T-lymphocyte subsets in follicular lymphomas compared with those in non-neoplastic lymph nodes and tonsils

Follicular lymphoma and macrophages: impact of approved and novel therapies

The survival and proliferation of follicular lymphoma (FL) cells are strongly dependent on macrophages, because their presence is necessary for the propagation of FL cells in vitro. To this regard, as also shown for the majority of solid tumors, a high tissue content of tumor-associated macrophages (TAMs), particularly if showing a protumoral phenotype (also called M2), is strongly associated with a poor outcome among patients with FL treated with chemotherapy. The introduction of rituximab, an anti-CD20 antibody that can be used by TAMs to facilitate antibody-dependent cellular cytotoxicity and antibody-dependent cellular phagocytosis, has challenged this paradigm. In the rituximab era, clinical studies have yielded conflicting results in FL, showing variable outcomes based on the type of regimen used. This highlighted, for the first time, that the impact of TAMs on the prognosis of patients with FL may depend on the administered treatment, emphasizing the need to better understand how currently available therapies affect macrophage function in FL. We summarize the impact of approved and novel therapies for FL, including radiation therapy, chemotherapy, anti-CD20 monoclonal antibodies, lenalidomide, and targeted agents, on the biology of TAMs and describe their effects on macrophage phagocytosis, polarization, and function. Although novel agents targeting the CD47/SIRPα axis are being developed and show promising activity in FL, a deeper understanding of macrophage biology and their complex pathways will help to develop novel and safer therapeutic strategies for patients with this type of lymphoma.

Bone Marrow Histopathological and Molecular Changes of Small B-Cell Lymphomas after Rituximab Therapy: Comparison with Clinical Response and Patients' Outcome

This study correlates bone marrow changes after Rituximab (RTX) treatment with the clinical characteristics and outcome of 26 patients with small B-cell lymphomas. The percentage, phenotypic profile and clonality pattern of bone marrow lymphoid infiltrate were analysed before and after RTX treatment. Clinical, histological and molecular responses to RTX were correlated to the clinical outcome of the patients. Sixteen out of twenty-six patients obtained a complete clinical remission (CR). A favourable histology - follicular lymphoma (FL), hairy cell leukaemia (HCL) and marginal zone lymphoma (MZL) - was associated with a higher frequency of clinical CR and histological remission (HR), in comparison with mantle cell lymphoma (MCL), chronic lymphocytic leukaemia (CLL) and lymphoplasmacytic lymphoma (LPL). Two patterns of bone marrow HR were observed: 1) complete lymphoid cell disappearance (9 patients); or 2) nodular/interstitial T-cell infiltration (10 patients). Three histological persistence (HP) patterns were observed: 1) persistence of CD20+ small lymphoid cells in 1 patient with MCL; 2) loss of CD20 antigen expression in 4 patients with CLL; or 3) persistence only of clusters of monotypic plasma cells in 2 patients with LPL. CR and HR were strongly correlated. The percentage of lymphomatous infiltrate after RTX was higher in patients who subsequently died of the disease. Molecular response showed no correlations with the further clinical course in 12 patients achieving a complete clinical remission. In conclusion, bone marrow morphological and immunohistochemical analysis with a restricted panel of antibodies is useful to avoid 42% false positive and 85% false negative interpretations. Persistence of monoclonality after RTX might have a role in evaluating the molecular pattern of CD20-negative clones that can emerge after RTX as a tumoral escape to therapy.

Immunohistochemical Patterns of Reactive Microenvironment Are Associated With Clinicobiologic Behavior in Follicular Lymphoma Patients

Purpose

Recent molecular data have suggested that non-neoplastic cells are powerful modulators that may confer a selective advantage or disadvantage on the outcome of follicular lymphoma (FL) patients.

Patients and Methods

The prevalence of the principal inflammatory and immune-infiltrated cells was measured immunohistochemically in the tissue of 211 FL patients, and associations were sought with their traditional clinicobiologic characteristics.

