MALT Type Research Articles

Pulmonary Localized AA Type Amyloidosis with Cyst-like Structures and Marginal Zone B-cell Lymphoma of the MALT Type Coexisting Independently in the Left upper Lung

A 77-year-old man was found to have an abnormal shadow on chest X-ray. Chest CT indicated four lesions in both lungs. One was located in the left S1+2. The others were located in the left S3, right S8 and S9, and those had cyst-like structures. The tumor in S1+2 showed diffuse proliferation of atypical lymphocytes, which were positive for CD20. The diagnosis of pulmonary mucosa-associated lymphoid tissue lymphoma was made. The tumor in S3 was composed of eosinophilic amorphous deposits. The diagnosis of amyloidosis was confirmed by polarized light examination. After oxidation with permanganate solution, the Congo red staining disappeared.

Results from a Phase II Study of Lenalidomide Oral Monotherapy in Relapsed/Refractory Indolent Non-Hodgkin's Lymphoma.

Background: Indolent non-Hodgkin's lymphoma (NHL) has a median survival as long as 10 years but is rarely cured. Lenalidomide (Revlimid®), an immunomodulatory drug, is approved in the US for treatment of myelodysplastic syndromes associated with a del[q5] cytogenetic abnormality and is approved both in the US and the EU for the treatment of relapsed/refractory multiple myeloma. Lenalidomide also has activity in chronic lymphocytic leukemia and cutaneous T-cell lymphoma.Aim: This study was designed to assess the safety and efficacy of lenalidomide monotherapy in patients with relapsed/refractory indolent NHL.Methods: Patients with relapsed/refractory indolent NHL with measurable disease ≥ 2cm after at least 1 prior treatment regimen were eligible. Patients received 25 mg lenalidomide orally once daily on Days 1–21 every 28 days and continued therapy for 52 weeks as tolerated or until disease progression. Response and progression were evaluated using the IWLRC methodology.Results: Forty-three patients were enrolled in the study and included in this analysis. The median age was 63 (43–89) and 17 were female. Histology was small lymphocytic lymphoma [SLL] (n=18), follicular center lymphoma grades 1, 2 [FCL] (n=22), nodal marginal B-cell lymphoma (n=2) and extranodal marginal zone B-cell lymphoma of MALT type (n=1). Median time from diagnosis to lenalidomide treatment was 4.5 (0.4–24) years and median number of prior treatment regimens was 3 (1–15). Eleven of the 43 patients (26%) exhibited an objective response (2 complete responses (CR), 1 complete response unconfirmed (CRu), 8 partial responses (PR)), 15 had stable disease (SD), 13 had progressive disease (PD) and 4 were not evaluated. Responses included 4/18 SLL (22%) and 7/22 FCL (32%). Median time to response was 3.6 months (range 1.7–4.1). Progression free survival is 4.6 months for all patients, > 7.7 months (range 4.4 - > 13.5) for responding patients and ongoing. Sixteen patients (37%) required at least one dose reduction with a median time to first dose reduction of 2 months (0.5–9.6). The most common Grade 4 adverse event was neutropenia (14%) and the most common Grade 3 adverse events were neutropenia (21%) and thrombocytopenia (12%).Conclusion: Lenalidomide oral monotherapy is active with manageable side effects in relapsed/refractory indolent NHL.

Mantle Cell Lymphoma of the GI Tract: Is It Distinctive from Other Gastrointestinal Lymphomas?

