Pseudolymphoma of the stomach. A clinicopathologic study of 15 cases

Fifteen cases of gastric pseudolymphoma (GPL) were studied and classified into three subtypes: The nodular type, which is elevated, representing a submucosal tumor. Histologically, the tumor is composed of lymphoid hyperplasia with no associated ulcer. The lesion is well demarcated with no sinusoidal structure. Those findings indicate a nonreactive state. The ulcerative type, which usually is accompanied by deep ulceration with extensive fibrosis. The erosive type, which is infiltrated by extensive lymphoid hyperplasia in the propria mucosa and submucosa. The latter two types represent the reactive state in response to chronic gastric ulcer or inflammation. One of four ulcerative GPLs, however, was associated with focal malignant lymphoma which accounted for one of the fifteen GPL studied. Although there is a low incidence of malignant lymphoma among GPL patients, pseudolymphoma should be considered as a precursor lesion with malignant potential.     

胃黏膜相关淋巴组织型淋巴瘤临床病理分析

目的；研究胃黏膜相关淋巴组织（MALT）型淋巴瘤的形态特征。方法：应用HE染色及免疫组化Eivison二步法观察胃MALT型淋巴瘤。结果：17例胃MALT型淋巴瘤为B细胞表达。Kappa( )6例，Lambda( )8例。瘤细胞以CCL细胞型为主，淋巴上皮病变13例，滤泡克隆化8例，反应性滤泡增生11例。结论：淋巴上皮病变，滤泡克隆化，反应性滤泡增生及B细胞单克隆性是胃MALT型淋巴瘤的主要特征。有别于胃良性病变引起的淋巴组织反应性增生。     

Assessment of new macroscopical classification of gastric malignant lymphoma.

We macroscopically classified gastric malignant lymphoma into ST type (submucosal tumor type), non-ST type (non-submucosal tumor type) and Combined type (combination of ST and non-ST type) and assessed this new classification by examining 60 surgically resected cases. Of these, 18 cases (21 lesions) were classified into ST type, 38 cases (54 lesions) into non-ST type and 4 cases (4 lesions) into Combined type. All the large cell, immunoblastic type cases were of ST type and most of the diffuse, small cleaved cell type cases and all the plasmacytoma cases were of non-ST type. Diffuse, large cell type and diffuse, mixed type cases did not seem to be biased toward any of these three macroscopical types. The non-ST type cases frequently showed an infiltrative growth pattern and reactive lymphoid cell hyperplasia adjoining the lesions, while the ST type cases frequently showed an expansive growth pattern without reactive lymphoid cell hyperplasia. The Combined type cases showed both infiltrative and expansive growth patterns in the same lesion. The macroscopical classification defined in this study can be considered useful in determining a range for surgical resection of gastric malignant lymphoma.     

Gastric pseudolymphoma with monotypic cytoplasmic immunoglobulin

Two cases of hyperplastic lymphoid lesion of the stomach with cytoplasmic immunoglobulin of monotypic pattern are presented. Both patients were young, and the postgastrectomy course was uneventful for 38 and 76 months, respectively. The lesion had been diagnosed as pseudolymphoma based on the presence of hyperplastic follicles with germinal center and mixed infiltration of plasma cells and mature lymphocytes with no significant cytologic atypia. However, the immunoperoxidase method showed monotypic cytoplasmic immunoglobulin; lambda/IgM in one case and lambda/IgG in the other. The staining pattern of germinal centers was also monotypic in one, but polytypic in the other. These cases suggest the presence of monoclonal but reactive lymphoid hyperplasia, i.e., monoclonal-type pseudolymphoma in the stomach. On the other hand, this type of lesion has to be carefully followed for the possible development of malignant lymphoma.     

Assessment of New Macroscopical Classification of Gastric Malignant Lymphoma

We macroscopically classified gastric malignant lymphoma into ST type (submucosal tumor type), non-ST type (non-submucosal tumor type) and Combined type (combination of ST and non-ST type) and assessed this new classification by examining 60 surgically resected cases. Of these, 18 cases (21 lesions) were classified into ST type, 38 cases (54 lesions) into non-ST type and 4 cases (4 lesions) into Combined type. All the large cell, immunoblastic type cases were of ST type and most of the diffuse, small cleaved cell type cases and all the plasmacytoma cases were of non-ST type. Diffuse, large cell type and diffuse, mixed type cases did not seem to be biased toward any of these three macroscopical types. The non-ST type cases frequently showed an inflltrative growth pattern and reactive lymphoid cell hyperplasia adjoining the lesions, while the ST type cases frequently showed an expansive growth pattern without reactive lymphoid cell hyperplasia. The Combined type cases showed both infiltrative and expansive growth patterns in the same lesion. The macroscopical classification defined in this study can he considered useful in determining a range for surgical resection of gastric malignant lymphoma.     

