Monocytoid B-cell Research Articles

Plasmacytic differentiation in parafollicular (monocytoid) B-cell lymphoma. A study of 12 cases.

Parafollicular (or monocytoid) B-cell lymphoma (PBCL) is a recently described low grade lymphoma. The relationship of parafollicular B cells to other B lymphocytes is not known, but the authors observed plasmacytic differentiation in the initial case of PBCL. In this report 12 cases of PBCL were studied by light microscopy and immunophenotypic analysis, and plasmacytic differentiation was found in four cases. This plasmacytic differentiation and the anatomic relationship of the neoplastic cells to reactive follicular centers suggest a functional relationship between these cell types.

Monocytoid B-cell lymphomas: An assessment of diagnostic criteria and a perspective on histogenesis

To determine which morphologic criteria are most useful in distinguishing reactive from malignant monocytoid B cells (MBCs), we compared 16 monoclonal cases (11 nodal, five extranodal) of monocytoid B-cell lymphoma (MBCL) with 12 cases of various reactive diseases in which MBCs were polyclonal. The results of our study showed that in MBCL the MBC component was the predominant architectural finding and that there was confluence of MBCs in all but one case. In contrast, the MBC component did not predominate in the reactive group ( P < .000001) and focal confluence was seen in only one case. A cytologic comparison showed that in MBCL areas there were more large transformed (prominent nucleolated) MBCs ( P = .003), a higher mitotic rate ( P = .03), and more nuclear irregularities ( P = .007) than were present in the reactive group. In addition, evolution to an aggressive histologic type was found in four cases of MBCL. Our results also revealed concomitant multiple, monoclonal, morphologically distinct populations in other compartments (follicular center cells in seven, mantle cells in five, small lymphocytes in five, and plasma cells in 11). These unique findings can be reconciled by postulating (1) that the simultaneous presence of these diverse cytologic types represents morphologic expressions of a B cell whose population is in different phases of its cell cycle and/or its evolution or (2) that the histogenesis of MBCL is possibly from a nodal pluripotent B-stem cell that can differentiate directly into these various cytologic types.

Antigenic phenotypes of hairy cell leukemia and monocytoid B-cell lymphoma: An immunohistochemical evaluation of 66 cases

Using a large panel of antibodies on multi-tumor block sections of routinely processed, paraffin-embedded fixed tissue, we compared the antigenic phenotype of 42 clinically, morphologically, and immunologically well-characterized cases of hairy cell leukemia (HCL) with 24 cases of monocytoid B-cell lymphoma (MBCL) selected from the Monocytoid B-Cell Lymphoma Registry at the City of Hope National Medical Center. The predominant antigenic phenotype of hairy cells was CD45 (leukocyte common antigen)+, CD45Ra (4KB5, MB1, MT2)+, L26+, CDw75 (LN1)+, CD74 (LN2)+, LN3+, MB2+, CD45RO (UCHL1)-, MT1-, CD15 (Leu-M1)-, neuron-specific enolase (NSE)-, epithelial membrane antigen-, and CD30 (Ber-H2)-. The immunophenotype of neoplastic monocytoid B lymphocytes was essentially identical to that of the hairy cells, with one exception: the neoplastic monocytoid B lymphocytes were stained by epithelial membrane antigen in seven cases. An interesting observation was the staining by anti-muscle-specific actin of the neoplastic cells of MBCL in 53% of cases, but of none of the cases of HCL. The results of our study (1) indicate that HCL and MBCL can be immunophenotyped reliably on fixed tissue samples, (2) further confirm the proposed lineage relationship between these two lymphoproliferative disorders, and (3) indicate that decalcification of bone marrow biopsies does not adversely affect the immunoreactivity of hematopoietic-associated antigens.