Purpose: Mantle cell lymphoma (MCL) is a relatively new subtype of B-cell lymphoma that involves the GI tract in up to 88% of patients. MCL is distinguished by overexpression of the cyclin D1 protein which promotes cell division, and mucosal affinity for the alpha-4-beta-7 receptor. Our aim was to examine the clinicopathologic features of MCL compared to follicular (FL), marginal zone lymphoma of MALT type (MZL) and diffuse large B-cell lymphoma (DLBCL). We tested the null hypothesis that there is no difference in site of involvement between MCL and other GI lymphomas. Methods: Cases of gastrointestinal lymphoma were collected from five community hospitals in San Diego and identified by histology and flow cytometry. Age, gender, clinical presentation, site of involvement, endoscopic appearance, and bone marrow involvement were analyzed. Results: A total of 96 cases were reviewed and included (MCL = 10, FL = 20, MZL = 28, DLBCL = 38). Median age at presentation was similar (age range 28–97; median age 62–68). 70% of MCL patients were men. Endoscopic appearances varied from multiple small nodules to large polypoid lesions to ulcerated masses. There were no characteristic endoscopic findings for any lymphoma type. Compared to patients with FL, MZL and DLBCL, patients with MCL had significantly more colonic involvement (P < 0.001) and were more likely to present with stage IV disease (P < 0.02–0.001). Greater than 85% of MCL patients were positive for cyclin D1. MZL and DLBCL were more likely to present with GI bleeding (14.3% and 10.5%, respectively), while no patients with FL or MCL bled. While 25% of patients with FL presented with small bowel obstruction, no patients with MCL had this presentation. These data disprove the null hypothesis. Conclusion: Clinical markers are available to distinguish MCL from other lymphomas. Age, sex, and endoscopic appearance are overlapping and not distinctive. The most helpful distinctions are colonic site of involvement, advanced disease and presence of cyclin D1. Correct subclassification of GI lymphoma has important implications for both treatment and prognosis and even small lesions, should be biopsied.[figure1]Figure

P1-178: Synchronous multisystemic(pulmonary and gastrointestinal) extranodal marginal zone lymphoma of malt type and two lung carcinomas with different histologic and immunophenotypic features

P1-178: Synchronous multisystemic(pulmonary and gastrointestinal) extranodal marginal zone lymphoma of malt type and two lung carcinomas with different histologic and immunophenotypic features

Intestinal marginal zone B‐cell lymphoma of MALT type: clinical manifestation and outcome of a rare disease

Intestinal marginal zone B-cell lymphoma of the MALT type (I-MZL) is a relatively uncommon form of lymphoma. Twenty-seven patients with histologically-confirmed I-MZL were analyzed. The patients initially presented with abdominal pain (62.9%), and diarrhea (22.2%). The most common involved site was the ileo-caecal area (40.7%). Musshoff's stage I(E), II(E)1, II(E)2, III(E) and IV were present in 44%, 15%, 11%, 7.4% and 22% respectively. Sixty-three percent were in the low-risk group according to the Follicular Lymphoma International Prognostic Index. Complete response and partial response were achieved in 82% and 4% patients. The estimated 5-year overall survival (OS) and progression-free survival (PFS) rates were 86% and 54%. Stage > or = II(E)2 was determined to be a poor prognostic factor for PFS and OS. I-MZL commonly manifests in an early-stage, low-risk state and tends to respond well to local and systemic treatment with favorable prognosis. I-MZL tends to be an indolent disease - characterized by prolonged survival with frequent relapses, similarly to other site MZLs.

Unusual Treatment of a Gastric Marginal Zone B-Cell Lymphoma of MALT Type

Patients with gastric marginal zone-B-cell lymphoma of MALT-type of stage I are usually treated by eradication therapy as Helicobacter pylori infection is evident in the majority (> 90%) of them. In case of a negative Helicobacter pylori status, if the lymphoma does not reveal regression after successful eradication of the bacterium, or in stage II, radiation is nowadays the treatment of choice. Gastrectomy is only reserved for special conditions such as endoscopically not treatable bleeding or patient's explicit request. All treatment modalities follow a curative intention. We here report on a patient with a Helicobacter pylori negative MALT lymphoma of stage I presenting as a localized polypoid lesion in the gastric fundus. Radiotherapy was indicated. However, the patient refused this standard therapy as well as surgical resection as a possible alternative. When signs of lymphoma progression became evident we performed an endoscopy-assisted laparoscopic resection of the fundus which resulted in a continuing lymphoma-free condition. Thus, local treatment modalities such as endoscopic mucosal resection or laparoscopic resection may represent a therapeutic option in case of a localized lymphoma finding in the individual patient who is not suitable for or who refuse standard therapeutic approaches.