Lymphoproliferative diseases of the lung in Japan: review of thirty-six patients with an immunohistochemical study

Thirty-six cases of primary lymphoproliferative disease of the lung, collected from hospitals in Japan, have been reviewed. Histologically they were divided into three groups: definite lymphoma (DL) showing monomorphous proliferation of medium to large cells (17 cases), small lymphoid cell proliferation (SLP) frequently containing lymphoid follicles (11 cases), and pseudolymphoma showing lymphoid follicular hyperplasia (LFH) (six cases) or mixed diffuse infiltration of small lymphocytes and macrophages (two cases). In some DL cases, lymphoid follicles were present in or near the tumors. Pulmonary lesions in SLP and LFH patients were frequently detected at their medical checkups. Immunohistochemistry revealed that proliferating cells in 15 out of 17 DL and all SLP cases were B cells with restricted expression of the immunoglobulin light chain, all lambda type, in three DL and four SLP cases. From morphologic and immunologic findings, 10 SLP cases were diagnosed as intermediate lymphocytic lymphoma (ILL) and one as being of lymphoplasmacytic type. Two DL cases with convoluted nuclei proved from immunohistochemistry to be of T-cell type, showing a much lower frequency of T-cell type than that found in the USA (approximately 50%).     

Primary gastric lymphoid proliferations: immunological criteria to distinguish gastric lymphoma from reactive hyperplasia.

A group of six patients with a marked gastric lymphoid "hyperplasia", two of these with generalised lymphoma and the others suspected for primary gastric lymphoma, were investigated to discriminate between simple reactive hyperplasias and lymphomatous proliferations. Microscopical and ultrastructural examinations were not useful for this purpose but immunological data can give evidence of a two-fold nature of gastric lymphoid hyperplasia. Some cases are without immunological disorders, others are met with peripheral blood signs of immunological alterations similar to those observed in malignant lymphomas and in chronic lymphocytic leukemia. Only these latter cases should, in our opinion, be regarded as primitive gastric lymphomas.     

粘膜相关淋巴组织(MALT)型淋巴瘤的临床特点和处理

粘膜相关淋巴组织(MALT)型淋巴瘤是非霍奇金恶性淋巴瘤中一个独立的亚型，有其独特的临床病理特点。它是结外低度恶性B细胞淋巴瘤中最常见的一型。此型淋巴瘤病人常有慢性感染病史或自身免疫性疾病。MALT淋巴瘤是一种惰性病变，可较长时间局限于局部。局部治疗有效。胃MALT淋巴瘤最常见。本文以胃MALT淋巴瘤为重点，对MALT淋巴瘤的临床特点和处理作一个综述。     

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.     

Malignant lymphoma of the rectum

Eleven patients with primary lymphoma of the rectum were reviewed on a mainly histological basis, especially in association with reactive lymphoid hyperplasia (RLH). They included three males and eight females with an age range of 21-71 (median 59) years. Common symptoms were anal bleeding, melena, difficulty with defecation and constipation. A physical examination echogram and computed tomographic scans showed the tumor to be restricted to the rectum. The tumors were classified microscopically as six intermediate lymphocytic lymphomas (ILL) and five others. Histologic findings compatible with RLH were found in all five ILL cases and three of the others. Immunohistochemistry on paraffin-embedded sections revealed eight cases to be of B-cell type and one with a pleomorphic histology, to be of T-cell type; one case did not react with any of the antibodies tested, but were regarded as being of B-cell type purely on morphological grounds. A gene rearrangement study carried out in one ILL case showed a monoclonal rearrangement of the Jh chain. The findings showed rectal lymphoma to be characterized by a high frequency of ILL cases and an association with RLH. These are also common findings among patients with thyroid, salivary and gastric lymphoma, suggesting a common etiologic role in these diseases of long-standing inflammation.     