Results

Our results confirmed the presence of a large number of T lymphocytes (CD4+and CD8+) and CD57+cells and, at a moderate level, the presence of TIA-1+cytotoxic cells, CD68+macrophages, CD123+plasmacytoid cells, and FOXP3+regulatory T cells among the pool of non-neoplastic cells. In addition to the conventional clinical variables, univariate analysis identified a low level of infiltrated CD8+T lymphocytes as a significantly negative prognostic factor of overall survival. The following significant differences in the abundance of cells of specific and nonspecific immunity were observed in relation to the clinicobiologic features of FL: (1) a reactive microenvironment mainly made up of T lymphocytes and macrophages was significantly associated with a favorable clinical behavior of FL patients; and (2) a reactive microenvironment infiltrated predominantly by CD57+T cells was associated with a significantly higher frequency of adverse clinicobiologic manifestations such as “B” symptoms and bone marrow involvement.

Conclusion

Our results demonstrate the existence of two specific patterns in the reactive microenvironment of FL, an immunosurveillance pattern (T lymphocytes and macrophages) and an immune-escape pattern (CD57+T cells), that were directly associated with the clinicobiologic features of these patients.

Germinal centre-like versus undifferentiated stromal immunophenotypes in follicular lymphoma

Follicular dendritic cells (FDCs) in reactive germinal centres (GCs) show modulated expression of antigens indicative of step-wise maturation from more undifferentiated stroma. The present study compared the expression of FDC markers CD21, CD23, CD35, and chemokine CXCL13 and the stromal markers low-affinity nerve growth factor receptor (LNGFR) and CNA.42 in 35 follicular lymphoma (FL) cases with reactive lymphoic tissue. CXCL13 was expressed by follicular stroma in all FLs but most cases showed either partial (11/35 cases, 31%) or complete (10/35 cases, 29%) absence of other FDC antigens, most commonly CD23, followed by CD21 and CD35, with variable patterns of LNGFR and CNA.42 immunostaining. Only a minority of FL cases (14/35, 40%) showed stroma that resembled mature FDCs (CD23+, CD21+, CD35+) and these tumours were always associated with numerous intrafollicular T-cells, similar to reactive GCs. In the 25 FL cases that had identifiable extrafollicular tumour cells, the immunophenotype of follicular stroma showed the same variability but the extrafollicular stroma showed an absence of FDC markers, with the exception of frequent strong LNGFR staining. Stromal phenotypic changes in FL were not correlated with mean follicle size, percentage of diffuse growth, tumour mitotic rate or the proliferation index as determined by PCNA immunostaining. Serial biopsy specimens analysed in a subset of 15 patients showed either a stable stromal phenotype (seven cases, 47%) or loss of FDC antigens in tumour-associated stroma over time (seven cases, 47%). The GC-like subset of FLs, having both abundant intrafollicular T-cells and fully differentiated CD23+ FDCs, comprises a minority of FL cases that likely have different growth requirements from FLs that lack these features. The pattern of FDC antigen loss in stroma of FL is a readily assessable biological feature that appears independent of architectural growth pattern and may serve as a useful surrogate marker of tumour progression.

Establishment of a follicular lymphoma cell line (FLK-1) dependent on follicular dendritic cell-like cell line HK

A novel cell line, FLK-1, was established from bone marrow cells of a patient with follicular lymphoma by means of co-culture with follicular dendritic cell (FDC)-like cell line HK. Immunophenotypic analysis showed that FLK-1 expressed CD10, CD19, CD20, CD38, IgG and HLA-DR, which is a typical feature of germinal center B cells. Cytogenetic analysis of FLK-1 demonstrated t(14;18)(q32;q21) translocation involving BCL2 and immunoglobulin heavy chain genes. Especially noteworthy is that the growth of FLK-1 was found to be dependent on a FDC line, HK. When HK cells were removed from the culture, FLK-1 cells stopped growing and eventually died. An apoptotic mechanism appeared to be involved as indicated by the presence of chromosome condensation and DNA ladder formation. The culture experiment using micropore membranes showed that soluble factor(s) of HK cells supported the growth, while direct cell-to-cell contact appeared to be necessary for longterm cell proliferation. These findings suggest the importance of the micro-environment for follicular lymphoma cells to grow. The FLK-1 cell line may thus prove to be useful for studying the growth mechanism of follicular lymphoma and provide new insights into the pathogenesis of follicular lymphoma.