Extranodal Marginal Zone B-cell Lymphomas of the Ocular Adnexa

Extranodal marginal zone B-cell lymphomas of MALT type (MALT lymphomas) show site-dependent variations in their morphologic, phenotypic, and/or cytogenetic findings. This report describes a comprehensive analysis of 34 ocular adnexa MALT lymphomas, including interphase fluorescence in situ hybridization for MALT lymphoma-associated cytogenetic abnormalities and polymerase chain reaction for Chlamydia psittaci, which has recently been suggested to be associated with ocular adnexa lymphomas. A typical morphologic pattern was identified in 79% of cases, while overtly monocytoid cytology (12%), predominantly plasmacytic features (9%), and lymphoepithelial lesions (3%) were uncommon. Aberrant CD43 or CD5 expression was also uncommon (12% and 3%, respectively). Plasmacytic differentiation (41%) was associated with stage IV disease (P=0.036) and gains of chromosomes 3 and/or 18q (P=0.021) (79%). +3 was more frequent in the orbit than in lacrimal gland or conjunctiva (P=0.005). Each of 31 cases was negative for MALT1 translocations. IGH translocations were identified in 3 cases (10%), although the translocation partner gene could not be identified. Polymerase chain reaction assays targeting species-specific regions within the C. psittaci omp1 and omp2 genes were negative in each of 30 cases. This study identifies the characteristic morphologic, phenotypic, and cytogenetic findings in ocular adnexa MALT lymphoma, including a subset differing from those arising at other anatomic sites. The frequent presence of +3 and/or +18q suggests that these abnormalities may contribute to lymphomagenesis. The lack of C. psittaci in this series, in contrast to some prior reports, indicates that there may also be geographic heterogeneity in the pathogenesis of ocular adnexa MALT lymphoma.

中咽頭ＭＡＬＴリンパ腫例

A mucosa-associated lymphoma (MALT) is a tumor of lymphoid tissue involving the mucosa. Histopathological examination revealed a marginal zone B-cell lymphoma of MALT type. MALT lymphomas are low-grade lymphomas found mainly in the stomach and intestinal tract. Oto-rhino-laryngologically, MALT lymphomas have rarely been reported in the salivary gland. To the best of our knowledge, there have been reported only four cases in the minor salivary glands. Our patient was a 71-year-old woman with discomfort in the mesopharynx. Initially, we suspected malignant lymphoma. Such a tumor must be immediately enucleated. The pathological diagnosis was MALT lymphoma occurring in the minor salivary glands. The treatment was four courses of CHOP, rituximab and radiotherapy. About two years have passed since treatment, and there has been no recurrence.

Chłoniak grudkowy migdałka podniebiennego – opis przypadku

Non Hodgkin's lymphomas quite often present in the head and neck region and after squamous cell carcinoma are the second most common neoplasm of this area. The most predominant localization for extranodal NHL in the head and neck region is the tonsil. The vast majority of NHL at this site are B-cell lymphomas, including diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, extranodal marginal zone B-cell of MALT type. The authors presented the case of primary extranodal non Hodgkin's lymphoma of the right tonsil in patient with the long history of chronic tonsillitis and after bilateral tonsillectomy. The affected tonsil together with enlarged lymph node was surgically removed. The histologic examination detected follicular (nodular) non Hodgkin's lymphoma, grade 3. The patient was refered to the Hematology and Oncology Department for additional treatment. In the Hematology and Oncology Department staging was conducted recognizing lymphoma – clinical stage I according to Ann Arbor. The patient was treated with R-COP regiment (six cycles rituximab + COP – cyclophosphamid, vincristin, prednisolon). The complete remission was achieved. The patient is in observation period both in Otolaryngology and Hematology Department. Recurrent, non-typical chronic tonsillitis with enlarged neck nodes may be follicular lymphoma's symptom, especially in older patients.

