Demonstration of immunoglobulin production by tumor cells in non-Hodgkin's and Hodgkin's malignant lymphomas and its significance for their classification

Immune markers in hematologic malignancies

The precise delineation of biologic traits that distinguish normal hematopoietic cells from their malignant counterparts is of fundamental importance in understanding all aspects of hematologic malignancies. An increasingly sophisticated technologic battery has been utilized to dissect out these differences--primarily utilization of monoclonal antibodies, by immunoperoxidase, immunoalkaline phosphatase and flow cytometric techniques. An even more basic understanding of normal and malignant hematopoietic cells has begun to evolve as molecular biology begins to unravel gene misprogramming by Southern and Northern blot analysis and the polymerase chain reaction. These techniques not only help distinguish a normal cell from a malignant one, but characterize the malignant clone as B-lymphoid, T-lymphoid or myeloid and allow further subcategorization within these broad lineages. These distinctions are vital to the entire spectrum of basic and clinical research involving hematologic malignancies and are assuming an increasingly important role in their diagnosis, prognosis and treatment.

Follicular malignant non-Hodgkin's lymphoma with pronounced plasmacytic differentiation: a plasmacytoma-like lymphoma

A case of follicular centroblastic-centrocytic lymphoma with an unusually pronounced plasmacytic component occurring in the gingiva and cervical lymph nodes of a 74-year-old male patient is described. Immunohistological analysis revealed a monotypic intracytoplasmic immunoglobulin pattern (IgM/lambda). The relation between follicular malignant non-Hodgkin's lymphomas and extramedullary plasmacytome is discussed. In the present case the tumour may represent the development of an autonomous plasma cell clone within a follicular centroblastic-centrocytic lymphoma.

Characteristics of Sternberg-Reed, and related cells in Hodgkin's disease: an immunohistological study

A panel of monoclonal antileucocyte antibodies was used in a study of Hodgkin's disease (HD) to explore the phenotypic characteristics of Sternberg-Reed and related cells (collectively termed HD cells). Cryostat preparations of 31 lymph nodes and 2 spleens were obtained from 30 patients with active HD. The histological diagnoses were: lymphocyte predominance (LP), 4 patients; nodular sclerosis (NS), 22; mixed cellularity (MC), 2; lymphocyte depletion (LD), 2. The monoclonal antibodies used were: OKT3, T11, Leu-1 (pan T cell specific); Leu-3A (T "helper" specific); Leu-2A, OKT8 (T "suppressor" specific); immunoglobulin (Ig) antibodies: anti kappa and lambda light chains, anti mu and delta heavy chains; B1 (anti B lymphocyte); CA2-11 (anti HLA-DR); OKM1, Mo-2 (anti myeloid/monocyte); OKT9 (anti transferrin receptor); Leu-7 (anti "NK" cell) and J5 (anti common ALL antigen). Reactions with peanut lectin (PNL) were also studied. The reactions were developed using a modified "ABC" immunoperoxidase technique. Specific attention was paid to the cell surface phenotype and anatomical localisation of HD cells in relation to surrounding T and B lymphocytes. HD cells formed distinct "rosettes" with T cells of "helper" phenotype although in 3 cases (1: LP, 2: NS) Leu-7 positive cells formed a prominent component of these interactions. In partially involved lymph node and spleen, HD cells were prominently distributed in a perifollicular distribution. In addition follicular mantle zones were frequently infiltrated by HD cells, the degree of ensuing destruction being related to the extent of lymph node effacement by HD. In 2 cases (1: NS, 1: LD) HD cells expressed clear, positive reactions with B1 although in neither of these cases nor in any other instance, was surface Ig expressed on the HD cell surface. The great majority of HD cells reacted positively with both OKT9 and, as previously reported, with anti HLA-DR antibody. In addition, HD cells demonstrated intense surface and cytoplasmic staining with PNL. HD cells were negative with all other antibodies. On the basis of these findings, no lineage specificity can confidently be attributed to the HD cell. However, the pattern of immunohistological reactions suggest that it is related to a cell of B follicular origins.

