LYMPHOID FOLLICLES APPEARING IN GASTRIC MUCOSA, ESPECIALLY IN REACTIVE LYMPHOID HYPERPLASIA AND MALIGNANT LYMPHOMA

Histopathological analysis of reactive lymphoid hyperplasia (RLH) and malignant lymphoma (ML) of the stomach was made based on the observations of lymphoid follicles appearing in gastric mucosa. The materials used for study consisted of 28 stomachs without RLH or tumor obtained from either operation or autopsy, 18 stomachs with RLH, and 46 stomachs with ML. Lymphoid follicles appeared soon after birth, increased with mucosal atrophy, and decreased in mucosa with intestinal metaplasia. They possessed a sinusoidal structure and appeared in the muscularis mucosae intimately related to the lymphatic flow. Excepting for the significant proliferative nature, the structural evolution of lymphoid follicles in RLH was similar to that in atrophic mucosa. They showed, however, a wide spectrum of changes containing cases with simple reactive changes to those with prelymphomatous changes. As to ML, the large cell type demonstrated a destructive proliferation, while both small and medium-sized cell types showed proliferation and infiltration preserving their original structure. In the superficial type, ML was frequently accompanied by RLH and mucosal atrophy. The histological features of ML consisted of not only the characteristics of tumor cells but also the proper mucosal changes including lymphoid follicles.     

PRIMARY CEREBRAL MALIGNANT LYMPHOMA OF THE HISTIOCYTIC TYPE

A 60-year-old house wife complained of anorexia, headaches and vomiting for several months. Later she developed disturbances in gait. At the terminal stage of her clinical course, 3 masses in the cerebrum and one in the cerebellum were detected by angiography and CT-scan. At autopsy, 3 masses in the frontal lobes, and one in each thalamus and still another in the cerebellum were found. They were accompanied with necrotic and haemorrhagic changes. Tumor cells were large irregular or round in shape, and showed metallophilia by the silver impregnations for reticlum cells and microglia. Some of them were multinucleated giant cells. Tumor cells showed occasionally phagocytic activity. Perivascular infiltration of tumor cells was marked around the tumor masses.     

MALIGNANT LYMPHOMA, SMALL NON-CLEAVED, NON-BURKITT'S TYPE

An autopsy case of "Malignant lymphoma, small non-cleaved, non-Burkitt's type" with hypercalcemia is presented. A 57-year-old Japanese man suffering from epigastralgia and "retroperitoneal tumor" for nine months was found at autopsy to have two large tumor masses in the retroperitoneum and pelvic cavity. Tumor cell infiltration into the liver, spleen, both kidneys, and both adrenal glands was observed on microscopic examination. The tumor cells were lymphoid cells with the characteristics of "Malignant lymphoma, small non-cleaved, non-Burkitt's type". The importance of recognizing non-Burkitt's type is pointed out. The cause of the presence of hypercalcemia is also discussed. ACTA PATHOL. JPN. 34: 1365–1373, 1984.     

T CELL LYMPHOMA PRESENTING CLINICAL AND MORPHOLOGICAL FEATURES RESEMBLING POLYMORPHIC RETICULOSIS AND LYMPHOMATOID GRANULOMATOSIS

A male, 53 years old, complained of a mass on the left side of neck. The biopsy specimens revealed extensive necrotizing lesions with polymorphonuclear leukocyte Infiltration. About three years later a recurrence from the same site was noted and the reblopsy specimens showed features of malignant lymphoma of pleomorphic type. Subsequently multiple cutaneous nodules and then ulcerative lesions of the midfacial region developed and repeated biopsies were done. Immunological examination indicated that the lymphoid cells obtained from the skin lesion had predominantly T-lymphocyte marker. He died of massive hemorrhage from the nasopharyngeal lesion 51 months after the first admission. Autopsy revealed multiple organ Involvements, including the nasopharynx, lungs, subcutaneous tissue, and adrenal gland. The morphological features In the present case were compatible with a diagnosis of lymphomatoid granulomatosis or polymorphic reticulosis (midline malignant reticulosis), and were thought to be best designated as T cell lymphoma.     