節外性の低悪性度リンパ腫 ＭＡＬＴリンパ腫を含む

Malignant lymphoma (ML) of low grade malignancy includes small lymphocytic lymphoma and follicular lymphoma other than large cell type. Recent study revealed intermediate lymphocytic lymphoma (ILL) and monocytoid B-cell lymphoma (MBCL) to be new types of ML of low grade malignancy. These two types of ML are fundamental elements of ML developing in so-called mucosa associated lymphoid tissue (MALT). In this report, results of our study on ILL and MBCL of extranodal organs were described.ILL is composed of small lymphoid cells with morphologic features between those of well-differentiated lymphocytic lymphoma and poorly differentiated lymphocytic lymphoma of follicular center cell origin. The frequency of ILL in nodal and extranodal non-Hodgkin's lymphoma was almost same. The frequency was high in salivary gland and thyroid lymphoma. Histologic features of chronic lymphocytic thyroiditis (CLTH) are constantly observed in cases with thyroid lymphoma. Histologic findings suggestive of Sjogren's syndrome such as formation of lymphoid follicles and myoepithelial islands were observed in one third of cases with salivary lymphoma. These findings suggested that autoimmune diseases such as CLTH and Sjogren's syndrome played an important role in the etiology of thyroid and salivary lymphoma.MBCL shows the proliferation of the atypical lymphoid cells with abundant and pale cytoplasm and reniform nucleus. The high incidence of Sjogren's syndrome in cases with MBCL was evident suggesting the etiologic role of Sjogern's syndrome for development of MBCL. Six cases of MBCL developing in extranodal sites such as thyroid, stomach, and rectum were described below. Two of three patients with thyroid lymphoma presented with positive serum antithyroid antibodies, and one had CLTH. In all three patients with gastric or rectal lymphoma, reactive lymphoid hyperplasia was present near the tumors. These findings suggested the important role of long-standing inflammation for development of MBCL as well as ILL.

Hodgkin's Disease Occurring in Monocytoid B-Cell Clusters

The authors report three cases of Hodgkin's disease (HD) occurring in monocytoid B-cell (MBC) clusters within lymph nodes, a finding heretofore not published. MBC clusters were found mainly in a perisinusoidal and perifollicular distribution in all three cases. Within some of the MBC clusters of each case, small foci of overt necrosis were evident. Sternberg-Reed cells or their variants were found adjacent to all of these foci, as well as within some MBC clusters that were free of necrosis. These findings suggest that the presence of necrosis within MBC clusters has diagnostic utility. In two cases, evidence of HD was detected only within MBC clusters and nowhere else. In the third case, HD was found primarily within MBC clusters. These observations imply that HD arose within MBC clusters. Minimal involvement of lymph node by HD can occur within MBC clusters and should be recognized as such on the basis of morphologic features. The earlier a diagnosis of HD can be made, the better is the patient's outlook for survival.

Monocytoid B Lymphocytes and Epithelioid Cell Clusters in Abscess‐forming Granulomatous Lymphadenitis With Special Reference to Cat Scratch Disease

In order to clarify the appearance of monocytoid B lymphocytes (MBLs) in abscess-forming granulomatous lymphadenitis (AGL) and the relation between AGL and cat-scratch disease (CSD), 48 cases of AGL were studied histologically. MBLs were present in about 50% of AGL cases. Warthin-Starry (WS) silver stain-positive bacteria, which are the causative agent of CSD, were present in 52.4% of AGL cases with MBLs and 59.2% of AGL cases without MBLs. The appearance of MBLs in AGL was not related to various clinical features, including disease interval from initial lymphadenopathy to lymph node biopsy. Histologically, epithelioid cell clusters appeared in about 70% of MBL-positive AGL cases, but were not observed in MBL-negative AGL. Therefore, a close interaction between MBLs and epithelioid cells in AGL is suggested, and we emphasize that the histological features of some AGL cases resemble those of toxoplasmic lymphadenitis.