Intracranial Pseudolymphoma

Intracranial pseudolymphoma is a rare tumor of the central nervous system. A 35-year-old woman presented with a frontal subcutaneous tumor. Magnetic resonance imaging revealed a left frontal meningeal tumor involving subcutaneous tissue without bone involvement. The mass was completely removed and the histological aspect of all tumor sections was that of a lymphoid hyperplasia with polyclonal proliferation. These findings were characteristic of pseudolymphoma defined as a hyperplasia of follicular and diffuse lymphoid type with assessment of its polyclonality by immunophenotyping on frozen sections, completed by molecular biology techniques.     

Clinicopathologic Assessment of Ocular Adnexal Lymphoproliferative Lesions at a Tertiary Eye Hospital in Iran

Background The most common type of ocular lymphoma is nonHodgkin lymphoma (NHL) categorized into two groups indolent (slow growing) and aggressive (rapid growing) Differentiating benign reactive lymphoid hyperplasia (RLH) from malignant ocular adnexal lymphoma (OAL) is challenging Histopathology immunohistochemistry (IHC) and ow cytometry have been used as diagnostic tools in such cases Materials and Methods In this retrospective case series from 2002 to 2013 at Farabi Eye Center 110 patients with ocular lymphoproliferative disease were enrolled Prevalence anatomical locations mean age at diagnosis and the nal diagnosis of the disease with IHC were assessed. Comparison between previous pathologic diagnoses and results of IHC was made Immunoglobulin light chains and Bcell and Tcell markers and other immunophenotyping markers including CD20 CD3 CD5 CD23 CD10 CYCLIND1 and BCL2 were evaluated to determine the most accurate diagnosis The lymphomas were categorized based on revised EuropeanAmerican lymphoma (REAL) classi cation Results Mean ageSD (years) of the patients was 556 193 and 61 were male Patients with follicular lymphoma large Bcell lymphoma or chronic lymphocytic leukemiasmall cell lymphoma (CLLSLL) tended to be older Nine patients with previous diagnoses of low grade Bcell lymphoma were reevaluated by IHC and the new diagnoses were as follows extranodal marginal zone lymphoma(EMZL) (n1) SLL(n1) mantle cell lymphoma (MCL) (n3) reactive lymphoid hyperplasia RLH (n2) Two cases were excluded due to poor block Flowcytometry reports in these sevenpatients revealedSLL with positive CD5 and CD23 MCLwith positive CD5 and CyclinD1 and negative CD23 EMZL with negative CD5CD23 and CD10. One RLH patient wasnegative for KappaLambda and positive for CD3 and CD20 and the other was positive for all of the light chains CD3 and CD20 Orbit (491) conjunctiva (161) and lacrimal glands (161) were the most common sites of involvement Conclusions Accurate pathological classi cation of lesions is crucial to determine proper therapeutic approaches This can be achieved through precise histologic and IHC analyses by expert pathologists     

Primary extranodal lymphomas of stomach: clinical presentation,diagnostic pitfalls and management

Gastrointestinal lymphoma is the most common form of extranodal lymphoma, accounting for 30%–40% of cases. The most commonly involved site is the stomach (60%–75% of cases), followed by the small bowel, ileum, cecum, colon and rectum. The most common histological subtypes are diffuse large B-cell lymphoma (DLBCL) and marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT). Helicobacter pylori infection has been implicated in the pathogenesis of MALT gastric lymphoma, but its role in gastric diffuse large B-cell non-Hodgkin's lymphoma (NHL) is controversial. The therapeutic approach for patients with gastric NHL has been revised over the last 10 years. Conservative treatment with anthracycline-based chemotherapy alone or in combination with involved-field radiotherapy has replaced gastrectomy as standard therapy in cases with DLBCL. Additionally, MALT lymphomas are mainly treated with antibiotics alone, which can induce lasting remissions in those cases associated with H. pylori infection. Nevertheless, various therapeutic aspects for primary gastric lymphomas are still controversial and several questions remain unanswered. Among others, the role of rituximab, consolidation radiotherapy as well as H. pylori eradication in histological aggressive subtypes warrants better clarification.     

