Castleman's disease with isolated extensive cervical involvement

Castleman's disease is a lymphoproliferative disorder of uncertain cause characterized by a distinctive pattern of hypervascular lymphoid hyperplasia. Computed tomography and MRI can be used to define the extent of disease. The latter may be used to detect curvilinear hypointensities within the abnormal node. Symmetrical involvement of nasopharyngeal and parapharyngeal regions in our case without disease elsewhere is considered to be an unusual presentation.     

Cellular reactions in tumor stroma and reactive changes in regional lymph nodes in breast cancer

A study of 65 cases of breast cancer patients showed a complex interrelation between morphological characteristics (grade of malignancy, lymphoid infiltration, level of sinus histiocytosis and lymphoid hyperplasia in lymph nodes), clinical data (stage of the disease and extent of metastatic spread) and the results of immunological tests such as spontaneous rosette-formation and blastogenic reaction of lymphocytes. The level of lymphoid infiltration was found to be in direct correlation with that of tumor differentiation and in reverse correlation with patents' age. Cases exhibiting sinus histiocytosis developed metastases with a lower frequency. An increase in the level of lymphoid hyperplasia in lymph nodes was observed at early stages of tumor dissemination. A considerable drop in blastogenic reaction of lymphocytes was registered in cases of lymphoid infiltration-free tumors. Lymphoid hyperplasia in lymph nodes was associated with a lowered B-lymphocyte count in peripheral blood. A drop in the frequency of lymphoid infiltration was registered in patients with a stable decrease in the level of T-lymphocytes in the course of treatment. Also, clinical course was notably unfavorable in cases of lymphoid infiltration who responded well to treatment.     

Nasopharyngeal lymphoid hyperplasia after therapy for childhood lymphomas

Although diffuse thymic hyperplasia after therapy has been reported in lymphomas, no report is found in the medical literature about hyperplasia of other lymphoid tissues following chemotherapy in malignancies as far as we could reach. So, we planned to investigate the nasopharyngeal region of the lymphoma cases during their follow-up while at remission. Children who were in follow-up after cessation of oncological therapy with the diagnosis of lymphoma were evaluated for their nasopharyngeal lymphoid tissues by means of computed tomography. When a mass lesion was diagnosed, biopsies were taken. Among 23 lymphoma cases in follow-up, at a median of eight months (range 1-13 months), eight patients (six Hodgkin's and two Non-Hodgkin's malignant lymphoma) developed nasopharyngeal lymphoid hyperplasia (34.78%) that were proven to be benign by means of biopsies. Two of the patients also developed thymic hyperplasia. Nasopharyngeal hyperplasia regressed in four patients at a median of four months. Nasopharyngeal lymphoid hyperplasia may be diagnosed after the cessation of therapy in lymphomas and whatever the cause, it seems to be a benign process.     

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.     

Focal Lymphoid Hyperplasia of the Terminal Ileum Presenting Mantle Zone Hyperplasia with Clear Cytoplasm. A Report of Three Cases

We report three unusual cases of focal lymphoid hyperplasia of the ileocecal valve. The gross specimens showed thickening of the ileocecal valve. Low power magnification showed a dense lymphoid infiltrate in the mucosa and submucosa. This condition was characterized by reactive lymphoid follicles with large reactive germinal centers surrounded by a pale cuff of mantle zone lymphocytes presenting a marginal zone distribution pattern. These cells had intermediate- to- medium-sized round or slightly indented nuclei and a broad rim of clear cytoplasm. However, immunohistochemical study demonstrated that both the mantle zone lymphocytes and the pale cuff of the lymphoid cells were CD20+, sIgM+, sIgD+, CD5−, CD10−, CD23−, CD43−, Bcl-2+, Bcl-6−, CyclinD1−. The polytypic nature of these cells was demonstrated by immunohistochemistry and polymerase chain reaction. This unusual mantle cell hyperplasia with clear cytoplasm associated with focal lymphoid hyperplasia in middle-aged and elderly patients should be differentiated from the extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue type or mantle cell lymphoma showing a marginal zone distribution pattern. To avoid overdiagnosis and overtreatment, it is suggested that immunophenotypic and genotypic studies might be required, and careful attention should be paid to the morphologic examination.     

