Cytochemistry of lymphoid cells: a review of findings in the normal and leukaemic state

Possibilities and limitations of cytochemical methods in diagnosis of acute leukemia

Accurate identification and classification of leukemic blast cells is a very important prerequisite of the precise diagnosis of acute leukemia and has a great impact on therapy and prognosis. The purpose of this review is to consider, in the broad sense of the word, the present possibilities and limitations of enzyme cytochemistry and to emphasize how cytochemistry may contribute, on integration with the other methods of study, to the final classification and differential diagnosis of acute leukemia, a highly variable hematological disorder. In this review, the role of conventional enzyme cytochemistry, either dominant or subsidiary, in the discrimination of acute leukemia subtypes is discussed. The survey confirms the absolute necessity of immunologic marker analysis in the accurate diagnosis of acute lymphoblastic leukemia, undifferentiated or minimally differentiated leukemia and mixed-lineage leukemia because in these cases, the cytochemical evaluation provides insufficiently relevant information regarding blast cell origin, specificity of leukemia subtypes and the discrete stages of leukemic cell maturation. On the other hand, cytochemical investigation is appreciated to be dominant over immunophenotyping in characterizing acute myeloid leukemia, because of the lack of specificity of the majority of immunological markers against myeloid antigens and, because of the availability of standardized and sufficiently specific cytochemical reactions. The cytogenetic, molecular biological and electron microscopic studies mentioned in this review supplement the important information for correct differential diagnosis of acute leukemia. The prognostic impact of enzyme cytochemistry in correlation to other methods is evaluated.

Epithelial alpha-naphthyl acetate esterases in the green vervet monkey gingiva before and after periodontal surgery and during tooth eruption

To provide enzymatic information on de novo formed junctional (JE) and sulcular epithelium (SE), we performed periodontal surgery on 24 teeth. Ten to 14 days postoperatively, all experimental and 16 control teeth were extracted with adjacent buccal gingiva. In addition, specimens from unerupted and partly erupted teeth containing enamel epithelium (EE) were examined. Fixed cryostat sections were cut in series, stained with HE, or incubated with and without substrate for demonstration of alpha-naphthyl acetate esterase activity and for control purposes, respectively. The distribution and intensity of the alpha-naphthyl acetate esterase activity of newly reformed JE and SE was identical to that of the original JE and SE, i.e. suprabasal and very strong. In contrast, both the oral gingival epithelium (OGE) and the EE displayed a very weak enzyme reaction. These observations indicate that the presence of alpha-naphthyl acetate activity of original and reformed JE and SE is probably site specific and of nondevelopmental origin. Heavy inflammation after healing was associated with enhanced epithelial proliferation of OGE and, in addition, marked esterase activity of these proliferations and corresponding OGE. This points at a possible inflammatory induction of the marked esterase activity seen in JE and SE as well as site-specific, connective tissue influences. Further investigation is needed to elucidate the effect of inflammation on the esterase activity.

Expression of the rat CD26 antigen (dipeptidyl peptidase IV) on subpopulations of rat lymphocytes

The T cell activation antigen CD26 has been recently identified as the cell surface ectopeptidase dipeptidyl peptidase IV (DPP-IV). DPP-IV is found on many cell types, including lymphocytes, epithelial cells, and certain endothelial cells. The MRC OX61 monoclonal antibody (MAb) which specifically recognises rat DPP-IV was used to examine the expression of CD26/DPP-IV on rat lymphocytes. The molecular nature of the antigen was examined by immunoprecipitation from thymocytes, splenocytes, and hepatocytes. Analysis by one- and two-dimensional gel electrophoresis indicated that the native form of CD26 includes a 220-kDa homodimer. On tissue sections MRC OX61 MAb stained nearly all thymocytes and in the spleen and lymph nodes predominantly stained the T cell areas. However, in immunofluorescence experiments OX61 stained 80 to 87% of lymph node cells and 78 to 85% of spleen cells. Furthermore, two-colour immunofluorescence analysis of the CD4+, CD8+, and Ig+ lymphocyte subsets indicated that only 2 to 5% of each of these subsets lacked OX61 staining. Spleen cells and thymocytes of both CD4+ and CD8+ subsets stained much more intensely with OX61 after these cells were stimulated with phytohemagglutinin. These findings indicate that rat CD26 antigen expression is not confined to the T cell population as has been suggested, but also occurs on B cells, and is increased on T cells following their activation.

