T cells in cutaneous lesions of Sézary syndrome and T-cell leukemia. Characterization by monoclonal antibodies

Anti-T-cell monoclonal antibodies (LEU series) immunoperoxidase technique study for the presence of T cells in cutaneous lesions from four patients with Sézary syndrome and one patient with chronic T-cell leukemia showed that most dermal-lymphoid cells from three patients with Sézary syndrome were reactive with monoclonal antibodies to anti-pan T-cell (LEU-1) and helper T-cell (LEU-3a) subsets but not with those to suppressor-cytotoxic T-cell (LEU-2a) subsets. One patient with progressive disease had atypical dermal-lymphoid cells positive for pan T-cell (LEU-1). Epidermotropic cells were reactive to LEU-1 in all four patients, LEU-2a in one patient, and LEU-3a in one patient. Neoplastic cells in skin lesions of chronic T-cell leukemia showed strong positive staining with LEU-1, but were reactive with both anti-T-cell subset, monoclonal antibodies. The atypical, dermal-lymphoid cells in Sézary syndrome represent mature, helper T cells in most cases. The absence of T-cell subset antigens in one patient with fulminant Sézary syndrome and the finding of both T-cell subset antigens on T-cell leukemia cells suggest the presence of actively proliferating, immature T cells in those cases.

Immunohistologic and cytochemical studies of temporal arteritis

Arteritic lesions from 14 patients with temporal arteritis were studied by cytochemical and immunohistochemical methods to identify the nature of the inflammatory cell infiltrate and to demonstrate immunoglobulin deposition. The infiltrating cells typically seen were histiocytes, giant cells, monocytes, and lymphocytes. The lymphocytes were mainly T cells and the majority of them were of the helper/inducer (Leu-3a) T cell subset, as indicated by monoclonal antibody reactivity. Immunoglobulin deposits on the internal elastica were identified in only 6 patients and neutrophils were either very sparse or absent. These findings are consistent with the hypothesis that cell-mediated immunity may be important in the pathogenesis of temporal arteritis.

T-cell subsets in cutaneous sarcoidosis

Skin lesions from four patients with systemic and cutaneous sarcoidosis were studied, by the use of monoclonal antibodies, for the presence of T cells and T-cell subsets. Large numbers of lymphoid cells reacting with anti-pan T-cell (LEU-1) and anti-helper and inducer subset (LEU-3) monoclonal antibodies were observed around and within the sarcoid granulomas in three of the four patients. Only rare LEU-2-reactive suppressor cells were observed in all four patients. Activated T lymphocytes with focal acid phosphatase activity, together with epithelioid cells and multinucleated giant cells with strong diffuse activity of acid phosphatase and nonspecific esterase, were identified within the granulomas. The two patients with active disease demonstrated substantially more T cells in the sarcoid granulomas than did the two patients with chronic disease. Our study results suggest the importance of helper T cells in the formation of the sarcoid granuloma by mononuclear phagocytes and imply that the activity and duration of disease may be related to the T-cell populations.

Lymphoma of the nose and paranasal sinuses

The records of 37 patients with lymphoma of the nose and paranasal sinuses in an 18-year period were studied. The symptoms were divided into three categories: (1) local symptoms: obstruction, bleeding, and rhinorrhea; (2) symptoms of invasion of adjacent structures: facial pain and ear fullness; and (3) systemic symptoms: fever, weight loss, and nocturnal sweating. The presence of an intranasal mass was the most common physical finding. Conventional tomography and computed tomography were helpful for diagnosis. Abnormalities were usually disclosed on biopsy specimens from the nose or mouth. As a rule, several sites in the nose and sinuses were involved. An early diagnosis of sinonasal lymphoma and other malignant neoplasms generally allows effective treatment; therefore, the otorhinolaryngologist should be alert for such disease and, if the clinical picture warrants, should add tomography to the diagnostic workup.