Intra-tumoral cytolytic cells: pattern of distribution in B-cell non Hodgkin s lymphoma

Non-Hodgkin s lymphomas (NHLs) constitute a heterogeneous group of lymphoid neoplasms and a majority of them in India are of B-cell phenotype. Varying numbers of T lymphocytes and natural killer (NK) cells are consistently present within the lymph nodes (LNs). The role of these reactive cells is becoming understood. TIA-1 is a cytotoxic granule associated RNA binding protein, the expression of which is restricted to cytotoxic T lymphocytes (CTLs) and NK cells. Snap frozen lymph node biopsies obtained from 41 B-cell NHLs were localized for intra-tumoral TIA-1 + cytolytic cells by immunohistochemistry. Distribution of T cell subsets and NK cells were also quantified. Cells expressing TIA-1 antigen was observed in all the cases, seen as a strong granular cytoplasmic signal. Results indicate significantly higher number of TIA-1 cytolytic cells outside (periphery of the follicle and interfollicular areas) than within the neoplastic follicle in follicular lymphomas (p<0.001). In small lymphocytic lymphomas, cytolytic cells were mainly seen as uniformly scattered single cells, distributed throughout the tumor environment. In mantle cell and diffuse large B-cell lymphomas these were most often seen as small clusters and less frequently as singly scattered cells. Higher numbers of CD4 + than the CD8 + T cells were observed in most cases. Contrary to the follicles in follicular hyperplasia, CD57 + NK cells were predominantly observed outside the neoplastic follicle in follicular lymphomas (FLs). These results outline specific interactions between the potential anti-tumoral cytolytic and the malignant cells of B-cell NHLs.

Characterization of germinal center dendritic cells in follicular lymphoma

A subset of dendritic cells called germinal center dendritic cells (GCDC) has recently been described inside germinal center from reactive lymphoid organs. We investigated this newly recognized population in follicular lymphoma (FL), which is considered to be the pathologic counterpart of germinal center B cells. Immunohistochemistry analysis with a panel of antibodies demonstrated the presence of a cell population with the peculiar GCDC phenotype in FL biopsies and a similar localization of these cells inside tumoral and reactive follicles. Therefore, we analyzed the relationships between GCDC and the other cell subsets of the tumor follicles. Some of CD4+ and CD8+ T lymphocytes present inside the follicle were found to be in close association with GCDC, suggesting a potential implication of GCDC in their activation. In addition, the distribution of GCDC inside FL and reactive follicles did not appear disrupted, in contrast to follicular dendritic cells, the other follicle dendritic cell type. Finally, we demonstrated that GCDC could be detected from FL lymph node cell suspension by flow cytometry. Taken together, these results indicate that FL development is not associated with a disappearance of GCDC or with a lack of physical interactions between GCDC and T cells inside the follicles. In addition, the fact that GCDC can be observed in FL samples by flow cytometry should allow their purification to further study their putative role in FL development and maintenance.

T-cell-rich B-cell lymphoma--a distinct clinicopathologic entity?

T-cell-rich B-cell lymphoma is a particular variant of large B-cell lymphomas with the morphological hallmark of a small number of large neoplastic B-cells scattered in between a dense background of reactive T-lymphocytes, while histiocytes may be admixed in variable numbers. In the typical case, the neoplastic population resembles large germinal center cells including cells similar to the L+H-variants of Reed-Sternberg cells. The immunophenotype of these tumour cells is L26 + Leu-M1-BerH2-. Apart from these unifying features, the individual cases constitute a broad spectrum of various growth patterns, so that a multiplicity of different relations to other types of malignant lymphomas are discussed in the literature. This occurs to such an extent that it may be doubted, that one deals with a distinct and separate lymphoma entity. Moreover, a close relationship exists between T-cell-rich B-cell lymphoma and lymphocyte predominant Hodgkin's disease, because there are striking similarities between the two, and, in addition, coexistence of T-cell-rich B-cell lymphoma with Hodgkin's paragranuloma has been reported. It, therefore, seems conceivable that T-cell-rich B-cell lymphoma represents a developmental stage of lymphocyte predominant Hodgkin's disease. Be that as it may: There is no doubt that, presently, the nosological position of T-cell-rich B-cell lymphoma is unsettled and still remains to be clarified.

