunohistochemical analysis. A diagnosis of stage I HL was made based on the absence of any detectable sites of involvement outside of the oral cavity. After treatment, the patient was considered free of disease at 6-month follow-up. These 2 cases contribute to the paucity of cases documented in the literature of extranodal HL of oral soft tissues. Cervical lymphadenopathy is the most common head and neck presentation for Hodgkin's lymphoma (HL). Although uncommon, extranodal HL observed at the time of diagnosis is well documented and is typically associated with generalized disease and a consequence of local spread from adjacent lymph nodes. Extranodal HL of the upper aerodigestive tract soft tissue is extremely rare, but has been reported to involve the oral cavity, oropharynx, nasopharynx, and larynx. Two cases of extranodal HL of the oral soft tissue are being reported. A 32-year-old male presented with a 5.0-cm ulcerated lateral palatal swelling and a history of recently diagnosed HL. Clinical impression was palatal abscess, r/o HL. Diagnosis on biopsy was malignant lymphoid infiltrate, consistent with HL. The patient was determined to have stage IV HL, with involvement of the low pelvic area, oral cavity, and cervical lymph node chain. A second case of extranodal HL of the oral soft tissue was identified in a 70-year-old female as a swelling of the floor of the mouth. Clinical impression was mucocele, r/o salivary gland tumor. The biopsy specimen was diagnosed on routine microscopy as consistent with lymphocyte-predominant HL. The diagnosis was confirmed by immunohistochemical analysis. A diagnosis of stage I HL was made based on the absence of any detectable sites of involvement outside of the oral cavity. After treatment, the patient was considered free of disease at 6-month follow-up. These 2 cases contribute to the paucity of cases documented in the literature of extranodal HL of oral soft tissues.