GASTROINTESTINAL NON-HODGKIN'S LYMPHOMA CLINICO-PATHOLOGIC STUDY

The aim of this study is to deter­mine the clinicopathologic features of primary gastrointestinal non-Hodgkin's lymphoma (Gl NHL) at King Abdulaziz University Hospital-Jeddah, and to compare our results to those reported in the literatures. Patients and Methods: Twenty three aduit patients with primary G! NHL diagnosed over 5-years period (2000-2005) were retro­spectively studied clinically and histo--pathologically. They were classified using the REAL/WHO histopathologic classification. Results: Of the 23 patients with primary Gl NHL, 14 (60.9%) were Saudi, with male to female ratio of 1.3:1. The mean age of the male patients was 61. 3 years ranging from (42-83) years with a SD ± 13.09 while for fe­males was 64 years, age range (50-75) with a SD± 9.14 .Abdominal pain was the most common presenting symptoms (78.3%) and the most common primary site was the stom­ach (73.9%) followed by the small bowel (13 %). The most frequent hls-tologic subtype was the diffuse large-B cell lymphoma accounting for (60.9%) of all cases, followed by mar­ginal-zone cell lymphoma (MALT type) which was Helicobacter pylori associated in (39.1%). A large propor­tion of patients with primary Gl NHL had early disease (Stage IE: 20%, Stage HE 58.6%).

Marginal zone lymphoma of both spleen and kidney displaying transformation into large B-cell lymphoma

We report a case of simultaneous involvement of the spleen and the left kidney in a marginal zone lymphoma with a monotypic lymphoplasmacytic cell component, which transformed into a diffuse large B-cell lymphoma of the immunoblastic type. PCR showed that the small and large B-cell populations carried the same type of immunoglobulin heavy chain gene rearrangement. This type of rearrangement was detected in the spleen, the latero-aortic lymphadenopathy and the kidney demonstrating that it is the same lymphoma that affected both organs and the lymph nodes. Primary renal lymphoma is very rare and only a few cases of renal marginal zone lymphoma, MALT type, have been reported. Involvement of simultaneous multiple sites has been described in MALT type lymphoma, but splenic involvement secondary to renal MALT lymphoma seems to have never been observed. Nevertheless, in our case the huge size of the spleen associated with splenic hilar node involvement is consistent with primary splenic marginal zone lymphoma. The extension into latero-aortic lymph nodes of this lymphoma can explain secondary kidney involvement. The nodal Kaposi's sarcoma observed in this patient of Mediterranean origin was probably coincidental.

Intestinal Marginal Zone B-Cell Lymphoma of MALT Type: Clinical Manifestation and Outcome of a Rare Disease.