Changes in the colonic enteric nervous system in rats with chemically induced colon dysplasia and carcinoma

The enteric nerve plexus in the colon was investigated in rats with chemically induced colonic adenocarcinoma. Tissue specimens from the colons of four group rats, namely controls, treated animals without development of colonic macro- or microscopic changes, rats with dysplasia and lymphoid hyperplasia, and rats with colonic adenocarcinoma were studied using immunocytochemistry, and quantified by computerized image analysis. No morphometeric changes were found in the treated rats regarding the myenteric and submucosal ganglia, with the exception of nitric oxide synthase (NOS), where the number of nerve cell bodies/ganglia was reduced in the myenteric ganglia in rats with both lymphoid hyperplasia and dysplasia, and carcinoma. The relative volume density of protein gene product (PGP) 9.5-immunoreactive (IR) nerve fibres was higher in the muscularis propria in rats with lymphoid hyperplasia and dysplasia, and carcinoma. However the relative volume density of PGP 9.5-IR nerve fibres was higher in the submucosa in rats with carcinoma only. The relative volume density of substance P- and VIP-IR nerve fibres was significantly higher in the muscularis propria in rats with colonic carcinoma. The relative volume density of NOS-IR nerve fibres was significantly decreased in both muscularis propria and submucosa in rats with lymphoid hyperplasia and dysplasia, and carcinoma. These findings imply that regulatory signals of the enteric innervation may be involved in the pathogenesis of colorectal cancer.     

Gastric carcinoma with prominent reactive lymphoid hyperplasia; report of two cases with an immunohistological study

An immunohistological study using a Leu 7 antibody, which is a marker for human NK and K cells, was carried out in two cases of gastric carcinomas with prominent reactive hyperplasia. The patients were a 72-year-old man and a 55-year-old man who had shown good postoperative courses in spite of the advanced stage of their tumors. There were many scattered Leu 7 positive cells in the lymphoid hyperplasia, predominantly in the germinal centers and the peri-follicles. The number of Leu 7 positive cells were even more pronounced in a patient whose condition was more advanced. These findings suggest that lymphoid hyperplasia, particularly with regard to the NK and K cell response, plays a significant role in the clinical benignity of the tumors.     

胸部血管滤泡性淋巴组织增生21例分析

背景与目的：血管滤泡性淋巴组织增生（Castleman’s disease，CD）是一种罕见的淋巴组织异常增生性疾病。本研究分析经病理证实的21例CD患者的临床特征。方法：回顾性分析1971年1月-2007年12月胸部CD21例，其中男性10例，女性11例，平均年龄（38．6&#177;6．5）岁。局限型19例，播散型2例，经X线胸片、CT、开胸手术和病理证实。结果：全部病例均为透明血管型。X线和CT扫描：19例局限型平均直径为（5．2&#177;1．2）cm大小的单发软组织肿块，位于左肺门3例，右肺门2例，肺内3例，胸壁2例和纵隔9例；2例播散型为纵隔内多组淋巴结增大[直径1．5～4．0cm，平均（2．3&#177;0．9）cm]，无浅表淋巴结和其他脏器累及。平扫CT值平均42Hu，增强扫描呈显著强化，高达112Hu。术前CT误诊率90．5％。结论：胸部CD确诊主要依靠病理检查。局限型CD手术切除可以治愈，播散型CD手术切除疗效不佳，应选择多种模式治疗方法。     

Histopathological and Immunohistochemical Study of Atypical Lymphoid Hyperplasia and Benign Lymphoid Hyperplasia of the Stomach

We propose dividing histologically reactive lymphoid hyperplasia (RLH) of the stomach into two categories: atypical lymphoid hyperplasia (ALH), characterized by abnormal follicular architecture and infiltration of atypical lymphoid cells, and benign lymphoid hyperplasia (BLH), where normal follicular patterns are preserved and no atypical cells are found. Using twenty RLH cases (10 ALHs and 10 BLHs), both categories were compared front histopathological and immunohistochemical aspects. Macroscopic division into superficial, thick-walled and nodular types revealed most ALH (80%) to be superficial in character whereas in BLH superficial and thick-walled types were almost equally represented. Lesion size tended to be larger in ALH (> 6.1 cm) than in BLH (6.0 cm >) cases. As for prognosis after gastrectomy, both categories were favorable. On immunohistochemistry, ALH tended to be strongly labeled by B lymphocyte markers as compared to BLH, where only a weakly positive reaction was expressed. Infiltration of cells labeled by T lymphocyte markers was less conspicuous in ALH than in BLH. From these data, we concluded that ALH and BLH are two distinctive categories of lesion and that ALH has characteristics similar to these demonstrated by malignant lymphoma.     