Genotype study of non-Hodgkin's lymphoma

DNA from 47 patients with non-Hodgkin's lymphoma (NHL) was studied for immunoglobulin and T-cell receptor (TCR) gene rearrangements with Southern blot hybridization. In 83% of the cases the genotypic changes were consistent with immunophenotypic and morphologic examination. Two cases showed mixed genotype and 9 cases of B-cell NHL (67% of centroblastic, 36% of follicular and 33% of large cell anaplastic) showed a population of cells with TCR gamma rearrangements in addition to immunoglobulin rearranged bands. We compared the TCR gamma variable region usage in these rearrangements in B-cell NHL with T-cell NHL and reactive hyperplasia. In T-cell NHL TCR gamma variable regions located at the 3' part of the variable locus were used more often, whilst in B-cell NHL regions of the 5' portion of the locus were preferentially used. Our results confirm the genotypic heterogeneity of histologically defined subtypes of NHL.

Primary T-cell rich B-cell lymphoma of the common bile duct

A 34-year-old woman was hospitalized for the investigation of a one-month history of intestinal disorders, gastric heaviness and transitory icteric episodes. Extensive clinical investigations suggested the diagnosis of gall bladder carcinoma or sclerosing cholangitis. At laparotomy, the proximal part of common bile duct was markedly thickened by a white, firm, fish-flesh like tumour extending in to the cystic duct, gall bladder wall and to the liver. Histological study showed a diffuse lymphoid proliferation of the common bile duct mainly composed of small cells mixed with scattered large atypical cells. Immunohistochemistry revealed that most of the small cells expressed T-cell markers with predominant CD 4 and alpha-beta T-cell receptors and without phenotypic gap, whereas large atypical cells showed monotypic B phenotype with co-expression of mu and delta heavy chains and light lambda chain restriction. No evidence of primary nodal lymphoma was found during extensive clinical, radiological, sonographic or scanographic examinations. Sequential chemotherapy (MACOP-B) was instituted and the patient was still alive 4 years after diagnosis. Morphological and immunohistochemistry findings fulfilled criteria for a primary high grade B-cell lymphoma (centroblastic type, Kiel classification) from common bile duct concealed by numerous small reactive T-cells, so called T-cell rich B-cell lymphoma, not previously described in this location.

Immunohistochemistry of Nasopharyngeal (Waldeyer's ring equivalent) lymphoid tissue in the rat

Previously we have described the presence of Waldeyer's ring equivalent (WRE) lymphoid tissue in the rat, and pointed out the importance of such an experimental model for studying the immunological role of nasopharyngeal lymphoid tissue. Here we extend this work with immunohistological data in terms of compartmentalization and distribution of the various lymphoid and non-lymphoid cells of this WRE lymphoid tissue in situ. WRE tissue consists of distinct T cell and B cell areas. B cell areas predominate; they are located directly under the mucosal epithelium and consist mainly of follicles. These follicles frequently contain a germinal center with IgD negative B cells interspersed with scattered CD4 (helper/inducer) T cells. Follicular dendritic cells are present in the germinal centers. T cell areas, on the other hand, are predominantly present at the abluminal side of the WRE in interfollicular areas. In these areas high endothelial venules and both CD4 and CD8 (suppressor/cytotoxic) T cell populations with a clear preponderance of CD4 over CD8 cells can be observed. MHC class II positive interdigitating dendritic cells are also scattered throughout these T cell areas. Mononuclear phagocytes (ED1-positive monocytes/macrophages) are scattered throughout the WRE, but especially in the T cell areas. A subpopulation of (ED3-positive) mononuclear phagocytes, e.g., the lymphoid tissue macrophage, is exclusively scattered between the small blood vessels along the abluminal side of the lymphoid tissue. Here, plasma cells, including those of the IgA type, are located. The data show that nasopharyngeal lymphoid tissue in the rat can be considered as an immunologically fully equipped and active mucosal lymphoid organ presumably executing similar immune functions as the tonsils in the human Waldeyer's ring.

