Expression of Functional Molecules in Non-Hodgkin's Lymphoma

It is well known that non Hodgkin's lymphoma (NHL) cells express various antigens which are normally involved in a variety of functions. In addition, NHL is diverse in its proliferative capacity. To investigate the relation between these factors and the clinical picture, 45 cases of NHL were studied by immunohistochemistry using snap-frozen materials obtained before therapy. Reactivities with 27 monoclonal antibodies were examined and the results were correlated with clinical findings. The expression of surface μ and CAM-1 in B-NHLs and CD25 in T-NHLs were significantly associated with bone marrow involvement. B-NHLs without expression of CD21(B2) and T-NHLs with CD25 were seen more frequently in cases with a LDH value of over 500 units/ml. The positivity rate of Ki-67 on B-NHLs was correlated with serum LDH value, NHL histologic classification, and overall survival. These data indicate that immunophenotyping and determination of the proliferative capacity of NHL are of value not only for confirmation of the histopathologic classification of the tumor but also for assessment of clinical behavior.     

Adult T cell leukemia/lymphoma with massive involvement of cardiac muscle and valves

An autopsy case of a 58-year-old woman with massive cardiac Involvement of adult T cell leukemia/lymphoma (ATLL) is reported. She developed cardiac failure due to aortic and mitral regurgitation with cardiac infiltration of ATLL cells, and underwent replacement of both aortic and mitral valves. Studies of the cut-surfaces revealed diffuse thickening of the subendocardial wall of the left chamber with widespread whitish-brown tumor infiltrates. In the regions surrounding the replaced aortic and mitral valves there was also massive tumor cell infiltration. The tumor cells infiltrating the cardiac muscle wall were T cell in origin and exhibited Leu-3a (CD4)-positive immunoreaction. Ultrastructurally, tumor cells contained markedly indented nuclei and some were attached directly to the muscle cells. These findings suggest that this was an unusual form of ATLL with widespread involvement of the heart.     

Detection of the Epstein-Barr virus in primary gastric lymphoma by in situ hybridization

The Epstein-Barr virus (EBV) has been shown to be associated with numerous human malignancies including Burktt's lymphoma and nasopharyngeal lymphoepithelioma. In addition, some typical gastric adenocarcinomas were also recently reported to demonstrate EBV relevance. The present study was designed to detect EBV in primary gastric lymphoma, using the in situ hybridization (ISH) method, in which oligo-nucleotide probes for the EBERl RNA and the EBV DNA W region have been used. Of the 49 cases of primary gastric lymphoma studied, which all showed B cell immunopheno-type, EBER1 sequences could only be found in four cases, including two low-grade cases and two high-grade cases of histological subtypes while the number of positive cells was less than 50% of the tumor cells. In one case of low-grade mucosa associated lymphoid tissue (MALT) lymphoma, the EBER1 -positive neoplastic cells were found in the regional lymph node, but the primary site of the stomach showed no positive signals. The EBV presence was further confirmed by the EBV DNA ISH. Using the ISH method, rare or occasional positive lymphoid cells (probably non-tumorous bystander cells) could be detected in 10 other cases including all histological subtypes. The present study shows that only a small proportion of primary gastric lymphoma is associated with EBV, and such positive cases could be found in both high- and low-grade histological subtypes. It is also suggested that the EBV presence in the neoplastic cells of some cases of primary gastric lymphoma is most likely a secondary phenomenon.     

多克隆性IBL样T淋巴瘤一例报告——病理组织学、免疫组织化学和免疫电镜综合观察

本文报道一例用病理组织学、免疫组织化学和免疫电镜综合确诊的多克隆性IBL样T细胞性淋巴瘤。讨论了这三种病理研究手段综合应用在本例诊断中的意义。指出免疫电镜在确定阳性反应细胞的细微形态上较光镜有明显优越性。     

165例恶性淋巴瘤中p16基因异常的研究

目的 检测恶性淋巴瘤（ML）中p16基因的缺失、甲基化及p16蛋白的表达,探讨p16基因异常在淋巴瘤中的意义。方法 收集淋巴瘤鹇组织标本50例,存档石蜡包埋组织标本115例,均包括T、B非霍奇金淋巴瘤（NHL）及霍奇金淋巴瘤（HL）。用PCR、甲基化特异的PCR方法检测新鲜组织中的p16基因的等位缺失及5‘CgG岛异常甲基化;用免疫组织化学方法检测石蜡标本中p16蛋白的表达情况。另外,分别选取9例反应性增生（RH）组织的标本作对照。结果 12/50例（24.0%）新鲜标本中检出p16基因纯合性缺失,16/50例（32.0%）检出p16基因异常高甲基化;石蜡包埋标本中p16蛋白的失表达率为41.6%,其中B-NHL为46.0%,T-NHL为54.5%,HL为31.6%。恶性程度较高的淋巴瘤类型中p16蛋白的失表达率也相应较高,各类型之间比较：弥漫性大B细胞淋巴瘤（DLBCL）和滤泡性淋巴瘤（FL）的p16失表达率存在组间差异的显著性。所有RH标本均未见p16基因或蛋白表达的异常。结论 恶性淋巴瘤中p16基因的异常是一个频发事件,p16基因表达异常参与了淋巴瘤的发生及进展。     