Histopathological and immunohistochemical study of atypical lymphoid hyperplasia and benign lymphoid hyperplasia of the stomach.

We propose dividing histologically reactive lymphoid hyperplasia (RLH) of the stomach into two categories: atypical lymphoid hyperplasia (ALH), characterized by abnormal follicular architecture and infiltration of atypical lymphoid cells, and benign lymphoid hyperplasia (BLH), where normal follicular patterns are preserved and no atypical cells are found. Using twenty RLH cases (10 ALHs and 10 BLHs), both categories were compared from histopathological and immunohistochemical aspects. Macroscopic division into superficial, thick-walled and nodular types revealed most ALH (80%) to be superficial in character whereas in BLH superficial and thick-walled types were almost equally represented. Lesion size tended to be larger in ALH (greater than 6.1 cm) than in BLH (6.0 cm greater than) cases. As for prognosis after gastrectomy, both categories were favorable. On immunohistochemistry, ALH tended to be strongly labeled by B lymphocyte markers as compared to BLH, where only a weakly positive reaction was expressed. Infiltration of cells labeled by T lymphocyte markers was less conspicuous in ALH than in BLH. From these data, we concluded that ALH and BLH are two distinctive categories of lesion and that ALH has characteristics similar to these demonstrated by malignant lymphoma.     

Lymphocyte populations with abnormal kappa:lambda ratios in reactive lymphoid hyperplasia

The lymph node biopsies of 12 patients with lymphadenopathy due to reactive hyperplasia contained lymphocyte populations with increased percentages of B-cells and abnormal numbers of cells with single class surface immunoglobulins. Ten patients were followed for periods of 3-30 months: one developed a non-Hodgkin's lymphoma and one Hodgkin's disease. One other has persisting lymph node enlargement. Two patients had nonlymphoid malignancies. The other six remain well without lymphadenopathy. Twenty-five of 40 patients with reactive lymph node hyperplasia and normal kappa/lambda ratios followed for 9-36 months had a similar incidence of lymphoid malignancy and persistent lymph node enlargement. The follow-up data so far available do not support a hypothesis that reactive lymphoid hyperplasia with increased numbers of cells with single class surface immunoglobulin is associated with higher morbidity than reactive hyperplasia containing the usual polytypic lymphocyte populations.     

Polyclonal polymorphic B-cell lymphoproliferative disorder with prominent pulmonary involvement in children with acquired immune deficiency syndrome

Four cases of pediatric Acquired Immune Deficiency Syndrome (AIDS) with lymphoproliferative disorder are described and other lymphoid lesions in previously reported cases of pediatric AIDS are reviewed. The lymphoproliferative disorder was characterized by polyclonal, polymorphic B-cell content without evidence of cellular atypia, necrosis or prominent mitotic activity but with predominantly extranodal systemic and prominent pulmonary involvement. Since the lesion has overlapping features it is considered to be intermediate between benign and malignant lymphoproliferations and designated as polyclonal, polymorphic B-cell lymphoproliferative disorder (PBLD) of pediatric AIDS. The PBLD is part of a spectrum of lymphoid lesions in pediatric AIDS consisting of follicular lymphoid hyperplasia of nodal and extranodal sites, pulmonary lymphoid hyperplasia/lymphoid interstitial pneumonitis complex (PLH/LIP complex) in cases previously reported by the authors, and also malignant lymphoma reported by others. It is possible that Epstein-Barr virus (EBV) by itself or in synergism with human T-lymphotropic virus-type III (HTLV-III) is related to pathogenesis of PBLD in children with AIDS.     

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.     

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.     

Nodular Lymphoid Hyperplasia and Colo-Rectal Carcinoma

Two cases of colo-rectal carcinoma with prominent nodular lymphoid hyperplasia in adjacent bowel are presented. The normal incidence and associated conditions are discussed.     

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.     