Monocytoid B‐cell lymphoma: morphological variants and relationship to low‐grade B‐cell lymphoma of the mucosa‐associated lymphoid tissue

Twenty-eight cases of monocytoid B-cell lymphoma of lymph nodes and 16 lymph node metastases of primary gastric lymphomas, mostly low-grade B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) type were investigated morphologically and immunohistochemically. Both groups showed the same morphological and immunohistochemical features: diagnostically important sites of infiltration were the sinuses and the marginal zones. The tumour cells were either medium-sized or small. The cytoplasm stained grey with Giemsa and was sometimes rather pale. In imprints the grey colour of the cytoplasm was a characteristic feature. The medium-sized cell type was more frequent; in one third of the cases it was combined with a prominent lymphoplasmacytic component from the same clone, and it resembled the monocytoid B-cells of the sinuses. The small cell type was less common, was not combined with a lymphoplasmacytic component and more closely resembled marginal zone cells. The difference was underlined by the negative reaction with the monoclonal antibody Ki-B3 in the small cell type, which, conversely, was positive in the medium-sized cell type and in the monocytoid B-cell reaction of the sinuses. Both of these cell types, however, showed a granular reaction with the new monoclonal antibody Ki-Mlp. The morphological and immunohistochemical parallels are arguments in favour of the assumption that monocytoid B-cell lymphoma is the nodal equivalent of low-grade B-cell lymphoma of MALT type. This is further supported by the fact that in nine of our 28 cases of monocytoid B-cell lymphoma, lymphomas were found simultaneously or subsequently in organs of the MALT. Monocytoid B-cell lymphoma must be differentiated from an infiltration that occurs in the form of clusters of monocytoid B-cells in other low-grade B-cell lymphomas, especially in immunocytoma with a high content of epithelioid cells.

Monocytoid B-cell lymphoma in patients with Sjögren's syndrome: A clinicopathologic study of 13 patients

A recent clinicopathologic study of a series of patients with monocytoid B-cell lymphoma (MBCL) indicated that there is a frequent association between MBCL and Sjögren's syndrome (SS) and raised the possibility of a relationship between these two disease entities. To further investigate the possible relationship of MBCL and SS, we studied pathologic and clinical characteristics of 13 patients with MBCL who had clinically documented SS. In all patients, the lymphoma had the characteristic morphologic features of MBCL, and immunologic and molecular hybridization studies confirmed the B-cell nature of the lymphoma. Twelve of the 13 patients were female, with a median age of 66 years at diagnosis. Eleven had localized disease and presented with either salivary gland or cervical lymph node enlargement; one patient presented with a breast mass, and another with generalized lymphadenopathy and hepatosplenomegaly. In five of 13 patients, the MBCL was associated with or progressed to large cell lymphoma. In two patients, there was bilateral involvement of the parotid gland; one had a synchronous high-grade lymphoma in both parotid glands. In two patients, bone marrow biopsies showed involvement by MBCL. Eleven patients are alive 2 to 55 months after the diagnosis of MBCL. One patient died with the disease 8 months after the initial diagnosis. Another patient died of an unrelated cause without evidence of disease 16 months after the diagnosis of MBCL. We conclude that there is a more than fortuitous association between MBCL and SS. This concept is consistent with previously reported observations of reactive monocytoid B cells in patients with benign lymphoepithelial lesions of salivary glands, which may result from selective homing of reactive monocytoid B lymphocytes to the benign lymphoepithelial lesions and their subsequent neoplastic transformation.

Monocytoid B-cell lymphoma arising in extranodal organs

Six cases of monocytoid B-cell lymphoma (MBCL) developing in extranodal sites (thyroid, three; stomach, two; rectum, one) are described. Patients were all women aged 46 to 65 years (median, 53 years). Three patients with thyroid lymphoma presented with an increasing goiter, two with positive serum antithyroid antibodies, and one patient had chronic lymphocytic thyroiditis (CLTH). The histologic type of surgically resected specimens was a diffuse proliferation of atypical lymphoid cells with monocytoid appearance, i.e., abundant pale cytoplasm with distinct cell border and small reniform nucleus. These cells were CD20+, 22+, 24-, 9- showing their B-cell origin. The monoclonal nature of the proliferating cells was confirmed by restricted expression of immunoglobulin (Ig) light chain and/or gene rearrangement study in three cases. Two cases of thyroid lymphoma in which the monoclonality could not be confirmed had histologic appearances characteristic of malignant lymphoma. All three patients with gastric or rectal lymphoma had reactive lymphoid hyperplasia (RLH) near the tumors. These findings showed presence of MBCL in the extranodal sites with invariable coexistence with lymphoid follicles formed by CLTH in thyroid or RLH in stomach and rectum.

