Molecular analysis of clonality of sporadic angiomyolipoma

Angiomyolipoma, which consists of three intimately intermixed components, smooth muscle, blood vessels, and adipose tissue, is variably considered a hamartoma, a choristoma or a true neoplasm. This study has investigated the clonality of sporadic angiomyolipomas in seven women, each with a single lesion, by determining the pattern of X-chromosome inactivation. Polymerase chain reaction (PCR) amplification of the highly polymorphic human androgen receptor gene (HUMARA) was performed on the DNA extracted from the paraffin-embedded lesional tissue microdissected to sample the admixed smooth muscle and blood vessel component (SMC/BV) and the adipose tissue component. All seven patients were heterozygous for HUMARA polymorphism upon amplification of undigested DNA from non-lesional tissue and were therefore informative for further analysis. In all patients, lesional DNA, representative of the components, was predigested with HpaII restriction enzyme for amplification of the methylated allele. In six patients, the lesions were clonal, while in one, polyclonal. The polyclonal lesion was small and had less than 20 per cent SMC/BV component. Microdissected SMC/BV component was clonal in 6/7 lesions; the scanty SMC/BV in the remaining lesion did not yield amplifiable DNA. Microdissected adipose tissue was polyclonal in all seven lesions. Angiomyolipomas are three clonal lesions due to a clonal smooth muscle cell and blood vessel component, while the polyclonal adipose tissue is probably metaplastic or reactive. Copyright © 1999 John Wiley & Sons, Ltd.     

Demonstration of clonality in T-cell lymphoma using an anti-T-cell receptor variable region antibody panel

Frozen sections from 35 T-cell lymphomas were stained with the Diversi-T alpha beta T-Cell Receptor panel which includes seven antibodies to T-cell receptor variable region gene products. In five cases a monoclonal population of T-cells could be demonstrated (one case V beta 5+, three cases V beta 8+ and one case V beta 6+) and in a further case a biclonal population (V beta 5+ and V beta 8+). We conclude that this antibody panel is of limited usefulness for the demonstration of clonality in T-cell lymphoma.     

PCR-based clonality analysis: a reliable method for the diagnosis and follow-up monitoring of conservatively treated gastric B-cell MALT lymphomas?

AIMS: We evaluated polymerase chain reaction (PCR) amplification of specific immunoglobulin heavy chain (IgH) gene rearrangements as a means of demonstrating monoclonality during follow-up of conservatively treated gastric MALT lymphoma, and compared the reproducibility of PCR on sequential frozen and paraffin-embedded endoscopic biopsies. We established an association between clonality detected by PCR and the histological observations. METHODS AND RESULTS: Sixty-nine pairs of sequential frozen and paraffin-embedded endoscopic biopsies from 21 conservatively treated patients were graded according to the Wotherspoon-Isaacson histological scoring system, which provides a measure of diagnostic confidence on a scale 0-5. PCR amplification of the IgH gene was performed using FR3/JH and FR2/JH primers. 68/69 paired samples (98.5%) showed identical mono- or polyclonal PCR amplification patterns. Forty-seven out of 48 pairs of samples sharing similar histological features produced identical amplification patterns in both fresh and paraffin-embedded tissues. In comparison with the histological grading, monoclonality was detected in 64.2% and 41.6% of samples scored 5 and 4, respectively. Conversely, among 64 samples scored 0-3, a monoclonal pattern was observed only in two samples, one of which was from a patient who relapsed 9 months later. CONCLUSIONS: PCR-based clonality analysis by demonstration of specific IgH gene rearrangement can be easily and reliably performed on both frozen and paraffin-embedded endoscopic biopsies. In conjunction with histological observation, this method can be used as a complementary tool to monitor MALT lymphoma regression during conservative treatment.     