Extramedullary non-gastrointestinal plasmocytoma. An immunohistochemical study of sixteen cases

Sixteen cases of extramedullary non-gastrointestinal plasmocytoma were studied for intracytoplasmic immunoglobulins by means of the immunoperoxidase-complex technique. Of the sixteen cases IgG class were observed in 4, IgM in one and IgA in 9 cases. Kappa light chains were found in 9 cases and lambda light chains in 6 cases. In one case a bitypic pattern of k- and lambda-positivity was encountered. In 2 cases only kappa light and no heavy chains were detected. The predominance of the IgA class in extramedullary, non-gastrointestinal plasmocytomas is in contrast to the prevalence of IgG type in multiple myeloma. The better possible behaviour of IgA-plasmocytomas is discussed further.

Light and immunoelectronmicroscopic study of Hodgkin's disease: evidence of immunoglobulin synthesis by tumor cells

The direct immunoperoxidase technique with peroxidase-conjugated F(ab')2 fragments was used at the light and electron microscopic levels to identify intracytoplasmic immunoglobulin (CIg) components in malignant cells of Hodgkin's disease. In each of the 27 cases studied, Hodgkin and Reed-Sternberg cells contained either IgG or IgM, with both light chains often present simultaneously. The number of IgG-positive malignant cells was inversely related to changes in the lymphoid compartment, as defined by the Rye grading system. The evolution from lymphocytic predominance to lymphocytic depletion was paralleled by a decrease of IgM-positive cells and by a substantial increase (to exclusiveness) of IgG-containing cells. These immunoelectronmicroscopic studies disclosed definite morphologic evidence of CIg synthesis by Hodgkin, Reed-Sternberg and lacunar cells. The immunoglobulin components were also synthesized by lymphoid B cells at different levels of modulation. Immunoglobulin synthesis by malignant cells was localized in perinuclear zone, on free cytoplasmic ribosomes and profiles of rough endoplasmic reticulum. The results of this joint light and electron microscopic study support the view that Hodgkin, Reed-Sternberg and lacunar cells belong to the B-cell compartment within Hodgkin's disease.

An immunocytochemical study of non-Hodgkin's lymphomas

Lymph node specimens obtained intraoperatively and/or at autopsy from 89 patients with non-Hodgkin's lymphoma were studied immunohistochemically. The peroxidase anti-peroxidase (PAP) technique was used for detecting monoclonal cytoplasmic immunoglobulin (CIg) and for determining the classes and types of immunoglobulins in the tumors. Following rigid criteria, monoclonal CIg was demonstrated in four (16%) of 25 cases of nodular, poorly differentiated lymphocytic lymphoma (NPDL); in three (14%) of 21 cases of diffuse, poorly differentiated lymphocytic lymphoma (DPDL); and in 13 (30%) of 43 cases of diffuse histiocytic lymphoma (DH). Of the four NPDL patients, two had the M kappa, one the A kappa, and one the lambda chain type. Of the three DPDL patients, one had the M kappa, one the G kappa, and one the lambda chain type. Of the 13 DH patients, five had the M kappa, four the A kappa, one the GM kappa, one the A kappa, one the G kappa, and one the kappa chain type. In two DH patients negative for cytoplasmic immunoglobulins, cytoplasmic lysozyme was present, indicating the histiomonocytic nature of the tumor cells. There was no significant difference between the overall survival rates for the DH patients with or without monoclonal CIg. In all three types of lymphoma studied, we encountered many patients (67%) who had tumor cell populations without demonstrable CIg and few patients (11%) with polyclonal CIg. There are several possible reasons why many of the patients were PAP-negative and why some had polyclonal cell populations. The PAP method may be useful in establishing the monoclonal nature of neoplastic lymphoid cell populations.