Monocytoid B-cell lymphoma: A study of 36 cases

We have studied 36 cases of monocytoid B-cell lymphoma (MBCL). We confirm the predilection for females (30 of 36; ratio, five women to one man). The median age was 65 years (range, 29 to 85 years). Monocytoid B-cell lymphoma characteristically involves peripheral lymph nodes (30 of 36) with a propensity for paraparotid or intraparotid nodes. Salivary glands were affected in five patients. Other extranodal sites of involvement included breast, thyroid, stomach, and soft tissue of chest wall. Eight patients manifested with Sjögren's syndrome, one had systemic lupus erythematosus, one presented initially with Raynaud's phenomenon, and two had monoclonal gammopathy. “Composite lymphomas” were encountered in seven patients. In addition, association with or progression to a higher-grade lymphoma, ie, mixed small and large cell (one) and large cell (six), was observed in seven patients and was associated with a more aggressive behavior of the lymphoma. Immunohistochemical studies performed on biopsy sections from 20 patients confirmed the B-cell nature of MBCL. An average reactivity of less than 10% of the monocytoid B cells with the proliferation marker Ki-67 was demonstrated, in keeping with the indolent behavior of MBCL. Despite our observation of follicular lymphomas frequently accompanying MBCL, the t(14;18) chromosomal translocation does not appear to play a pathogenetic role for MBCL, as determined by molecular studies for the t(14;18) chromosomal translocation and immunologic studies for the BCL2 protein. Our observations also provide support for the proposal that there is an overlap between MBCL and “MALT lymphomas” (those arising from mucosa-associated lymphoid tissue).

Expression of a New Cellular Protein by Monocytoid B-Lymphocytes Differentiated from the Acute Lymphoblastic Leukemia Cell Line (REH)

In an attempt to identify differentiation-related changes in cellular proteins, the common acute lymphoblastic leukemia (ALL) cell line, REH, was studied. REH cells were cultured in either the absence or presence of 12-0-tetradecanoylphorbol-13-acetate (TPA). Changes in surface phenotype were analyzed using monoclonal antibodies and flow cytometry. Cellular proteins were analyzed with two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) of [(3)H]leucine and [(32)P]orthophosphate labeled cells. Immunophenotype and 2D-PAGE studies were replicated three times on untreated (control) and TPA-treated cells on day 5. Immunophenotypic analysis showed that TPA induced further differentiation of REH cells along the B-cell lineage as indicated by significant decrease in the expression of CD10, induction of CD11c and increase in the expression of CD22. 2D-PAGE of [(3)H]leucine but not the [(32)P]orthophosphate showed that TPA induced the expression of a unique protein. The apparent relative molecular mass (Mr) of the resolved protein was ~23 kd with a ~6.2 isoelectric point (PI). Based on the morphologic and phenotypic findings, our data suggest that the new protein (p23-6.2) and the quantitative changes in protein synthesis induced by TPA are differentiation-related. Our study also indicates that 2D-PAGE analysis is a sensitive and complementary tool to phenotypic markers in the study of differentiation of malignant B-cells.

Primary breast lymphoma: An immunohistologic study of 20 new cases

Primary malignant lymphomas of the breast (PBL) are uncommon. The authors report the clinical, histologic, and immunoperoxidase findings on 20 cases recorded at the Alberta Cancer Registry over the last 23 years. These cases were then added to material on 257 cases abstracted from the literature and analyzed. It was found that there are two clinicopathologic types of PBL. The first affects pregnant or lactating women with bilateral, diffuse disease, is rapidly fatal, and corresponds histologically to a Burkitt's-type lymphoma. The second is unilateral at presentation and afflicts a broad age range, but primarily older women. This has a variable course only part of which is predicted by histologic grade and stage. Tumor size, treatment, and side of presentation were not found to be significant prognostic factors. Histologically, these tumors can be grouped into large cell B-cell lymphomas, monocytoid B-cell lymphomas (MBCL), and undifferentiated, some of which may be T-cell. Evidence suggesting that the MBCL of breast are the equivalent of the malignant lymphomas of the mucosa-associated lymphoid tissues (MALT) is reviewed. The breast is a hormone-dependent member of the MALT and therefore it is interesting that two of these tumors were strongly positive for estrogen receptors.