Hepatic cytotoxic T-cell infiltrates in patients with peripheral T-cell proliferative diseases/lymphomas: clinicopathological and molecular analysis

Seventy patients with various types of peripheral T-cell proliferative disease/lymphoma who manifested with prolonged fever, weight loss, anemia, lymphadenopathy, hepatosplenomegaly and elevated serum levels of alkaline phosphatase and/or lactate dehydrogenase were evaluated. Histopathological examination of the livers revealed T-cell infiltration into the hepatic sinusoids and portal tracts. The morphology of the infiltrated T cells varied from mature small lymphocytes to malignant lymphoid cells. The liver pathology was classified into four groups on the basis of cellular atypia. Group A and group B showed mature lymphoid cell infiltration; however, only group B had multiple large areas of hepatocellular necrosis. Group C showed atypical lymphoid cell infiltration and in group D malignant lymphoid cell infiltrates were demonstrated. The majority of the antigenic phenotypes of these T-cell infiltrates were CD3+, CD4-, CD8+, CD20-, CD45RO+, CD56-, CD57-, TIA-1+ and betaF1-. Epstein-Barr virus RNA in the nuclei of the infiltrated T cells was recorded in 38.6% of the patients and was more common in groups C and D. Patients in groups B, C and D had a very poor prognosis, median survival was only 1 month, whereas median survival in group A patients was 36 months. Chemotherapy was not effective in improving survival. Monoclonal band/s of T-cell receptors (TCR) beta and/or gamma gene rearrangements were detected in 88.6% of patients, and DNA-sequence analysis showed high identity to the human TCR germline gene.     

Optimal primer selection for clonality assessment by polymerase chain reaction analysis: I. Low grade B-cell lymphoproliferative disorders of nonfollicular center cell type

Recent polymerase chain reaction (PCR)-based studies focused on the detection of immunoglobulin heavy chain gene (IgH) rearrangements have suggested that clonal populations may be amplified more easily from certain categories of B-cell neoplasia than others and that primer makeup can be a critical factor in successful amplification. However, these particular reports contained relatively few low grade B-cell lymphoproliferative disorders of nonfollicular center cell type (LG-BLPD) and used only a limited panel of available primer sets for PCR amplification of monoclonal B-cell populations. To address this issue more extensively we evaluated 156 samples of LG-BLPD by the PCR to determine optimal primer selection in this setting. All cases were classified according to standard morphological and immunophenotypic criteria, with monoclonality documented by Ig light chain restriction analysis. The LG-BLPD included 33 cases of chronic lymphocytic leukemia (CLL), 57 cases of small lymphocytic lymphoma (SLL), 10 cases of atypical CLL, 32 cases of mantle cell lymphoma (MCL), 17 plasma cell neoplasms (PCNs), and seven cases of hairy cell leukemia (HCL). All primer sets included a 3′ IgH joining region consensus primer, whereas the 5′ IgH variable region (VH) primer was different in each set. The first-line panel included the following: Set 1, VH-framework III consensus primer, and Set 2, seven separate VH-framework I family-specific primers. A reserve panel of alternate VH consensus primers directed at framework II or III regions was used only when Set 1 showed no evidence of B-cell monoclonality. Overall, monoclonal B-cell populations were amplified in 153 of 156 (98%) neoplasms by the PCR; two PCNs and one plasmacytoid SLL were negative with all primer pairs. Higher amplification efficiency was obtained with Set 1 primers than Set 2 primers in the entire series (96% ν 84%) as well as within each subtype of LG-BLPD. In each diagnostic category monoclonal B-cell populations were detected by Set 1 in 96% or more of neoplasms, the only exception being plasma cell neoplasms where the monoclonality detection rate was 76% (ie, 13 of 17 cases). With the additional use of Set 2 and the reserve panel primer sets, 15 of 17 (88%) PCNs were shown to contain PCR-detectable monoclonal B-cell populations. Our data suggest that the vast majority of CLLs, SLLs, MCL, and HCL samples can be successfully genotyped by the PCR with a single primer set (Set 1). In contrast, plasma cell tumors and rare SLL samples appear to require more extensive analysis (ie, additional primer sets) to adequately assess B-cell clonality.     