胃肠道淋巴瘤并发急性穿孔36例临床病理特征及预后因素分析

目的 探讨胃肠道淋巴瘤并发急性穿孔的临床病理特征及预后影像因素。方法 回顾性分析2013年1月至2020年12月复旦大学附属中山医院收治的因胃肠道淋巴瘤并发急性穿孔行急诊手术的36例病人的临床资料。分析其临床病理特征、术后死亡情况以及死亡相关风险因素。结果 36例病人中32例（88.9%）为小肠淋巴瘤穿孔。所有病人均为非霍奇金淋巴瘤,且以侵袭性病理类型多见,其中单形性嗜上皮性肠道T细胞淋巴瘤［44.4%（16/36）］和弥漫性大B细胞淋巴瘤［33.3%（12/36）］为最常见的两种病理亚型。术后共11例病人（30.6%,11/36）发生死亡,其中10例为术后即转入重症监护室（ICU）的病人。在转入ICU的29例重症病人中,发生死亡者术后动脉血乳酸水平（P=0.006）及序贯器官衰竭（SOFA）评分（P=0.016）均高于生存者,而其他指标差异均无统计学意义（P>0.05）。结论 淋巴瘤引起的消化道急性穿孔多发生于小肠,术后病死率高;较高的SOFA评分及动脉血乳酸水平可能是死亡相关危险因素。     

Successful kidney transplantation in a patient with pre-existing chronic myeloid leukemia treated with imatinib

Active malignancy is an absolute contraindication to kidney transplantation. As for chronic myeloid leukemia (CML), a Philadelphia chromosome-positive myeloproliferative neoplasm, the introduction of tyrosine kinase inhibitors has transformed CML from a lethal into a manageable chronic disease with a close-to-normal life expectancy. To date it is unknown whether kidney transplantation can be safely performed in patients with pre-existing CML. We describe the clinical course of a 57-year-old male patient with chronic kidney disease caused by reflux nephropathy. This patient had undergone first kidney transplantation 20 years earlier and had again been on chronic hemodialysis for 6 years when CML was diagnosed. First-line therapy with 400 mg imatinib daily was well tolerated and induced an optimal cytogenetic and molecular response 3 months after initiation. One and a half years after CML diagnosis, a second kidney transplantation from a deceased donor was performed. Immunosuppression included basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids. Currently, 2 years posttransplant, renal allograft function is stable (serum creatinine 1.09 mg/dL, estimated glomerular filtration rate 75 mL/min per 1.73 m²), and CML remains in deep molecular remission with imatinib. Imatinib-treated CML in deep molecular remission could be regarded as inactive malignancy and may therefore not be viewed as an absolute contraindication to kidney transplantation.     

Towards a new WHO classification of renal cell tumor: what the clinician needs to know—a narrative review

In 1952, renal cell carcinomas had been divided into 2 categories—clear cell or granular cell—depending upon their cytoplasmic staining characteristics. In the following years, the inventory of renal epithelial tumors has expanded by the addition of tumors named by their architectural pattern (i.e., papillary RCC, tubulocystic RCC), anatomic location (i.e., collecting duct carcinoma, renal medullary carcinoma), associated diseases (i.e., acquired cystic disease-associated RCCs). With the extensive application of molecular diagnostic techniques, it becomes possible to detect genetic distinctions between various types of renal neoplasm and discover new entities, otherwise misdiagnosed or diagnosed as unclassified RCC. Some tumors such as ALK rearrangement-associated RCC, MiT family translocation renal carcinomas, SDH-deficient renal cancer or FH-deficient RCC, are defined by their molecular characteristics. The most recent World Health Organization (WHO) classification of renal neoplasms account for more than 50 entities and provisional entities. New entities might be included in the upcoming WHO classification. The aim of this review is to summarise and discuss the newly acquired data and evidence on the clinical, pathological, molecular features and on the prognosis of new RCC entities, which will hopefully increase the awareness and the acceptance of these entities among clinicians and improve prognostication for individual patients.