Purpose: Intestinal marginal zone B-cell lymphoma of MALT type (I-MZL) is a relatively uncommon type of lymphoma. Because of the rarity, the natural history and optimal treatment modality has not been well defined. Therefore, we performed a retrospective analysis of the clinical features and treatment outcomes of I-MZL.Methods: From 1990 to 2005, a total of 27 patients with histologically confirmed I-MZL were analyzed.Results: The median age was 51 (range: 19–83) years. The study involved 16 males (59%) and 11 females (41%). Patients initially presented with abdominal pain (62.9%), diarrhea (22.2%) and various symptoms. The most common involving site was ileo-cecal area (40.7%) followed by small intestine (25.9%), colorectal (18.5%), multiple intestine involvements (14.8%) in the decreasing order of frequency. Musshoff stage IE, IIE1, IIE2, IIIE, and IV were present in 44%, 15%, 11%, 7.4%, and 22%, respectively. B symptom was observed in 11%. Twenty one (78%) and five (19%) patients were in low or low-intermediate risk group according to international prognostic index (IPI). Sixty-three percents (17/27) were in low risk group in follicular lymphoma international prognostic index (FLIPI). Treatment was mainly combined with surgical modality. Complete and partial remissions were achieved in 22 (82%) and 1(4%). After the median follow-up duration of 56.1 months, Median progression free survival (PFS) were 8.8 (95% CI: 3.8–13.8) years. The estimated 5-year overall survival (OS) and PFS were 86% and 54%, respectively. Stage ≥ IIE2 was poor prognostic factor of PFS and OS.Conclusion: I-MZL trends to be an indolent disease - prolonged survival with frequent relapse like other site MZL of MALT type. They present commonly early stage, low risk state and respond well local and systemic treatment. I-MZL has favorable prognosis.

Fully Retargeted Oncolytic Measles Virus for Multiple Myeloma Therapy.

Multiple Myeloma (MM) is a disseminated plasma cell malignancy with approximately 14,600 new cases diagnosed in the USA annually. Despite recent progress in current therapeutical options the median survival is 3 to 5 years and cure is extremely rare. Therefore the evaluation of new treatment modalities for MM is highly warranted. An attractive approach to treat Myeloma with a minimum of undesired side effects is the use of a tumour antigen specific for MM cells. Wue-1, a monoclonal antibody binds very selectively normal and malignant plasma cells (50 of 51 MM samples, 14 of 15 immunocytoma and 13 of 13 MALT type lymphomas with plasma cell differentiation were Wue-1 positive, normal tissue including hematopoietic cells were negative) and offers the possibility to define MM cells as targets. The tool for selective killing of MM cells recognized by Wue-1 monoclonal antibody is in this study the measles virus vaccine strain Edmonston B in an ablated variant (MV-Wue) which no longer binds the usual measles receptors CD46 and CD150 (SLAM) expressed on almost every human cell type displaying a single-chain antibody (scFv) derived from the monoclonal Wue-1-antibody which has been tethered to the C-terminus of the H protein to restrict and retarget its interaction to malignant plasma cells especially MM cells. In addition, MV-Wue encodes EGFP facilitating the read out of infected cells. To determine if the fully retargeted MV-Wue would be able to infect MM cell lines and primary MM cells selectively an array of infection assays were performed using the MM cell lines U266 as well as primary CD138 positive MM cells expressing the Wue-1 antigen as expected targets and CD138 negative cells and normal B cells as controls negative for Wue-1. In these experiments selective infections of the MM cell line and primary MM cells were observed whereas the control cells were not infected with MV-Wue. In all cell types GFP expression indicating replicative infection correlated with the expression of the Wue-1 antigen determined by FACS. Infection experiments performed in the presence of monoclonal Wue-1 antibody showed a decreased GFP expression of about 78% in CD138 positive MM cells demonstrating specificity of the infection by MV-Wue. These results indicate that the engineered virus can be a safe and potential curative oncolytic agent to face the main problem in Multiple Myeloma which is responsible for frequent relapses, the minimal residual disease (MRD).

High Prevalence of Helicobacter pylori (Hp) Infection in Ocular Adnexal Lymphoma (OAL).