Use of imprints for monoclonal antibody studies: suitability of air-dried preparations from lymphoid tissues with an immunohistochemical method

Air-dried imprint preparations are conveniently produced from human lymphoid samples without the special methods required for snap-freezing tissues or rendering them into suspensions. T-cells, T-cell subsets (helper and suppressor), and HLA-DR-positive cells (B-lymphocytes, monocytic-histiocytic cells) can be identified in such imprints by the use of commercially obtained mouse hybridoma antibodies with a simple two-step immunoperoxidase method. Direct nuclear morphologic correlation with surface determinants is achieved by this method. Immunoreactivity is retained only eight to 10 days in such air-dried preparations, and attempts to prolong reactivity have been unsuccessful so far.

A systemic lymphoproliferative disorder with morphologic features of Castleman's disease. Pathological findings in 15 patients

This report describes the nodal and extranodal lesions observed in 15 patients with a generalized disorder that had been histologically diagnosed as Castleman's disease. The disorder was characterized by severe constitutional symptoms, constant involvement of multiple peripheral lymph nodes, and frequent hepatosplenomegaly, in association with clinical and laboratory features reminiscent of a "collagen disease." The clinical course was chronic, with remissions and exacerbations in seven patients, and aggressive and fatal in eight. The material examined included multiple lymph node biopsies, four surgical specimens of spleen, one open lung biopsy, and material from four autopsies. The diagnostic morphological findings were observed in the nodes and were represented by the following histologic triad: diffuse marked plasmacytosis, from the medulla to the subcapsular areas; prominence of the germinal centers; and good preservation of the architecture. One variant of this basic pattern featured abundant immunoblasts and blood vessels. The process appears to be a systemic reactive proliferation of B-lymphocytes, perhaps resulting from faulty immune regulation. Morphologic similarities indicate a relationship between this multicentric disorder and Castleman's disease of plasmacellular type. However, there are distinct differences between them in clinical presentation and evolution, and, consequently, in therapeutic approach.

Identification of T-cell subpopulations in granuloma annulare

Granuloma annulare is a lymphohistiocytic process of unknown cause characterized by necrobiotic dermal papules. Acetone-fixed frozen sections of eight granuloma annulare lesions were studied for the presence of T-cell subsets, using monoclonal antibodies to T-cell surface antigens. The palisading and perivascular lymphocytic infiltrate shows that most of the mononuclear cells are reactive with LEU-1 antibody, which characterizes peripheral T cells and activated T cells. Numerous cells were reactive with LEU-3a antibody, which identifies the helper-inducer T-cell subset. Some cells were positive with LEU-2a antibody, which detects suppressor-cytotoxic cell populations. Masses of histiocytes were identified infiltrating between the collagen fibers and surrounding the central necrobiosis area; the histiocytes showed a very strong diffuse acid phosphatase and nonspecific esterase activity. These findings suggest that a cell-mediated immune response may be the dominant pathogenic event in granuloma annulare.

The clinicopathologic spectrum of lymphomatoid papulosis: study of 31 cases

Herein we review the Mayo Clinic experience with thirty-one cases of lymphomatoid papulosis seen since 1965. All patients had chronic, recurrent, and self-healing erythematous papulonodular lesions, which often became pustular, ulcerated, and resolved with scarring. The clinical features often corresponded to those seen in Mucha-Habermann disease; however, the predominant histopathologic feature was an infiltrate composed primarily of atypical lymphoid cells suggestive of malignant lymphoma. In six patients, a lymphoproliferative disorder was eventually diagnosed. There were two cases of mycosis fungoides (stage I), one case of nodular sclerosing Hodgkin's disease, and three cases of malignant lymphoma--one diffuse mixed large and small cell type with features of T-immunoblastic type, one diffuse large cell type, and one follicular small cleaved cell type. The clinical course of the lymphomatoid papulosis was unaffected by chemotherapy for the lymphoproliferative disorder. Our data indicate that, with sufficient duration of follow-up, malignant lymphoma may develop in some patients with lymphomatoid papulosis.