Follicular lymphoid hyperplasia simulating intussusception in a 6‐year‐old boy: Clinical,radiological and histopathological findings

We report the case of a 6‐year‐old boy who initially presented with recurrent abdominal pain. Diagnostic imaging, including ultrasound and CT, showed findings typical of an ileocecal intussusception with abdominal lym‐phadenopathy. Sonographically, the morphological appearance of the intussusception did not change during a 4‐week follow‐up period. Surgery was performed on the tentative diagnosis of a tumour versus lymphoma. Upon laparatomy, intussusception was ruled out and a large, broad‐based tumour of the caecum was palpable. The histopathology after ileocecal resection revealed follicular lymphoid hyperplasia. Where there is radiological suspicion of an intussusception in children with no or insignificant symptoms, follicular lymphoid hyperplasia should be included in the differential diagnosis.     

Bone marrow histopathology and prognosis in malignant lymphomas.

Bone marrow trephine biopsies of patients with non-Hodgkin's malignant lymphomas (ML), followed for at least 4 years, were investigated using univariate and multivariate survival analyses to detect which anagraphic data and histomorphologic medullary patterns before therapy were related to the prognosis. In 234 ML (146 low grade, 88 high grade), univariate analysis showed that survival was reduced by bone marrow involvement, absence of reactive lymphoid nodules, and low marrow cellularity. Moreover, in low-grade ML, patients 50 years or older and showing absence of myeloid hyperplasia, excess of hemosiderin and mast cell hyperplasia had significantly lower-survival rates. The prognostic relevance of these parameters did not change when cases without marrow involvement were separately analyzed. Multivariate analysis showed that, besides marrow involvement, age and myeloid hyperplasia had significant prognostic importance in low-grade ML, and lymphoid nodules in high-grade ML. Our data confirm the value of bone marrow histopathology in ML and indicate that the prognosis is related not only to medullary involvement but also to the morphology of the uninvolved marrow.     

Survival with mammary cancer related to the interaction of germinal center hyperplasia and sinus histiocytosis in axillary and internal mammary lymph nodes.

In a review of the histologic sections of axillary and internal mammary lymph nodes removed during surgery for invasive ductal carcinoma of the breast, we found that 16 of 17 patients in whom sinus histiocytosis was the dominant lymphoid proliferative reaction are alive with no evidence of cancer 5 or more years after operation. In contrast, 5 of 6 patients in whom germinal center hyperplasia was the only significant reaction found died of cancer in less than 5 years. Patients with both sinus histiocytosis and germinal center hyperplasia in significant amounts had survival that was intermediate; 17 of 25 of these patients are currently alive and apparently free of cancer. In addition, 5 of 6 patients in whom no evidence was found of any lymphoid proliferative reaction and 3 of 3 patients with diffuse cortical hyperplasia in their axillary lymph nodes died of cancer in less than 5 years. Germinal center hyperplasia was associated with nodal metastases anatomically in individual lymph nodes and statistically in the series of cases. The internal mammary lymph nodes of most cases showed less proliferative reaction to tumor than the axillary lymph nodes. The pattern of proliferative reactions in lymph nodes and its correlation with survival after surgery suggest that different immune reactions may either suppress or enhance the growth of carcinoma of the breast.     

Gastric pseudolymphoma. Its three subtypes and relation to lymphoma

Three separate histologic types of gastric pseudolymphoma (GPL) are described: (1) the common "inflammatory" type usually accompanied by ulceration and extensive fibrosis; (2) the entity known as "nodular lymphoid hyperplasia," which was associated with multiple intestinal lesions; and (3) the third reported case of angiofollicular lymphoid hyperplasia of the stomach (one with nodal involvement). Criteria for the common type were developed and, in general, confirm previous studies. However, the importance of evaluating nuclear cytology and mitotic rate are stressed. Organ infiltration by chronic lymphocytic leukemia should be excluded by the absence of an absolute peripheral lymphocytosis. In addition to the ten cases presented, the literature on 175 previous cases is summarized. GPL is estimated to account for 10-15% of all gastric lymphoid tumors. In comparison to gastric lymphoma, GPL is usually smaller in size and occurs a decade earlier on the average. Since an associated focal lymphoma was documented in an additional five cases, this study proposes that pseudolymphoma be considered a precursor lesion with malignant potential. Extensive pathologic sampling and total surgical excision are recommended.