Regarding the Article Entitled “Monocytoid B-Cell Lymphoma with Bone Marrow and Peripheral Blood Involvement at Presentation”

Regarding the Article Entitled “Monocytoid B-Cell Lymphoma with Bone Marrow and Peripheral Blood Involvement at Presentation”

Mantle zone lymphoma—is it an entity?

The existence of ILL/MZL as an entity based on either morphologic criteria or origin from the mantle zone has subsequently been questioned. Firstly, a mantle zone growth pattern is not specific and may also be seen in Castleman's disease, benign mantle zone hyperplasia, monocytoid B-cell lymphoma, follicular lymphoma, B-CLL, T-cell lymphomas, B-cell lymphomas of mucosa-associated lymphoid tissue (MALT), and polymphocytic leukaemia. Secondly, there is increasing evidence that the normal mantle zone contains more than one population of lymphocytes, and thus may give rise to more than one type of lymphoma. It is therefore difficult to define precisely the term «mantle zone lymphoma» which has little to commend it

Monocytoid B-cell Lymphoma

Monocytoid B-cell Lymphoma

Monocytoid B-Cell Lymphoma with Bone Marrow and Peripheral Blood Involvement at Presentation

A case of malignant lymphoma showing in a lymph node the characteristic morphologic features of the so-called monocytoid B-cell lymphoma (MBCL) is described. This case differs from the reported cases in the literature because atypical cells were observed in the bone marrow biopsy and marrow and peripheral blood smears that were obtained from the patient, a 61-year-old man, during the staging procedures. Lymphocyte surface marker studies on peripheral blood by flow cytometry and DNA analysis revealed a monoclonal population of lambda-positive lymphocytes. The immunophenotype of MBCL cells was studied both in paraffin-embedded lymph node sections by immunoperoxidase method and in peripheral blood by flow cytometric analysis; the cells expressed the SIg with lambda light chain restriction and the HLA-DR antigen; they also had positive results for B-cell-associated antigens, including LN1, LN2, CD 20, CD 22, CD 19, CD 9 but not CD 21, CD 24, and CD 10, T-cell-associated antigens and monocytic markers. In addition, they had negative results for CD 25, CD 38, PCA-1. This report emphasizes that in MBCL, peripheral and marrow involvement may occur at presentation analogous to other low-grade B-cell lymphomas. The immunophenotypic characteristics of MBCL cells, though not pathognomonic, are considered to be helpful in differentiating them from circulating cells of other B-cell lymphomas.

Monocytoid B-Cell Lymphoma: Its Evolution and Relationship to Other Low-Grade B-Cell Neoplasms

Monocytoid B-cell lymphoma (MBCL) is a newly recognized B-cell neoplasm of uncertain histogenesis. The cytologic features of the neoplastic monocytoid B lymphocytes are virtually identical to those of hairy cell leukemia (HCL). As with HCL, progression of MBCL to a higher histologic grade is very unusual. However, whereas circulating leukemic cells are a characteristic feature of HCL, peripheral blood involvement has not been reported in MBCL. We recently studied a patient with MBCL of the spleen and axillary lymph nodes who developed peripheral blood involvement by MBCL cells. Unlike the cells of HCL, the circulating MBCL cells exhibited strong acid phosphatase activity that was tartrate sensitive. The leukemic cells had the antigenic phenotype IgM lambda, CD20+, CD11c+, CD5-, CD25(TAC)-, and PCA-1-. Immunogenetic studies of both lymph node and peripheral blood cells revealed identical immunoglobulin heavy-chain gene rearrangements. When compared with a series of HCL, the immunophenotype was similar except for the absence of PCA-1 and TAC. Progression of the MBCL to a large cell lymphoma, also expressing IgM lambda, was documented in an abdominal lymph node of this patient. Therefore, although rare, peripheral blood involvement by lymphoma cells may occur during the course of MBCL and should be distinguished from HCL with cytochemical and immunophenotypic studies. In addition, comparison of the clinical, pathologic, and immunologic features of MBCL with those of other low-grade B-cell neoplasms suggests that a close lineage relationship exists between MBCL and HCL.