Association between infectious agents and non-Hodgkin's lymphomas, such as Hp infection and MALT-type gastric lymphomas or Chlamydia psittaci and OAL, has been previously reported. Therefore, in a large monocentric cohort of OAL patients, we investigated the prevalence of Hp infection in gastric biopsy specimens obtained during the initial staging period. The detection of Hp infection was determined by Giemsa staining of gastric biopsies and by Hp-specific PCR. Among the patients treated at the Institut Curie between 1970 and 2006 for an OAL and for whom gastric tissues were available for PCR analyses, 83 cases were selected for the study. Pathological review according to the WHO classification showed 5 patients with lymphocytic lymphoma, 14 cases with lymphoplasmocytic lymphoma, 6 patients with follicular NHL, 47 cases with MALT type lymphoma (57%), 3 patients with unclassified low-grade NHL, 2 patients with mantle-cell lymphoma, and 6 cases with diffuse large B-cell lymphomas. Initial characteristics were: median age 66 years (range: 26–90); M/F sex ratio 0.9; B symptoms 1%; PS ≥ 2 in 2%; Stages I and IV 59% and 41%, respectively; nodal involvement 24%; 2 or more extra-nodal localizations 34% (10% of bone marrow involvement, 8% of gastric involvement, and 5% of lung localizations); elevated LDH in 9%; serum albumin lower than 40g/l in 32% of patients; and IPI score of 0–1/2/3/4–5 in 60%/21%/18% and 1% of cases, respectively. Ocular localization were intra-orbital in 32 patients (39%), conjunctival in 36 (43%), palpebral in 4 cases, lacrymal in 10 patients, and intra-ocular in 1 case; bilateral ocular sites were found in 10% of cases. The research of Hp infection was performed in 51 patients by Giemsa staining of gastric biopsies with 21 positive cases (41%), and in the 83 selected patients by PCR analysis with 29 positive cases (35%), with an overall number of 37 Hp positive patients (45%). Correlation between histopathological and PCR analyses evaluated on the 51 patients for whom both analyses have been performed is presented in Table 1 (p = 0.011). Finally, we observed that the presence of gastric Hp infection did not correlate with patients' characteristics of the overall population and of the 47 MALT-type cases. However, on the 83 studied patients, we found a trend of significant difference in Hp positive cases including low albumin levels (p = 0;09), elevated stage (p = 0.08), 2 or more extra-nodal localizations (p = 0.08), and high IPI score (p = 0.06). In conclusion, we observed a high prevalence of gastric Hp infection at the initial diagnosis of OAL, namely 45% of selected cases, with a possible but not significant association of Hp infection with pejorative clinical characteristics. In order to well define this observation and clearly evaluate the impact of Hp infection on the clinical presentation, we are now investigating the prevalence of gastric Hp infection in patients having different histopathological subtypes of nodal malignant lymphomas.Hp-Histopathological anlysesHp-Histopathological analyses−+Hp PCR analyses−22 (43%)8 (16%)Hp PCR analyses+8 (16%)13 (25%)

NOTCH2 Mutations in Marginal Zone Lymphoma.

Notch2 is a membrane receptor and transcription factor that is indispensable for marginal zone cell differentiation. Also, marginal zone cell lymphomas express increased levels of Notch2 when compared with other B-cell lymphomas. Of interest, activating mutations have previously been described for Notch1, a homologous transcription factor which is important for T-cell differentiation, in up to 50% of cases of acute T-lymphoblastic leukemia, and are thought to contribute to leukemogenesis. We therefore investigated whether activating mutations in the NOTCH2 gene could be identified, especially in marginal zone lymphoma (MZL). We analyzed 41 cases of MZL and 28 other B-cell lymphomas cases for the presence of potentially activating mutations in exons 26, 27 and 34 of the NOTCH2 gene. These exons code for the heterodimerization and the C-terminal transcriptional activation domains. We identified four cases with mutations among the MZL cases, but none in the other B-cell lymphoma cases. Mutations were found in two cases of splenic marginal zone lymphoma and two cases of extranodal marginal zone lymphoma of MALT type, respectively. To investigate whether elevated Notch2 expression in most of the other marginal zone lymphomas, as investigated by quantitative RT-PCR, was due to structural changes within the NOTCH2 locus, FISH analysis was performed. FISH analysis did not reveal structural changes of the NOTCH2 locus in any of the MZL cases. In conclusion, we have shown potentially oncogenic NOTCH2 mutations in 10% of MZL. It remains to be shown whether elevated Notch2 expression in most MZL can be caused by as yet other disease mechanisms.

