Gastrointestinal lymphoid neoplasms

Primary gastrointestinal lymphomas (PGLs) are the most frequent extranodal non-Hodgkin's lymphomas and involve stomach more commonly than small bowel in Western countries. PGLs need to be differentiated from a variety of tumor-like hyperplastic lymphoid lesions; this may be facilitated by immunotyping of lymphoid cells. In PGLs, large-cell types predominate. Our study of 76 PGLs utilizing the ABC immunoperoxidase technique has led us to conclude that the majority are of B cell origin and that, while true histiocytic PGLs do indeed exist, their incidence is not greater than in nodal lymphomas. An important observation was that 26% of the cases showed an intense admixture of muramidase-positive reactive histiocytes, a feature that could result in an erroneous impression of a histiocytic derivation of the neoplasm. The prognostic significance of immunologic subtypes is currently not known. However, survival in PGL is determined by the clinical stage of the disease and to a lesser extent by the histologic type. Current optimal therapy includes resection of tumor-bearing bowel followed by radiotherapy and/or chemotherapy.

Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part III. Six cases in children

This is the third in a series of articles dealing with oral presentations in non-Hodgkin's lymphoma. In this section the authors discuss the clinical and microscopic features of six cases occurring in children, four of which qualified as Burkitt's lymphoma.

Granulocytic sarcoma of breast: aleukemic bilateral metachronous presentation and literature review

This report describes an unusual case of bilateral metachronous granulocytic sarcoma of the breast. The patient initially did not have evidence of leukemia and her marrow cell culture in soft agar (CFU-C array) showed normal in vitro growth pattern. The patient was treated with systemic chemotherapy at a time when there was no evidence for systemic disease but she nevertheless developed meningeal leukemia and bone marrow disease 11 and 18 months, respectively, following the initial chemotherapy.

Osteogenic sarcoma producing human chorionic gonadotrophin. Case report with immunohistochemical studies

An osteogenic sarcoma occurring in a 22-year-old woman was found to be associated with production of a large amount of beta human chorionic gonadotrophin (B-hCG). Pregnancy was excluded on the basis of a normal ultrasonogram and a proliferative type endometrium obtained by curettage. A homogenate of the tumor was strongly positive for B-hCG while immunohistochemical staining of the tumor cells was strongly positive for B-hCG and negative for pregnancy associated glycoprotein. These results indicate ectopic production of hCG by the osteosarcoma.

Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part II. Fourteen cases arising in bone

In a series of 31 patients with NHL presenting in the oral region, nine lesions were in the maxilla and 5 were in the mandible, for a total of 14 (45%) lesions that arose in bone. The most common locations were the posterior regions of the maxilla (7 cases) and mandible (4 cases). Diffuse subtypes clearly predominated, 13 out of 14 cases demonstrating this pattern. Six of the cases were in children, and 4 of these qualified as Burkitt's lymphoma. In general, it was found that the statistics relating to survival of patients with jawbone lymphoma correspond closely to the findings reported for skeletal lymphomas. Despite the high incidence of diffuse patterns, 6 of these 14 patients with NHL in bone were alive with no evidence of disease 3 years or longer.

Immunohistochemistry of Hodgkin's disease. A study of 20 cases

An immunoperoxidase study of 20 cases of Hodgkin's disease demonstrated universal staining of Reed Sternberg cells and their mononuclear variants for both kappa and lambda light chains and, in all but one case, for IgG. Staining for IgA and albumin was variable and for IgD and IgM uniformly negative. A double staining procedure using two different chromogens produced the paradoxical finding of both light chain types within the same cell, but these could only be demonstrated sequentially and not simultaneously, suggesting a blocking phenomenon. The above findings coupled with the demonstration of muramidase and/or alpha-1-antitrypsin in Reed-Sternberg cells and their mononuclear variants in all but two cases studied favor a histiocytic origin for these cells. This characteristic profile of results is also very helpful in distinguishing Hodgkin's disease from other neoplasms which mimic Hodgkin's disease because of the presence of Reed-Sternberg-like cells.

Oral presentations in non-Hodgkin's lymphoma: a review of thirty-one cases. Part I. Data analysis

Thirty-one patients with oral manifestations of non-Hodgkin's lymphoma have been studied with reference to age, sex, race, location of lesion in oral cavity, stage of disease on presentation, duration of disease at time of presentation, histologic type, modes of treatment, and survival. There were 6 children and 25 adults, ranging in age from 3 to 89 years. Only 2 of the 31 patients were black. Sex incidence was almost equal, with 17 females and 14 males. In 12 cases the oral findings alone represented the initial presentation of lymphoma. The maxilla, mandible, and palate accounted for 24 of the 31 cases. The preponderance of diffuse histologic patterns was striking (77.4 percent). Eighteen cases (58.0 percent) presented in Stage I or Stage II, indicating relatively limited extent of disease. More generalized involvement was found in the remaining thirteen cases (41.9 percent). Thus, although NHL may appear in the oral region as the first detected evidence of disease, in many patients a work-up will show that the process is widespread in distribution. In this brief series survival data coincide with the established principles that a poorer prognosis is associated with the diffuse histologic pattern, as well as certain identified histiocytic and poorly differentiated lymphocytic subtypes.

Hemangiopericytoma of the colon: report of a case and review of literature

A patient with a hemangiopericytoma of the colon is discussed. This is the second such case reported in the English medical literature. Soon after discovery of the tumor, the patient presented with a colonic intussusception with the tumor serving as the lead point. This was reduced by a hypaque enema, but the intussusception recurred twice more, being reduced again by hypaque enema and finally having to be reduced by colonoscopy. At surgery a left hemicolectomy with primary anastomosis was performed. The microscopic, ultrastructural, and pathologic aspects of hemangiopericytoma are discussed with special attention to lesions of the gastrointestinal tract.

Subconjunctival lymphoma: a review of six suspected cases and the use of immunologic surface markers

Six cases of subconjunctival tumor clinically compatible with the appearance of subconjunctival lymphoma were evaluated. Two of the patients, Cases 1 and 2, were under treatment with either prednisone or gold therapy for severe rheumatoid arthritis. Patient 3 manifested further evidence of systemic disease (auxillary lymph node). Of the remaining cases, patient 4 had no further evidence of systemic involvement, whereas patient 5 was suspected of having a gastrointestinal tumor. The last case, a patient known to have pulmonary lymphoma, presented with dry eye and multiple subconjunctival lymphomatous masses. Immune surface marker studies demonstrated a B-cell monoclonal subconjunctival lymphoma, suggestive of an improved survival when compared to null cell-type lesions. Immune surface marker studies offer a new commercially available method for classifying and prognosticating subconjunctival lymphomas.

Bone marrow biopsy and clinical staging in chronic lymphocytic leukemia

We have examined the value of bone marrow biopsy histopathology in chronic lymphocytic leukemia (CLL). Cases involving a pattern of interstitial, nodular, or mixed interstitial plus nodular infiltration of lymphocytes were clinically similar and manifested a more benign course. These patterns correlated with the clinical Stages 0, I, and II. However, cases involving a pattern of diffuse or mixed diffuse plus nodular infiltration of lymphocytes formed a clinical group with a more rapidly progressive course and these patterns correlated with clinical Stages III and IV. Other measurements, e.g., calculation of the percentage of lymphatic tissue in the bone marrow biopsy specimen and of the ratio of the percentage of lymphatic tissue in marrow to the peripheral blood lymphocyte count, were found to be cumbersome to perform and of no additional value to clinical staging in prognosis indication in CLL.