不同亚型T细胞淋巴瘤与EB病毒的关系

目的 :探讨不同组织学类型T细胞淋巴瘤 (TCL)与EBV感染的关系。方法 :对 83例 (6种类型 )TCL进行研究 ,包括低度恶性 30例 (其中小多形 2 1例、小淋巴细胞性 9例 ) ,高度恶性 5 3例 (其中大 /中多形 31例、淋巴母细胞性 9例、间变性大细胞性 7例、透明细胞性 6例 )。采用PCR检测EBV特征性的DNA序列 (EBV DNA)和ISH法检测EBV编码的RNA(EBER 1/2 )。结果 :每种类型TCL均有EBV的阳性表达 ,低度恶性组与高度恶性组之间EBER 1/ 2表达率差别有显著性 (P <0 0 5 )。结论 :各种类型TCL的发生发展均与EBV感染有关 ,但高度恶性组EBER 1/ 2的表达比低度恶性组更显著。     

Polymerase chain reaction in the diagnosis of T-cell lymphoma in paraffin-embedded bone marrow biopsies: a comparative study

AIMS: In routine histological analysis of bone marrow biopsies, the distinction between reactive T-cell infiltrates and T-cell lymphoma can be difficult, even with the use of extensive immunohistochemistry. The aim of this study was to evaluate the diagnostic contribution of TCR-gamma gene rearrangement analysed by PCR. METHODS and RESULTS: The samples studied consisted of 46 paraffin-embedded bone marrow biopsies (diagnosis, staging and follow-up) from 26 patients with T-cell lymphoma. The bone marrow biopsies were categorized into three groups according to the morphological and immunohistochemical results. Group 1, positive for T-cell lymphoma (24 bone marrow biopsies), group 2, suspicion of T-cell lymphoma (15 bone marrow biopsies) and group 3, negative for T-cell lymphoma (seven bone marrow biopsies). DNA could be amplified in 45/46 bone marrow biopsies (98%). Clonal rearrangement was detected in 30/45 bone marrow biopsies tested (67%) including 15/24 bone marrow biopsies (62.5%) of group 1, 11/14 (78.5%) of group 2 and 4/7 (57%) of group 3. In total, PCR analysis supported a diagnosis of T-cell lymphoma in 15/45 bone marrow biopsies (33%), in which histological and/or immunohistochemical examination provided inconclusive evidence of malignancy. CONCLUSIONS: TCR-gamma PCR is a complementary tool for the assessment of T-cell lymphoma in bone marrow biopsies. Optimal evaluation of bone marrow biopsies requires an integrative approach of all available results from morphology, immunohistochemistry, molecular biology and clinical data.     

Molecular analysis of T-cell clonality with concomitant specific T-cell proliferation in vitro in nickel-allergic individuals

BACKGROUND: The peripheral blood mononuclear cells (PBMC) of individuals with nickel contact allergy are reported to proliferate to a varying degree upon nickel stimulation in vitro. Different phenotypes of the T cells involved are described. With regard to preferential use of the T-cell receptor (TCR), analysis of the several families of the TCR-gamma gene allows rearrangement evaluation of all T cells regardless of predominant surface expression of TCR alpha/beta. METHODS: The PBMC of 10 nickel-allergic and five nonallergic individuals were cultured for 4 days in the presence of either medium, PHA, NiSO4, or tetanus toxoid (TT). Proliferation was measured by radioactive thymidine uptake and expressed as stimulation index (SI). T-cell clonality was assessed by analysis of the TCR-gamma chain gene, including the use of PCR with a primer combination covering the four main groups (Vgamma1-8, Vgamma9, Vgamma10, and Vgamma11) of the variable region of the TCR-beta chain gene. RESULTS: In the allergic individuals, proliferation to NiSO4 was significantly (P<0.05) higher than in nonallergics (mean SI: 18.05/17.87 vs 0.67/2.27). In unstimulated and PHA-stimulated cultures, there was a random TCR spectrum in both groups. In contrast, in nickel-allergic individuals or individuals with recent TT-booster, oligoclonality could be observed in the correspondingly stimulated cultures. CONCLUSION: In addition to proliferation assay, analysis of T-cell clonality may be a further means to characterize clinical hypersensitivity reactions on the basis of antigen-dependent oligoclonal T-cell expansion, as in the case of tissue-infiltrating lymphocytes.     