Primary Cutaneous Marginal Zone B-Cell Lymphoma of MALT Type in a Child

Marginal zone B-cell lymphoma (MZBCL) of mucosa-associated lymphoid tissue type is a peculiar variant of B-cell neoplasm showing distinct clinical and pathologic features. Its occurrence in children or adolescents is extremely uncommon. We describe the case of an 11-year-old boy who developed such a lymphomatous process involving primarily the skin. The tumor was characterized by a maturing plasma cell population that included immunoblasts, heavy-chain but not light-chain restriction suggestive of monoclonality, and a prevalent, focally granulomatous component of histiocytes. As an additional interesting feature, a trisomy 3 was demonstrated by fluorescence in situ hybridization analysis. The clinical, morphological, phenotypic, and genetic characteristics seen in our patient do not differ significantly from those described in primary cutaneous MZBCL occurring in adults.

Chlamydia or Not Chlamydia , That Is the Question: Which Is the Microorganism Associated With MALT Lymphomas of the Ocular Adnexa?

In the mid-1990s, the demonstration that Helicobacter pylori infection is a risk factor for gastric marginal-zone B-cell lymphoma of MALT type (MALT lymphoma) and the fi nding that eradication of these bacteria can result in histological lymphoma regression in most patients made this tumor a popular model of antigen-driven lymphomagenesis ( 1 ) . The association of H. pylori with gastric MALT lymphoma led to the hypothesis that the microorganism provides an antigenic stimulus that sustains the growth of the lymphoma in the stomach, and today it is generally accepted that administration of antibiotics to eradicate H. pylori should be the sole initial treatment of gastric MALT lymphoma that is confi ned to the gastric wall. This approach has been validated in more than 20 reported studies ( 2 ) . These advances in the understanding and treatment of gastric MALT lymphoma pro mpted a search for microorganisms responsible for the growth of MALT lymphomas outside the stomach. Although Borrelia burgdorferi and Campylobacter jejuni have been associated with marginal-zone lymphomas arising in the skin and small intestine, respectively ( 3 , 4 ) , results implicating particular infectious microorganisms in nongastric lymphomas have often been elusive. In 2004, Ferreri et al. ( 5 ) reported in this journal that Chlamydia psittaci DNA was detected in 87% of lymphomas arising in the ocular adnexa (orbital soft tissue, lachrymal glands, and conjunctiva), and therefore, it has been proposed that C. psittaci infection may be a cause of these lymphomas. Furthermore, a very recent epidemiologic paper has shown a possible real increase in the incidence of ocular adnexal lymphomas, suggesting C. psittaci or another microorganism as possible causative agents ( 6 ) . However, subsequent to the report of Ferreri et al., other groups analyzed the prevalence of C. psittaci in these lymphomas, and overall, the reported data did not confi rm a strong link between C. psittaci infection and ocular adnexal MALT lymphomas ( Table 1 ). Thus, our understanding of the role of C. psittaci is far from complete. In this issue of the Journal, Ferreri et al. ( 7 ) report the results of a prospective trial in which patients affected by marginal-zone B-cell lymphoma of the ocular adnexa were treated for 3 weeks with the oral antibiotic doxycycline, with the intent of eradicating C. psittaci. The endpoints of the study were the rate of objective lymphoma response to antibiotic treatment and the presence or absence of C. psittaci DNA in peripheral blood mononuclear cells, the latter endpoint serving as a measure of C. psittaci eradication. Twenty-seven patients were enrolled and evaluated for response to treatment, 15 of them were newly diagnosed with ocular adnexal lymphoma and 12 had relapsed after previous therapies. Three patients had lymphoma involving regional lymph nodes and fi ve had bilateral MALT lymphomas. Preliminary results in the fi rst nine cases of the study have previously been published ( 8 ). C. psittaci was detected, using, as in the previous studies, a touchdown enzyme time release polymerase chain reaction ( 5 , 7 – 8 ) in 11 of 27 or 41% of lymphoma biopsies, a percentage lower than in the fi rst report from the same investigators