Expression of chemokine receptor CXCR3 and its ligand,mig, in gastric and thyroid marginal zone lymphomas. Possible migration and autocrine mechanism

Chemokine receptors mediate the migration of lymphocytes through the binding of ligands, and the expression is differentially regulated in lymphocyte subsets. CXCR3 is usually expressed in Th1 T cells, however, recently is reported to be expressed in B cell chronic lymphocytic leukemia, mucosa-associated lymphoid tissue type lymphoma (MALT) (extranodal marginal zone lymphoma), and other B cell non-Hodgkin lymphomas. Our study was designed to investigate the expression of CXCR3 and its ligand Mig, and their relationships in MALT using immunohistochemistry. In addition, CCR4, which is characteristic Th2 helper phenotype, and its ligand thymus and activation-regulated chemokine (TARC), were compared with CXCR3, as Th1 phenotype. We studied 14 cases of gastric B cell lymphoma [low-grade MALT, 5 cases; high-grade MALT, 5 cases; and diffuse large (DL), 4 cases] and 16 cases of thyroid B cell lymphoma [low-grade MALT, 4 cases; high-grade MALT, 5 cases; and DL, 7 cases]. CXCR3-expressing lymphoid cells were detected in all cases. In double immunostaining (CXCR3-CD20), gastric and thyroid low/high MALT showed CXCR3-positive neoplastic B cells, but DL, except two cases, did not. In DL, CXCR3-positive lymphoid cells were mainly reactive T-cells (CD3-positive cells). Mig was expressed mainly in stromal cells (histiocytes, macrophages, fibroblasts, and endothelial cells). In gastric lymphoma, low-grade MALT contained abundant Mig-strongly expressing cells, while staining in high-grade MALT and DL was mild. In thyroid lymphoma, staining was strong in low- and high-grade MALT, but moderate in DL. In double-staining, CXCR3-Mig-coexpressing lymphoma cells were abundant in high MALT of the stomach and thyroid, but rare in other subtypes. TARC-positive cells and CCR4-positive cells were rarely encountered in all cases. Our results indicate a tendency for low-grade MALT to contain CXCR3(+)Mig- lymphoma cells, high-grade to contain CXCR3(+)Mig+ and DL to contain CRCR3(-)Mig- lymphoma cells. We speculate that CXCR3 is associated with migration of lymphoma cells in low-grade MALT, and autocrine function in high-grade MALT, and not associated with any function in DL.     

肺黏膜相关淋巴瘤的诊断与鉴别诊断

目的 探讨肺黏膜相关淋巴组织边缘区B细胞淋巴瘤（MALToma）的临床、影像、病理学特征和可靠的诊断依据,并与形态非常相似的3种肺良性淋巴组织增生性病变相鉴别.方法 分析3例肺MALToma患者的病史、影像学、病理组织学等检查,与淋巴细胞性间质性肺炎、淋巴细胞性炎性假瘤、滤泡性支气管炎鉴别.结果 肺MALToma临床表现和影像学缺乏特异性,与肺癌不易鉴别.病理示边缘区淋巴细胞增生、围绕生发中心并相互融合,侵入支气管上皮形成“淋巴上皮病变”,侵入滤泡生发中心形成“滤泡植入”.结论 肺MALToma是一种少见的低度恶性肿瘤,临床症状和影像学无特异性,确诊需依据病理组织学.与其他肺淋巴组织增生性病变的主要鉴别点在于边缘带的范围大小、有无融合、有无“滤泡植入”、有无“淋巴上皮病变”、滤泡之间的细胞类型等.     

A clinicopathologic study of primary small intestine lymphoma: prognostic significance of mucosa-associated lymphoid tissue-derived lymphoma

BACKGROUND: It remains unclear whether the presence of mucosa-associated lymphoid tissue (MALT) lymphoma has prognostic implications for patients with primary small intestine lymphoma. METHODS: The clinicopathologic features of 80 patients with primary small intestine lymphoma were examined retrospectively in relation to the presence of MALT lymphoma. Survival was compared univariately and multivariately among the groups divided by clinicopathologic findings. RESULTS: Twenty-one cases (26%) were diagnosed as low grade B-cell lymphoma (15 marginal zone B-cell lymphoma of MALT type, 2 mantle cell lymphoma, and 4 follicle center lymphoma), 46 cases (58%) were diagnosed as high grade B-cell lymphoma (19 secondary large cell lymphoma with a low grade MALT component, 17 diffuse large cell lymphoma without MALT features, 7 Burkitt lymphoma, and 3 lymphoblastic lymphoma), and 13 cases (16%) were diagnosed as T-cell lymphoma. A significantly better survival was noted for patients without colorectal and/or gastric involvement, diffuse infiltration under macroscopy, high grade histology, and perforation. Those patients with MALT type tumors, less advanced stage of disease, B-cell phenotype, benign lymphoid follicular hyperplasia, and radical tumor resectability appeared to have a better survival rate. Based on Cox multivariate analysis, early stage disease and MALT-derived tumors were determined to be independent prognostic factors (P < 0.05). CONCLUSIONS: The presence of MALT-derived lymphoma appears to have a favorable prognosis among patients with primary small intestinal lymphoma.     