The polymerase chain reaction in the diagnosis of early mycosis fungoides

The earliest or patch stage of mycosis fungoides may present diagnostic difficulty both clinically and pathologically. The present study of the polymerase chain reaction (PCR) as a diagnostic tool in early mycosis fungoides was therefore undertaken, using a rapid PCR method for the detection of γ- and β-chain T-cell receptor (TCR) gene rearrangements in routine formalin-fixed, paraffin-embedded histological sections. Forty-two biopsies were studied from 26 patients with mycosis fungoides. Twenty-three skin biopsies with a clinicopathological diagnosis of early, or patch stage, mycosis fungoides were investigated. Of these, 18 (78 per cent) showed TCR-γ or both β- and γ-chain TCR gene rearrangements. TCR gene rearrangements were shown in seven of the 14 plaque stage lesions (50 per cent) and also in the single case of tumour stage disease. Where gene rearrangements were identified, these were identical in all biopsies from an individual patient, irrespective of the site of the lesion, the disease stage, or the time lapse between the biopsies. The PCR is therefore a highly sensitive technique, which can be performed on routine pathological material, in cases where the diagnosis of early mycosis fungoides cannot be made with certainty on conventional histopathological and immunohistochemical grounds. © 1997 John Wiley & Sons, Ltd.     

Malignant lymphoma of the urethra: report of a case with detection of Epstein–Barr virus genome in the tumour cells

We report a primary non-Hodgkin's B-cell lymphoma of the urethra in a 78-year-old female. Serum antibodies for Epstein–Barr virus (EBV) were negative, but there was a 40-fold increase in antibodies to EBV-associated nuclear antigen. Using PCR and in situ hybridization techniques, EBV genome was found in the tumour cell nuclei.     

142例结外NK/T细胞淋巴瘤免疫组织化学分析

目的:探讨结外NK/T细胞淋巴瘤(extranodal NK/T-cell lymphoma,ENKTL)的免疫组织化学特征.方法:回顾性分析142例ENKTL的免疫组织化学结果及EBER原位杂交结果,并用PCR方法检测1例ENKTL的TCR基因重排.结果:ENKTL免疫组织化学阳性率CD2为87.9％(116/132),CD3为99.3％(141/142),CD5为33.3％(44/132),CD7为74.7％(74/99),CD4为30.2％(13/43),CD8为35.9％(14/39),CD56为92.9％(132/142),TIA-1为100％(132/132),颗粒酶B为99％(111/112),穿孔素为100％(6/6),CD30为40.9％(36/88),PDGFRA为51.9％(28/54),CMYC为53.7％(29/54),Ki-67指数50％～90％,中位数为80％.EBER原位杂交阳性率为100％(142/142).TCR基因重排结果阴性.结论:结外NK/T细胞淋巴瘤存在较为特征性的免疫组织化学表型,并且EBER原位杂交呈阳性.     