Florid marginal zone differentiation in follicular lymphoma mimicking marginal zone lymphoma of MALT type in the lung

Florid marginal zone differentiation in follicular lymphoma mimicking marginal zone lymphoma of MALT type in the lung

Translocation (11; 18) and Gastric High Grade Lymphoma Risk

Purpose: Translocation t (11; 18) (q21; q21) is the most frequent chromosomal aberration in extranodal marginal zone lymphoma of the MALT type. This translocation has been associated with an aggressive course but has not been described in high grade gastric MALT lymphoma. Some authors propose that tumors with this translocation rarely or never progress to high grade lymphomas. However, these conclusions are based on examining few specimens. This study examines the frequency of chromosomal translocation t (11; 18) (q21; q21) in lymphomas from patients with low grade and high grade marginal zone lymphoma of the MALT type. Methods: We examined paraffin embedded tissue of patients with gastric marginal lymphoma of MALT type. The presence of the t (11; 18) (q21; q21) was determined using reverse transcription-polymerase chain reaction (RT-PCR); B-actin transcript was amplified to ensure specimen adequacy. Results: We examined 64 paraffin-embedded gastric lymphomas (39 high-grade MALT lymphomas and 22 low-grade MALT lymphomas) from Italy, USA and Japan. The actin transcript was amplified in 61 of 64 cases (95.3%). The t (11; 18) translocation was detected in 21% (8 of 39) cases with high-grade MALT lymphoma vs. 4 of 22 (18%) with low-grade MALT lymphoma [odds 0.861, 95% CI 0.227–3.267]. Conclusions: Translocation t (11; 18) (q21; q21) is characteristic of extra nodal marginal lymphomas of MALT type. It was found in both low-grade and high-grade gastric lymphomas of the MALT type at an approximately same frequency. These results challenges the assumptions that this translocation is absent in high grade lymphoma or that the translocation precludes its progression to high grade lymphoma. Testing for the translocation may provide additional prognostic information or help identify a subgroup where close follow is needed.

Effect of Cultivar, Year Grown, and Cropping System on the Content of Tocopherols and Tocotrienols in Grains of Hulled and Hulless Barley

In a three-year period (2000-2002) total tocols (tocopherols and tocotrienols), content of vitamin E and its isomers (alpha-, beta+gamma-, delta-tocopherols and tocotrienols) were assessed in grain of 13 barley genotypes. The highest content of tocols (60.3-67.6 mg kg(-1)) and content of vitamin E (Vitamin E equivalent-18.0-20.1 mg kg(-1)) were determined in the waxy varieties Wanubet, Wabet, and Washonubet. Standard varieties, i.e. of a malting type (Krona and Kompakt), had statistically significantly lower content of tocols (49.9 and 53.6 mg kg(-1)) and vitamin E (15.7-16.1 mg kg(-1)) compared to the waxy varieties. The hulless waxy variety Washonubet had statistically significantly higher total content of tocols (67.6 mg kg(-1)) and alpha- tocotrienols isomer (42.1 mg kg(-1)) versus all other genotypes in the set. Chemical treatment and fertilization statistically significantly increased the content of tocols (by 4.7 mg kg(-1)), vitamin E (by 1.9 mg kg(-1)), isomer alpha-tocopherol (by 0.9 mg kg(-1)) and isomer alpha- tocotrienols (by 3.3 mg kg(-1)). The average values of alpha-tocopherols and alpha-tocotrienols in the set were 6.7 mg kg(-1) and 29.7 mg kg(-1), respectively. Some of the reciprocal lines created by us from the malting and waxy varieties are suitable for food use for high contents of all tocopherols and alpha-tocotrienols.