Hodgkin's disease: establishment and characterization of four in vitro cell lies

Four in vitro cell lines (L 428, L 439, L 538, and L 540) were established from different materials of three patients with Hodgkin's disease: pleural effusions, peripheral blood, and bone marrow. The histological diagnosis was confirmed in all cases by several independent histologists. All four cell lines have been in culture for over 6 months up to over 3 years. The neoplastic nature of the culture cells is indicated by the demonstration of several structural and numeric chromosome abnormalities associated with a monoclonal pattern of marker chromosomes. EBV-specific antigens (EBNA, VCA) were not detected in either cell line. Ia-like antigens, receptors for human T cells, acid phosphatase, and acid esterase were showen to be present in the cultured cells. All cell lines lacked surface or cytoplasmic Ig, HTLA, receptors for C3b, C3d, IgG-Fc, mouse E or sheep E, and were devoid of lysozyme, peroxidase, and chloracetate esterase. The described features do not represent B cells, T cells, myeloid cells, monocytes, or macrophages. The morphology and the marker pattern of the culture cells, however, is identical with that of freshly obtained Hodgkin's (H)- and Sternberg-Reed (SR)-cells, except for the lack of CIg in the in vitro cells, which is explained by the culture conditions. Heterotransplantation in nude mice was achieved by intracranial inoculation and by s.c. transplantation of cultured cells embedded in a plasma clot. The described findings suggest that these cultured Hodgkin's cell lines are indeed derived from H and SR cells. The cellular origin of these cells is not clear, the loss of cellular differential markers during the process of possible dedifferentiation is discussed.

Immunohistological analysis of Hodgkin's and Sternberg-reed cells: detection of a new antigen and evidence for selective IgG uptake in the absence of B cell, T cell and histiocytic markers

To help clarify the origin and nature of Hodgkin's (H) and Sternberg-Reed (SR) cells, three different sets of experiments were performed. First, it was shown that cytoplasmic gamma, kappa, lambda occur not only in H and SR cells, but also in polymorphic tumor cells of epithelial, neurogenic, and lymphoid origin. Furthermore, human IgG that was injected i.v. into rats penetrated many rat liver cells, whereas injected human alpha 1-antitrypsin did not. Second, staining of frozen sections revealed that H and SR cells lack surface immunoglobulin and peripheral T-cell antigen. Third, an antiserum raised against the L 428 cell line (derived from Hodgkin's disease) and absorbed with human serum and normal cells did not react with any cells of tonsil tissue (lymphoid cells, histiocytes, and interdigitating reticulum cells), whereas it reacted strongly with the L 428 cell line cells and with H and SR cells of 10 different cases. In all ten cases, the antiserum stained the surface of H and SR cells; in two cases, it also stained the nucleoli and some chromatin spots in H and SR cells. The results obtained in these experiments indicate that H and SR cells are not closely related to lymphoid cells, histiocytes, or interdigitating reticulum cells. The findings also suggest that H and SR cells express one or more antigens that have not yet been detected on or in normal cells.

Morphological and immunological definition of a malignant lymphoma derived from germinal-centre cells with cleaved nuclei (centrocytes)

Thirteen lymphomas consisting of one particular cell type were selected from 135 cases of non-Hodgkin's lymphoma. The lymphoma cells were mainly characterized by irregularly shaped nuclei and faintly stained cytoplasm. The growth pattern of the tumour was diffuse. Immunological phenotyping of suspended cells showed that the tumour cells, irrespective of whether they were isolated from lymphoma tissue or from lymphoma tissue or from peripheral blood of leukaemic cases, bore a dense layer of surface immunoglobulin, lacked cytoplasmic immunoglobulin and receptors for mouse erythrocytes, and expressed both complement-receptor subtypes (i.e., receptors for C3b and C3d) in all but one case. The exceptional case was C3b receptor-positive and C3d receptor-negative. The number of IgG-Fc receptor-bearing cells was usually small. There was a consistently small proportion of non-malignant T cells in the tumour tissue. A comparison of the properties of these lymphomas with those of other types of non-Hodgkin's lymphoma and of non-malignant lymphoid cells, shows that the cells of this type of lymphoma (a) differ morphologically and/or immunologically from the cells of all other known types of non-Hodgkin's lymphoma and (b) resemble centrocytes (cleaved follicular-centre cells) of reactive germinal centres. Thus, this type of lymphoma appears to be an entity that is closely related to, or even derived from, centrocytes.

Distribution of T-lymphocytes in follicular lymphomas as revealed by acid alpha-naphthol acetate esterase

Twelve cases of follicular centroblastic/centrocytic malignant lymphoma were studied for acid non-specific esterase. The majority of the lymphocytes in interfollicular areas showed a pattern of enzymatic activity consistent with a T-cell nature. Variable numbers of lymphocytes with a similar enzymatic pattern were also seen among the negative centroblasts and centrocytes in neoplastic follicles.