NON-HODGKIN MALIGNANT LYMPHOMA WITH SPECIAL REFERENCE TO DESMOSOME-LIKE JUNCTIONS

Seventy-nine cases of non-Hodgkin malignant lymphoma were light and electron microscopically evaluated with special reference to intercellular correlationship comparing with non-neoplastic lymph nodal cells and cultured B cells. Reticulum cells and histiocytes are regarded as an independent cell unit. Reticulum cell sarcoma shows a fibrosarcomatous proliferation with abundant reticulin fibers, while histiocytic sarcoma is confined to a pleomorphic neoplasm with valid phagocytization. Lymphoid cells are divided into large, intermediate and small lymphocytes. Under inflammation and cultivation they, especially intermediate and large, preferentially proliferated clustering in a reticular fashion, which are designated as reticular lymphocytes, in contrast with nonreticular lymphocytes individually separated. The desmosome-like junctions are found among reticular lymphocytes not only in but also outside germinal centers as well as in vessels and among cultured B cells. Lymphocytic sarcomas, either nodular or diffuse, are classified into reticular and nonreticular types in association with their cellular sizes. The desmosome-like junctions are predisposedly disclosed in reticular lymphoma irrespective of proliferating patterns, nodular or diffuse, and of membrane character, B or T. And the junctions are not regarded as a hallmark for follicular or nodular lymphomas of germinal center cell origin.     

HEREDITARY HEMORRHAGIC TELANGIECTASIA WITH MALIGNANT LYMPHOMA An Autopsy Case

A 60-year-old Japanese woman was diagnosed at autopsy as having had hereditary hemorrhagic telangiectasia (HHT) associated with systemic hemangiomas. In her repoduction period, premenstrual epistaxis frequently occurred. At the age of 60, the patient died of malignant lymphoma. At autopsy, multiple telangiectatic spots were noted on the face, limbs and trunk. The paraaortic lymph nodes, which were enlarged and irregularly conglomerated, were histologically diagnosed as malignant lymphoma of the diffuse large cell type. Submucosal telangiectatic lesions were found in the gastrointestinal system from the oral cavity to the rectum. Cavernous hemangiomas were present in various visceral organs including the liver, spleen, small and large intestines, rectum, appendix, uterus, and jejunal and colonic mesenteries. There was an arteriovenous fistula in the left lung. Examination of her family pedigree showed that the patient had an autosomal dominant trait of inheritance. The pathogenesis of the systemic visceral hemangiomas observed in this patient was considered to be similar to that of hamartoma.     

IgM-MONOCLONAL GAMMOPATHY ASSOCIATED WITH MALIGNANT LYMPHOMA WITH RECURRENT PLEURAL EFFUSION

A case of malignant lymphoma (plasmacytold lymphocytic type) with IgM-monoclonal gammopathy is presented. The main site of the lesion was in the lung. The sole clinical manifestation was pleuropulmonary involvement with massive pleural effusion. A clue to the diagnosis was given by cytologlcal and immunocytological examination of pleural aspirates. Subsequent immunological survey of serum protein and a bronchial biopsy confirmed the diagnosis.     

MALIGNANT LYMPHOMA OF THE PAROTID GLAND WITH MONOCLONAL CYTOPLASMIC IMMUNOGLOBULIN

A 56-year-old Japanese man with a malignant lymphoma of the parotid gland was reported. The tumor was located in the superficial lobe of the parotid gland, and somewhat invaded the surrounding soft tissues, but the regional lymph nodes were not involved. Histologically, the tumor was composed of round cells with plasmacytoid configurations and small lymphocytes. The plasmacytoid cells showed eccentric nuclei with fairly marked irregularities and perinuclear halos. In a large number of tumor cells, a monoclonal cytoplasmic immunoglobulin (CIg), IgG-Kappa type, was demonstrated by the PAP method. Ultrastructurally, some of the tumor cells showed welldeveloped endoplasmic reticulum. From these findings, this tumor was diagnosed as a diffuse B-cell lymphoma, mainly composed of lymphoplasmacytoid cells. And this tumor may bear a similar nature to an extramedullary plasmacytoma of the classical terminology. Malignant lymphoma of the parotid gland is rare but a case with the demonstration of monoclonal CIg is considered very rare. ACT A PATHOL. JPN. 34: 1459–1467, 1984.     

PRIMARY CEREBRAL MALIGNANT LYMPHOMA WITH MACROGLOBULINEMIA AND CARCINOMA OF THE COLON

A case of primary cerebral malignant lymphoma, immunoblastic type was reported. The immunoelectrophoresis of the patient serum showed an abnormal bow of IgM lambda type. Autopsy revealed that the cerebral lymphoma showed no extracranial spread except for adenocarcinoma of the colon with hepatic metastasis. Ultrastracturally, some of the lymphoma cells showed plasmacytoid differentiation. Immunoperoxidase study showed intracytoplasmic polyclonal immunoglobulins in non-neoplastic plasma cells around the colonic carcinoma, in the bone marrows, and spleen. However, neither IgM nor lambda light chain was found in the cerebral lymphoma cells. The source of the macroglobulinemia in this case was discussed.     