TCR基因重排检测在T细胞淋巴瘤病理诊断中的作用

基因重排现象是每个淋巴细胞在早期经历的一个正常的过程,由于机体每个淋巴细胞的重排基因都是特有的,使每个淋巴细胞都有独特的重排形式。如若机体在某些致瘤因素的作用下失去对某个基因重排细胞的控制,则该细胞就会出现无控制的、单克隆性增生,最终导致淋巴瘤的形成。所以淋巴瘤所具有的是单克隆性重排。因此通过聚合酶链反应（polymerase chain reaction,PCR）技术进行T细胞抗原受体（T cell receptor,TCR）基因克隆性重排分析,尤其在常规HE形态学与免疫组化结果都不能确诊时,显得尤为重要。该文对其在T细胞淋巴瘤病理诊断中的作用作一综述。     

Primary T-cell non-Hodgkin's malignant lymphoma of the appendix

A case of primary T-cell lymphoma of the appendix in an 84-year-old female was reported. Appendectomy was performed as a result of the clinical diagnosis of acute appendicitis, due to the rebound tenderness of McBurney's point and thickness of the appendix wall as determined from ultra echo sonograph. Grossly, the surgical resected appendix did not have a dominant inflammatory appearance, therefore a tumor was suspected. Microscopic examination showed diffused proliferation of large and medium size lymphoma cells. Immunohistochemical examination further revealed that the lymphoma cells were positive for T-cell markers. To ensure this was a T-cell lymphoma, molecular examination was performed using paraffin-embedded tissue sections, since T-cell lymphoma of the appendix is extremely rare. Polymerase chain reaction (PCR) single-strand conformation polymorphism (SSCP) analysis demonstrated monoclonal T-cell receptor gene rearrangement. T-cell-rich B-cell lymphoma was excluded. To our knowledge, this is the first reported case of primary T-cell lymphoma of the appendix. PCR-SSCP analysis in paraffin-embedded tissue section was very useful in the diagnosis of lymphoma cell monoclonality.     

Value of clonality studies of cutaneous T lymphocytes in the diagnosis and follow-up of patients with mycosis fungoides

Histological features of early mycosis fungoides (MF) can simulate numerous inflammatory lesions and histological confirmation of MF is often delayed, compared with clinical diagnosis. Recently, using molecular techniques, the detection of a dominant T-lymphocyte clone has been reported in cutaneous lesions of MF. The aim of the present study was to determine the diagnostic value of a dominant T-lymphocyte clone as assessed by PCR-DGGE in early MF. Histopathological and molecular analyses were performed on cutaneous lesions from 104 patients clinically suspected as having MF. In this population, the positive predictive value of a PCRγ(+) was 0·86. In addition, four of six patients whose lesions were PCRγ(+) (detectable dominant T-cell clone) but not histologically MF progressed to MF within 2–48 months. In order to evaluate the relevance of PCRγ–DGGE in MF follow-up, serial biopsies were performed in 24 patients. In 89 per cent of cases, the presence or absence of a PCRγ(+) was constant during the course of the disease. When present, the DGGE imprint of PCR products was case-specific. These data demonstrate the diagnostic value in MF of T-lymphocyte clonality assessed by PCRγ–DGGE on cutaneous lesions and show that the technique can be used in MF follow-up to evaluate residual disease with high specificity. © 1998 John Wiley & Sons, Ltd.     

Accumulation of multiple T cell clonotypes in the synovial lesions of patients with rheumatoid arthritis revealed by a novel clonality analysis.

T cell activation in the characteristic synovial lesions of rheumatoid arthritis may play a major role in the pathogenesis of this autoimmune disease. Analysis of T cell clonal diversity in these sites remains equivocal. Using the PCR and subsequent single-strand conformation polymorphism analysis it is possible to assess the degree of junctional diversity in the TCR with minimal selection bias. Concentrating on the beta-chain of the TCR, a paucity of clonotypic T cell expansion is demonstrated in the peripheral blood of healthy individuals. After polyclonal stimulation in vitro (with concanavalin A or phytohemagglutinin) this pattern does not change. In contrast, some T cell clonotypes appear following in vitro stimulation with purified protein derivative. Analysis of the peripheral blood, synovial fluid, and synovial tissue of patients with rheumatoid arthritis indicated many dominant T cell clonotypes. These data argue for a clonally diverse T cell response in the affected tissues of rheumatoid arthritic subjects.