Primary mediastinal tumors in children

Mediastinal masses in children constitute a heterogeneous group of malignant and benign neoplasms. The majority of malignant tumors in our series of 188 children with a mediastinal mass were Hodgkin's and non-Hodgkin's lymphoma (87 patients) arising in the anterior and middle mediastinum. Ganglioneuroma (17) arising in the posterior mediastinum made up the bulk of benign tumors (52). Infants less than 2 yr old presented with symptoms of tracheal compression, whereas older children had fewer symptoms but a far greater likelihood of having a malignancy. In the assessment of patients with mediastinal tumors, the posteroanterior and lateral chest roentgenograms were most often diagnostic, and computed tomography of the chest provided the most information concerning preoperative resectability. The excellent survival of patients with stage I and II Hodgkin's disease reflects the radiosensitivity of the tumor; in our series of 33 patients, survival was not increased by radical resection. Unlike lymphomatous tumors, neurogenic masses should be completely excised. When initial exploration reveals unresectability, biopsy followed by radiation therapy and second-look excision of the tumor can be accomplished. In patients with primary mediastinal sarcomas, total resection should be carried out if possible. In our series, adjuvant radiation therapy or chemotherapy was effective in only 1 of 15 children with sarcoma. Surgical treatment of all mediastinal masses except lymphoma should be complete excision. In cases of suspected lymphoma, cervical or supraclavicular node biopsy can yield adequate tissue for diagnosis.

Angiofollicular lymph node hyperplasia and peripheral neuropathy: association with monoclonal gammopathy

An elderly man was found to have the plasma cell variant of angiofollicular lymph node hyperplasia. His course was complicated by peripheral neuropathy and generalized lymphadenopathy, which improved after a trial of corticosteroid therapy. Although the plasma cell variant has been associated with multiple systemic effects, including the nephrotic syndrome, growth failure, fever, hyperglobulinemia, and anti-erythropoietin-mediated anemia, concurrent peripheral neuropathy has only occasionally been reported. Angiofollicular lymph node hyperplasia should be included in the differential diagnosis of peripheral neuropathy associated with lymphadenopathy or a mediastinal mass. A discussion of the clinical, histologic, and immunopathologic characteristics of angiofollicular lymph node hyperplasia is presented.

Primary lymphoma of the central nervous system

Primary intracranial lymphoma usually remains localized to the central nervous system, and aggressive radiotherapy will prolong some patients' remission and perhaps cure them. Although the lesion is usually believed to arise from histiocytes or reticulum cells, at least some of the neoplasms are of B-lymphocyte origin. Provisional diagnosis occasionally may be possible by identifying lymphoma cells in the cerebrospinal fluid by using the cytocentrifuge. The use of computed tomography of the head may decrease the need of arteriography for tumor localization.

Angioendotheliomatosis of the nose with fatal systemic dissemination

Angioendotheliomatosis is a rare intravascular neoplastic process which has been presumed to be of endothelial origin. A 62-year-old woman had manifestations of this disorder which were initially localized to the nasal region, followed by fatal systemic dissemination. Electron microscopic examination of the neoplastic cells disclosed structures interpreted as Weibel-Palade bodies, lending some support to a theory of endothelial histogenesis. Forty cases of angioendotheliomatosis have been previously reported, providing data that help define this disease process as a distinct clinicopathologic entity.

The lung in immunoblastic lymphadenopathy

Immunoblastic lymphadenopathy presents with fever, malaise, cough, dyspnea, lymphadenopathy, hepatosplenomegaly, hypergammaglobulinemia, interstitial pulmonary infiltrates, mediastinal adenopathy, and effusions. The diagnosis is made on the basis of lymph node biopsy. Based on the course in our patients and the cases presented in previous reports, a suggested program of treatment for immunoblastic lymphadenopathy includes administration of moderate doses of steroids initially, with a subsequent increase to a higher dosage if desired improvement does not occur. Chemotherapy with three drugs, cyclophosphamide, vincristine, and prednisone, is indicated if remission using steroids fails. The diagnostic dilemma of whether pulmonary infiltrates are due to the disease itself or to pulmonary infection or to cytotoxic changes from chemotherapy always exists and often requires specimens from either transbronchoscopic or open-lung biopsy for definitive diagnosis and treatment.

Lymphocytic lymphoma involving the middle ear

A patient with lymphocytic lymphoma involving the middle ear had otalgia and facial palsy as his initial symptoms, and the definitive diagnosis was made by means of biopsy of the tumor in the middle ear. Review of the literature revealed only one other case with clinical involvement of the middle ear space.