MALIGNANT LYMPHOMA, LARGE CELL IMMUNOBLASTIC CLEAR CELL SHOWING UNUSUAL HISTOLOGIC PICTURE

A case of malignant lymphoma, large cell, immunoblastic clear cell (WF) in a 59-year-old woman was reported. This patient showed no remarkable symptoms except generalized lymphadenopathy and slightly elevated serum levels of IgG and IgM. Histologic examinations were performed twice at about 6 months interval. Marked differences were noticed between the period, and they were histopathologically interesting and unusual findings. By immunological staining in situ, T-clear cells showed a subset marker of helper/ inducer's characteristics. It was suggested that this case was different from AILD-like T-cell lymphoma in histogenesis. The results of marker study and the changes in histopathological morphology among two biopsied specimens were presented.     

肿瘤与Ⅰ型变态反应关系的研究——Ⅰ.恶性淋巴瘤病人的血清总IgE水平

淋巴瘤是免疫系统的恶性肿瘤,它的发生与免疫缺陷、免疫抑制和免疫刺激有关。由于免疫因素在淋巴瘤中占有一定的重要地位,因此我们对恶性淋巴瘤高发区之一——青岛市的一些病人进行了肿瘤与Ⅰ型变态反应关系的调查与研究。     

DIFFERENT PATTERNS OF HLA-DR ANTIGEN EXPRESSION IN NORMAL EPITHELIUM,HYPERPLASTIC AND NEOPLASTIC MALIGNANT LESIONS OF THE BREAST

Fifteen samples of non-tumoural breast tissue, 24 cases of benign lesions, four biopsies of inflammatory carcinomas and 94 tumour samples of primitive mammary carcinomas were analysed for HLA class II expression. We found, first, that HLA class II antigens were detectable in all cases of non-neoplastic breast tissue. Secondly, HLA class II antigen expression was notably increased in benign neoplasms and hyperplastic lesions. In contrast, only 32 out of 94 carcinomas showed expression of HLA-DR antigens, 17 tumours had HLA-DP antigens and 11 carcinomas were positive for the presence of DQ molecules. The expression of class II antigen was associated with the degree of histological differentiation (P < 0.05) but was independent of stromal leucocytic infiltration. Thirdly, HLA-DR was very strongly expressed in intravascular tumoural thrombi, especially in the ‘inflammatory carcinomas’. The immunephenotype of inflammatory infiltrate was analysed in benign and malignant lesions. In malignant lesions the mean number of inflammatory cells was significantly higher than in benign lesions. Interestingly, we found no differences in the amount and composition of inflammatory infiltrate between HLA-DR positive and negative tumours.     

TERMINAL DEOXYNUCLEOTIDYL TRANSFERASE STAINING OF MALIGNANT LYMPHOMAS IN PARAFFIN SECTIONS: A USEFUL METHOD FOR THE DIAGNOSIS OF LYMPHOBLASTIC LYMPHOMA

Terminal deoxynucleotidyl transferase (TdT) is a DNA polymerase located in the cell nucleus which catalyses the polymerization of deoxynucleotides at the 3′ hydroxyl ends of oligo- or polydeoxynucleotide initiators without a template. TdT is known as a useful marker for the diagnosis of acute lymphoblastic leukaemia/lymphoma, but its detection usually requires fresh tissue specimens or cell suspensions, using either an enzyme analysis or immuno-fluorescence or -peroxidase staining. Until the recent development of the use of microwave-treated paraffin sections for immunoperoxidase staining, detection of TdT in paraffin sections required rather complicated processes. This new simple technique was applied to paraffin sections from the tumour tissue specimens of 16 patients with lymphoblastic lymphoma and of seven patients with non-endemic Burkitt's lymphoma, which is sometimes difficult to differentiate from lymphoblastic lymphoma because of their similar clinicopathological characteristics. In addition, as a control, ten cases each were examined of adult T-cell leukaemia/lymphoma (ATLL) and angioimmunoblastic lymphoma (AILD), which are both peripheral T-cell lymphomas. The tumour cells from 15 of the 16 (94 per cent) patients with lymphoblastic lymphoma were found to be TdT-positive. The specificity of the anti-TdT antibody used was confirmed by immunoblot and the specific 60 kD band was detected only in a specimen of lymphoblastic lymphoma. These results show that the immunostaining of TdT on paraffin-embedded sections is a useful method for differentiating lymphoblastic lymphoma from other lymphomas. This method is applicable to a routine diagnostic service. © 1997 John Wiley & Sons, Ltd.     