5' Nucleotidase in chronic B cell leukemias: a cytochemical and ultrastructural study

We studied by cytochemical means the distribution of 5' nucleotidase (5' NT), a purine degradative enzyme, in the circulating lymphocytes of 24 healthy donors and 41 cases of chronic lymphoid leukemias, classified according to morphological and immunological criteria. About half the normal circulating lymphocytes were 5'NT positive and exhibited variable degrees of enzyme activity. Among chronic B lymphocytic leukemias we found high percentages of positive cells only in the phenotypically more mature cases. Moreover all cases of hairy cell, follicular cell, lymphoplasmacytic, and plasma cell leukemia showed moderate or weak 5' NT reactivity. Also one case of chronic T lymphocytic leukemia, CD8 positive, was moderately positive, while another, with large granular lymphocyte morphology, was completely negative. Electron microscopy revealed a discontinuous, granular plasma membrane reaction pattern, varying in intensity from case to case. In conclusion, our results confirm the usefulness of the 5' NT cytochemical reaction for identification of lymphoid populations at different stages of maturation in chronic B cell disorders.

Heterogeneous malignant non Hodgkin's lymphomas as a causative disorder in lethal midline granuloma

The present report describes the results of a combined morphological, enzyme- and immunohistochemical analysis of nine cases of malignant non Hodgkin's lymphomas (NHL) clinically presenting as lethal midline granuloma. In a previous report written before antibodies directed against B and T lymphocytes were available, a histiocytic origin of such neoplasms had been suggested. A panel of antibodies reactive with most B cells (L26, MB1, KiB3) and a majority of T cells (MT1, UCHL1) was applied on paraffin sections of formalin fixed tissues as well as antibodies directed against leukocyte common antigen (LCA), myeloid/histiocyte antigen (MAC 387), lysozyme, alpha-1-antitrypsin, alpha-1-antichymotrypsin, S-100 protein, prekeratin and immunoglobulin light chains. Enzyme histochemistry included tests for non-specific acid esterase, acid phosphatase, beta-glucuronidase and chloroacetate esterase. As a result, five T, two B and two unclassified (malignant histiocytosis probable) NHL were identified, indicating distinct heterogeneity of NHL as causative disorders in lethal midline granuloma.

Mg2+-dependent adenosine triphosphatase: an enzyme marker for ovine T lymphocytes

Sheep T lymphocytes showed a cell surface magnesium-dependent adenosine triphosphatase (Mg2+-ATPase) reaction, which is reported to be characteristic of human B lymphocytes. In cryostat sections of lymph nodes, spleen and thymus, Mg2+-ATPase positive regions closely matched those labelled by sheep pan T monoclonal antibodies (Moab). An Mg2+-ATPase reaction was also found in fibroblastic recticulum cells of T cell regions in lymph nodes. Double labelling of cells from peripheral blood and peripheral lymph for Mg2+-ATPase and the pan T marker showed that 78% of the lymphocytes were positive for both of these markers. In cell suspensions enriched for B lymphocytes the percentage of cells positively labelled was decreased to 37%. Samples of each cell population which were labelled with a pan T Moab and analysed by flow microfluorometry revealed T cell levels which were not significantly different from those obtained by histochemical or immunohistochemical techniques. Less than 1% of lymphocytes positive for heavy and light chains of immunoglobulin (Ig) G were labelled with Mg2+-ATPase. Veiled cells in lymph and monocytes showed a cytoplasmic Mg2+-ATPase reaction.