Monocytoid B-cell lymphoma: its evolution and relationship to other low- grade B-cell neoplasms

Monocytoid B-cell lymphoma (MBCL) is a newly recognized B-cell neoplasm of uncertain histogenesis. The cytologic features of the neoplastic monocytoid B lymphocytes are virtually identical to those of hairy cell leukemia (HCL). As with HCL, progression of MBCL to a higher histologic grade is very unusual. However, whereas circulating leukemic cells are a characteristic feature of HCL, peripheral blood involvement has not been reported in MBCL. We recently studied a patient with MBCL of the spleen and axillary lymph nodes who developed peripheral blood involvement by MBCL cells. Unlike the cells of HCL, the circulating MBCL cells exhibited strong acid phosphatase activity that was tartrate sensitive. The leukemic cells had the antigenic phenotype IgM lambda, CD20+, CD11c+, CD5-, CD25(TAC)-, and PCA-1-. Immunogenetic studies of both lymph node and peripheral blood cells revealed identical immunoglobulin heavy-chain gene rearrangements. When compared with a series of HCL, the immunophenotype was similar except for the absence of PCA-1 and TAC. Progression of the MBCL to a large cell lymphoma, also expressing IgM lambda, was documented in an abdominal lymph node of this patient. Therefore, although rare, peripheral blood involvement by lymphoma cells may occur during the course of MBCL and should be distinguished from HCL with cytochemical and immunophenotypic studies. In addition, comparison of the clinical, pathologic, and immunologic features of MBCL with those of other low-grade B-cell neoplasms suggests that a close lineage relationship exists between MBCL and HCL.

Ｍｏｎｏｃｙｔｏｉｄ Ｂ Ｌｙｍｐｈｏｃｙｔｅの増殖巣を伴う腫よう形成性肉芽腫性リンパ節炎について 特に猫ひっかき病との関係について

Forming granulomatous lymphadenitis with monocytoid B lymphocytes (MBL) foci was studied with special referance to the cat scratch disease (CSD)The 12 cases consisted of 8 male and 4 female, and their ages ranged from 8 to 53, and 4 had history of cat scratching and 1 had a trauma.Histologically, the lesion was comprised of suppurative granuloma, surrounded by layers of palisaded histiocytes. In addition to these findings, reactive follicular hyperplasia, multiple small clusters of epithelioid histiocytes and proliferating foci of MBL were recoginized in all cases.In 6 cases, pleomorphic bacteria were demonstrated with the Warthin-Starry silver stain. Toxoplasma and chlamydia were negative in all cases with immunoperoxidase method.These findings indicate that some cases of abscess forming granulomatous lymphadenitis with MBL would be included in CSD.

Monocytoid B-cell lymphoma. Clinicopathologic study of 21 cases of a unique type of low-grade lymphoma.

The morphologic and immunologic features of three cases of an unusual and distinct B-cell lymphoma were recently described and termed monocytoid B-cell lymphoma (MBCL) because of the striking resemblance of the neoplastic cells to reactive monocytoid B-lymphocytes. The morphologic spectrum and the clinical behavior of MBCL were investigated in a series of 21 patients. This study indicates that patients with MBCL usually present with lymphadenopathy and Stage I or II disease. MBCL also occurs at extranodal sites including the salivary gland. Because four of the patients with MBCL had Sjögren's syndrome with characteristic laboratory profiles, these results raise the possibility that there may be a relationship between MBCL and Sjögren's syndrome. Eight patients were male and 13 female (M:F = 1:1.6), and MBCL primarily involved the elderly (median age, 66 years). The most striking clinical findings were high percentages of complete remissions and long survival times indicating that MBCL is a low-grade lymphoma. Of 21 patients investigated, 18 were in complete remission at the time of completion of this study. Two patients died with the disease and one was lost to follow-up. Patients with localized MBCL may have a better survival rate than those with generalized disease. Like other low-grade lymphomas, MBCL can progress to a higher grade lymphoma of large cell type. Unlike other low-grade lymphomas, in MBCL splenomegaly, bone marrow involvement, and leukemic conversion are uncommon.