GLOMERULAR LESIONS IN MULTIPLE MYELOMA

An autopsy case of multiple myeloma (IgG, lambda type), clinically characterized by decreased glomerular filtration rate, is reported with particular emphasis on changes in the glomeruli of kidneys. Histologically, the glomeruli revealed slight increase in mesangial matrix and focal thickening of tuft capillary wall. Electron-microscopically, deposits were observed in a subendothelial location in the glomerular capillary walls, and inclusions were noted in the cytoplasm of the visceral epithelial cells. Histoimmunofluo-rescent study of the kidney demonstrated intense focal and slight diffuse positivity against labelled antisera of anti-IgG and anti-lambda type of light chain on the capillary wall of the glomerular tufts. Other immunoglobulins were not demonstrable in capillary walls. These findings represent the intraglomerular deposition of paraprotein of multiple myeloma without amyloidosis.     

LYMPHOMATOID GRANULOMATOSIS (LIEBOW)

An autopsy case with pulmonay lesions analogous to Liebow's lymphomatoid granulomatosis (LYG) and some other unusual pictures were reported. A 29-year-old male who had been diagnosed and treated as Sjögren's syndrome for eleven years because of intermittent swelling of the parotids with diffuse lymphoid cell infiltration and positive serum RA-test, showed several circumscribed densities on the chest X-ray examination which were deemed to be of interlobar pleurisy. On autopsy, the nodular lesions in the lung were composed of angiocentric-angiodestructive lymphoid cell proliferation analogous to LYG. In addition, the present case was characterized by focal glomerulonephritis and splenic trabeculitis which are quite unusual associations in LYG. The relationships of the present case to other similar diseases such as Wegener's granulomatosis, Sjögren's syndrome, primary lymphoma of the lung, etc. were discussed.     

NON-AFRICAN BURKITT'S LYMPHOMA IN A YOUNG WOMAN

Non-African Burkitt's lymphoma is presented in a 29-year-old, unmarried woman, who developed tumors in both breasts and ovaries, ascites and pleural effusion. Assessment of B cells in the tumor cells, derived from ascites, pleural effusion and tumor tissue is 90%, surface IgM being consisted of 86%, in an average. Histologically, the tumor tissue demonstrates prominent, so-called starry-sky effect, and cytologically, tumor cells are poorly-differentiated lymphocytoid ceUs in their features.     

RENAL VASCULAR LESIONS IN SEVERE HYPERTENSION

Renal vascular changes In severe hypertension were studied. Twenty–five cases selected from 4,629 autopsies were classified into 2 groups according to the cause of death: group 1 (9 cases died of renal failure) and group 2 (16 cases of extra–renal death). Group 1 had been clinically diagnosed as malignant hypertension and had the hallmarks of malignant nephrosclerosis characterized by arteriolar fibrinoid necrosis and edematous intimal thickening. Group 2 had been clinically diagnosed as benign hypertension and basically exhibited the changes of benign nephrosclerosis. However, about half of the cases of group 2 had arteriolar fibrinoid necrosis, though the lesion was usually less extensive than in group 1. Immunofluorescence revealed similar deposits of immunoglobulins and fibrinogen in the site of fibrinoid necrosis observed in both groups. As for the changes of interlobular arteries, a quantitative analysis disclosed a distinctive difference between groups 1 and 2 with respect to the narrowing ratio of arterial lumina, though edematous intimal thickening was recognized on relatively rare occasions in the distal interlobular arteries to a few cases of group 2. From the results, the problem of transition from the benign to malignant nephrosclerosis was discussed. ACTA PATHOL. JPN. 33: 323–331, 1983.     

ALIMENTARY TRACT LESIONS IN CYTOMEGALOVIRUS INFECTION

Ten autopsy and 2 biopsy cases of cytomegalovirus (CMV) infection of the alimentary tract were studied. CMV infection was microscopically determined by the presence of cytomegalic inclusion as well as by the immunofluorescent method. Clinical manifestations such as abdominal pain, diarrhea, hema-temesis, bloody stool, perforation, and/or abdominal distension with paralytic ileus were observed in 8 autopy cases and 1 biopsy case. Disappearance of cytomegalic cells was confirmed by the follow-up study in the biopsy cases. Macroscopically, mucosal hemorrhage or ulceration was found in the gastrointestinal tract from the esophagus to the colon. Ulceration showed a characteristic well-defined punched-out appearance. The esophagus was the most frequently involved organ. However, no cytomegalic cells were found in the squamous epithelium. In the stomach, regenerated epithelial cells were frequently involved in the deeper part of glands. Numerous endothelial cells transformed into cytomegalic cells in the mucosa surrounding the ulcer in the esophagus, stomach, and intestine. Ischemia caused by cytomegalic changes of vascular endothelial cells is thought to play an important role in the pathogenesis of the ulcer of the gastrointestinal tract.