Lymphadenitis mimicking Hodgkin''s disease

A variant of lymphadenitis mimicking interfollicular Hodgkin's disease is described. The morphology, immunohistochemistry and clinical course of 25 cases are reported. The morphology is characterized by changes in the interfollicular region within a well-preserved lymph node architecture. These changes include variegated hyperplasia of the pulp with epithelioid cells, mature eosinophilic granulocytes and immunoblasts occasionally resembling Hodgkin cells. In contrast to Hodgkin's disease no typical Sternberg-Reed cells could be found. Immunohistochemically, neither positive reactions with Hodgkin cell markers (anti-CD15: LeuM1; 3C4; C3D-1) nor B-cell monoclonality could be detected. Transition to malignancy, in particular Hodgkin's disease, did not occur in our cases.     

Phenotypic expression of Hodgkin''s and Reed-Sternberg cells in Hodgkin''s disease.

The phenotypic expression of Hodgkin's and Reed-Sternberg (H-RS) cells was determined by analysis with a panel of monoclonal antibodies and peanut agglutinin (PNA) by an immunohistochemical technique. Seven antibodies, including T200, anti-HLA-DR, anti-Leu 10, A1G3, anti-Tac, OKT9, and anti-Leu M1, were found to react with a great majority of H-RS cells. In some cases, H-RS cells also bound PNA. Other antibodies, including those highly specific for T cells (eg, Lyt 3) and B cells (eg, B1, anti-Leu 14) were consistently negative. The results argue against the derivation of H-RS cells from T or B lymphocytes. The H-RS cells were also negatively stained with antibodies which react with monocytes (OKM1, Mo-2, 63D-3), follicular dendritic cells (DRC-1), and natural killer/killer cells (Leu 7, Leu 11a, B73.1). The presence of Leu M1 and Tac in H-RS cells is of interest. Anti-Leu M1 positivity was seen in all 20 of Hodgkin's disease (HD) cases tested and should provide a very useful reagent for differential diagnosis of HD from other reactive and neoplastic conditions. Tac normally is present only on activated T cells. The presence of Tac in H-RS cells may reflect expression of T-cell growth factor receptor or a closely related protein during a stage of neoplastic transformation. Although the nature of the neoplastic cell of HD cannot be determined by these studies, they are consistent with an origin from interdigitating reticulum cells. Both H-RS cells and interdigitating reticulum cells have a similar antigenic phenotype (Leu M1+, T200+, HLA-DR+, Leu 10+, A1G3+, and OKT9+) and a similar pattern of lysosomal enzyme activity.     

Toxoplasma encephalitis complicating Hodgkin''s disease.

A case of Toxoplasma encephalitis is described in a patient who had received much immunosuppressive therapy for Hodgkin's disease. Such cases have been reported in immune suppressed patients outside the United Kingdom, but a search of the literature has not revealed any previous reports from this country. Since Toxoplasma gondii is a frequent pathogen and states of immune suppression are becoming more common, further cases, can be expected. Recognition of the clinical and pathological features is important because the condition can be treated.     

Immunophenotypic study of lymphocyte predominance Hodgkin''s disease

An immunophenotypic study of 17 cases of diffuse lymphocyte predominance Hodgkin's disease and 20 cases of nodular lymphocyte predominance Hodgkin's disease, along with eight of mixed cellularity and five of nodular sclerosing Hodgkin's disease, is reported. The atypical cells in nodular lymphocyte predominance Hodgkin's disease showed only minor differences from the published consensus. However, the atypical cells in diffuse lymphocyte predominance Hodgkin's disease showed an immunophenotype which was commonly B-cell positive (59%), but in a minority of cases LeuM1 (24%) or epithelial membrane antigen (12%) positive; none of the cases was Ber-H2 positive. These results do not differ greatly from our findings in nodular lymphocyte predominance Hodgkin's disease, but do diverge from the published consensus for diffuse lymphocyte predominance Hodgkin's disease. The question as to whether morphology or immunophenotype should form the primary diagnostic criterion for the definition of lymphocyte predominance Hodgkin's disease is discussed.     

Hodgkin''s disease presenting with the histological features of Castleman''s disease

Three cases are reported in which an initial diagnosis of the plasma cell variant of Castleman's disease was made, but in which a second lymph node biopsy within a year showed evidence of Hodgkin's disease. Review of the initial biopsy indicated that atypical CD15 and CD30 positive cells were present in the initial biopsy. This illustrates the difficulty in making the diagnosis of Castleman's disease and suggests that the lymphoid reaction to the presence of Hodgkin's disease may result in similar histological appearances. The need for re-evaluation of the diagnosis of Castleman's disease in the face of persistent or recurrent disease is stressed.     

Hodgkin''s disease: a flow cytometric study.

Flow cytometry was performed on paraffin embedded tissue from 115 cases of Hodgkin's disease. Thirteen (11%) tumours were aneuploid with no significant difference between the histological subgroups. The median proliferative index was 14%, and the highest values were found in the NS2 (16.4%) and lymphocyte depleted (16.0%) subgroups. The difference in proliferative index approached significance when the NS2 subgroup was compared with the NS1 subgroup (p less than or equal to 0.11) and when the lymphocyte depleted and NS2 subgroups combined were compared with the mixed cellularity, lymphocyte predominance, and NS1 subgroups combined (p less than or equal to 0.07). There was a trend towards better survival for patients with aneuploid tumours and those cases with a proliferative index below 15%, but neither of these trends was significant.     

A clinicopathological study of nodular sclerosing Hodgkin''s disease

The clinicopathological features of 29 patients with nodular sclerosing Hodgkin's disease are described. The histological appearances are those of a nodular pattern due to thick fibrous bands which encircle areas of abnormal lymphoid tissue in which a particular form of abnormal reticulum cell can be recognized. They can be further subdivided into well differentiated and poorly differentiated types; the median survival time from onset in the well differentiated type was approximately nine years and in the poorly differentiated type two years. The outstanding clinical feature of patients with the well differentiated histological pattern was repeated enlargements of various groups of lymph glands over long periods of time.