MALT lymphomas: pathogenesis can drive treatment

Marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is an indolent B-cell non-Hodgkin lymphoma arising from the lymphoid tissue at extranodal sites. It is genetically characterized by different, usually mutually exclusive, genetic abnormalities that lead to activation of the nuclear factor kappa B (NF-kappaB) pathway. These lymphomas can arise in any extranodal organ or tissue; however, the stomach--where MALT lymphoma development has been strongly linked to chronic Helicobacter pylori infection--is the most common site. Other microorganisms have been associated with non-gastric MALT lymphomas, but the evidence for such associations is weaker. Treatment aimed at eradicating H pylori infection results in remission of gastric MALT lymphoma in most patients and represents a model of anticancer treatment based on the eradication of the causative factor. Treatment of non-gastric MALT lymphomas is much less well established; either radiotherapy or systemic therapy (with chemotherapy and/or rituximab [Rituxan]) can be effective, while antibiotic therapies (e.g., doxycycline in ocular adnexal lymphomas) should still be considered investigational.     

Atypical cutaneous lymphoid hyperplasia induced by chemotherapy in a patient with advanced colon carcinoma

Some conditions are predisposed to excessive lymphocyte responses, which can progress to a benign condition, ie, atypical cutaneous lymphoid hyperplasia (ACLH), or a malignant lymphoma. Clinical diagnosis of drug-associated pseudolymphoma can be based on a temporal association between drug ingestion and lesion onset followed by resolution without recurrence after discontinuation of drug administration. Herein, we report the case of a 66-year-old man with advanced colon carcinoma with ACLH developed while receiving chemotherapy regimen with oxaliplatin/5-fluorouracil/leucovorin. The authors postulate that chemotherapy can promote an aberrant immune response to an antigen that can be the drug itself or other self-antigens.     

CD10和Bcl-6在Castleman病中的表达及其意义

目的 探讨CD10和Bcl-6在Castleman病中的表达及其意义.方法 收集经病理诊断的Castleman病10例,反应性淋巴组织增生13例,滤泡性淋巴瘤13例,其中包括手术切除标本和活检穿刺标本,均应用免疫组织化学染色技术检测各组的CD10和Bcl-6的表达情况.结果 CD10免疫组化染色结果显示,Castleman病与反应性淋巴组织增生差异有统计学意义(P=0.003);Castleman病与滤泡性淋巴瘤差异有统计学意义(P<0.0001).Bcl-6免疫组化染色结果显示,Castleman病与反应性淋巴组织增生及滤泡性淋巴瘤差异均有统计学意义(P<0.0001).结论 CD10和Bcl-6可作为Castleman病的诊断及其与反应性淋巴组织增生和滤泡性淋巴瘤鉴别诊断的免疫学标志物.Castleman病的发病过程可能与Bcl-6基因异常有关;Bcl-6基因异常可能是Castleman病形态学改变的基础.     

Retroperitoneal Castleman’s disease with colon cancer. A rare association

Castleman's disease (CD) is a rare disorder of uncertain aetiology characterised by massive proliferation of lymphoid tissue usually localised as mediastinal masses, although abdominal involvement has been reported. Localised forms are usually associated with a good prognosis, but several more aggressive multifocal variants have been observed. Two different histologic subtypes have been described: the hyaline vascular type, more common in unicentric CD and usually asymptomatic, and the plasma cell form. Unicentric CD may be associated with an increased risk of lymphoma, but there was no reported increased risk of other malignancies. A patient with plasma cell subtype unicentric CD localised in retroperitoneum associated with an adenocarcinoma of ileocaecal valve and liver metastasis is reported.