Quantitative and qualitative studies of leukaemic cell dipeptidylpeptidases II and IV

Cellular concentrations of dipeptidylpeptidases (DAP) II and IV were determined by fluorimetric assay in 152 cases of leukaemia and 24 permanent T-cell lines. Whilst its estimation appears to have few diagnostic applications, it was found that DAPII levels were generally higher in prolymphocytoid CLL variants (CLL-Pro) compared with "typical" CLL cases. Qualitatively, DAPII extracted from leukaemic B- and T-cells did not differ significantly with respect to molecular weight (Mr 82 kD: FPLC gel filtration) or substrate affinity (Km). Similarly, a single molecular weight species (Mr 189 kD) of DAPIV was also detected in all leukaemic sonicates examined although, in quantitative terms, increased DAPIV levels were primarily associated with a subgroup of CD4-positive postthymic malignancies. Studies of immature T-cell proliferations however indicated that DAPIV expression was unrelated to either stage of immunological differentiation or CD4 expression. No evidence of lineage restriction was found for either enzyme and it is concluded that variations in DAP cytochemical staining patterns reflect quantitative rather than qualitative differences.

Acid hydrolases in B-chronic lymphocytic leukemia (B-CLL): a comparison with normal peripheral B lymphocytes and normal B-cell subset with the phenotype of B-leukaemic cells

The acid phosphatase (AP), beta-glucuronidase (BG), and alpha-naphthyl-acetate esterase (ANAE) distribution and the morphology of stage 0 B-CLL lymphocytes were studied. The results were compared with the same hydrolase equipment and morphology of normal B-cell populations showing the B-CLL-like phenotype, and thus regardable as the possible counterpart of leukaemic cells. The functional and structural characters of the former were strikingly different from those of the latter. In fact the normal B-cell population with B-CLL-like phenotype showed an homogeneous enzyme pattern with predominant ANAE and a strictly lymphocytic cell morphology. In contrast, the leukaemic cells showed various and unrelated morphological and cytochemical features, thus forming apparent subgroups of B-CLL. The development of an irregular "switch on" mechanism in the blocked malignant cell clone, may account for these functional and structural maturation discrepancies. Moreover, the fact that in the leukaemic cells ANAE activity could be demonstrated only after the appearance of the other hydrolases, makes it a marker of functionally differentiated B lymphocytes.

The importance of protease histochemistry in pathology

The histochemical demonstration of the activities of proteases, based in the majority of cases on the use of discriminating synthetic substrates (aminoacyl or peptidyl derivatives of 4-methoxy-2-naphthylamine [MNA]), has proved very valuable in pathology. Its importance is illustrated by three topics investigated in our laboratory, namely lymphocytes, malabsorption syndrome and atherosclerosis.

Acid hydrolase activities in B cell chronic lymphocytic leukaemia lymphocytes: correlation of cytochemical reactions with immunological phenotype

The cytochemical reactions of 5 acid hydrolases, alpha-naphthyl acetate esterase (ANAE), acid phosphatase (AP), beta-glucuronidase, beta-glucosaminidase and dipeptidylaminopeptidase IV (DAP IV) were investigated in lymphocytes from 30 patients with B cell chronic lymphocytic leukaemia (B-CLL). Based on ANAE and AP reactivities, 4 cytochemically distinctive subgroups were identified: Group 1: AP and ANAE less than 50% positive lymphocytes (5 cases); Group 2: AP greater than 50%, ANAE less than 50% positive lymphocytes (11 cases); Group 3: AP less than 50%, ANAE greater than 50% positive lymphocytes (7 cases); Group 4: AP and ANAE greater than 50% positive lymphocytes (7 cases). beta-Glucuronidase displayed similar patterns of reactivity to AP. beta-Glucosaminidase activity was observed in the majority of lymphocytes in most patients, whereas DAP IV activity was present in less than 20% of lymphoid cells. The study failed to establish any relationship between cytochemical grouping and patients' clinical status, peripheral lymphocyte counts, E or mouse rosette values, light or heavy chain cellular immunoglobulin (Ig) class. Attempts to correlate acid hydrolase and Ig heavy chain isotype expression, putative markers of B cell maturation, were unsuccessful and indicate that within the narrow spectrum of B cell differentiation seen in B-CLL these characteristics are unrelated.