T-cell-rich B-cell lymphoma presenting as liver disease

We describe a series of eight cases of T-cell-rich B-cell lymphoma diagnosed on liver biopsy and collected over a period of 15 years. Of seven cases that were referred from elsewhere, in only one was the correct diagnosis of B-cell lymphoma suggested. Common errors included misdiagnosis as inflammatory disease on histology, and misinterpretation as T-cell lymphoma on immunohistochemistry. However, the cases had a distinct morphological appearance and immunohistochemical profile. They showed a lymphohistiocytic or granulomatous infiltrate, usually centred on portal tracts and containing abundant small T-cells and scanty B-cell blasts. All patients had an atypical clinical presentation which favoured non-neoplastic liver disease. In seven cases liver involvement represented Stage IV disease and in one case disease was confined to the liver consistent with a primary hepatic lymphoma. Despite combination chemotherapy, the prognosis was poor with no patients surviving beyond 15 months from diagnosis. We believe T-cell-rich B-cell lymphoma to be an under-recognized subset of non-Hodgkin's lymphoma that may mimic primary liver disease.

Cellular interactions in the germinal center: role of adhesion receptors and significance for the pathogenesis of AIDS and malignant lymphoma

The germinal center forms a specialized microenvironment that is thought to play a key role in the induction of antibody synthesis, affinity maturation of B cells, isotype switching, and memory B-cell formation. Moreover, the germinal center may also be involved in the maintenance of T-cell memory. In this paper we focus on the role of adhesion receptors in cellular interactions in the germinal center, and discuss evidence indicating that these molecules play an important role in regulating B-cell activation and differentiation. Furthermore, we discuss two important diseases involving the germinal center, i.e., HIV infection and malignant lymphoma. In HIV infection, destruction of the FDC network may explain the selective loss of memory cells observed in otherwise asymptomatic patients and is likely to represent a major pathway leading to AIDS. In follicular lymphoma, escape from physiological apoptosis in the germinal center by overexpression of Bcl-2 appears be a major pathogenetic pathway.

Follicular lymphoma: a model of lymphoid tumor progression in man

Human follicular lymphoma can be viewed as a malignancy in evolution. Since this disease is composed of a clonal population of B lymphocytes all expressing a given immunoglobulin light chain and heavy chain, it seems possible that the initial transforming event, the t(14; 18) chromosomal translocation, occurs in a cell already committed to the expression of a particular VH and VL gene. A panel of antibodies has been assembled which define a set of idiotypes expressed repeatedly by B-cell lymphomas. Nonetheless, VH gene usage in follicular lymphoma tumors appears to reflect the normal B-cell repertoire. Growth of follicular lymphoma appears to be partially under normal regulatory control. The expanding malignant B-cell clone grows in follicles with particular apposition to follicular dendritic cells and heavy infiltration with CD4+ T cells. Interaction with T cells can induce the proliferation of follicular lymphoma cells. This tumor eventually evolves into a diffuse large-cell lymphoma which is highly aggressive and lethal. It is now clear that the malignant progression occurs from a single cell within the expanding follicular lymphoma clone. A panel of monoclonal antibodies to cell surface molecules has been generated that inhibit proliferation of diffuse lymphoma cell lines, and some of the target molecules have been partially characterized. Therapeutic application of anti-idiotype monoclonal antibodies has shown a high degree of tumor responsiveness, but ultimately escape of idiotype-negative variant cells occurs. These variants arise as a result of extensive somatic point mutation in the VH and VL genes of follicular lymphoma. Active immunization can result in an immune response by patients directed against the idiotype expressed on their own B-cell tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Rheumatoid lymphadenopathy: a morphological and immunohistochemical study

Sixteen lymph nodes from 14 patients with rheumatoid arthritis were examined immunohistochemically and morphometrically and compared with 10 control nodes showing follicular hyperplasia from patients without rheumatoid disease. Frozen material was available from nine patients and all controls. The nodes from patients with rheumatoid arthritis seemed to share characteristic features. The most striking of these was follicular hyperplasia in which the germinal centres, in spite of being quite large, showed relatively sparse proliferative activity. The nodes often showed infiltration of germinal centres by CD8 positive T lymphocytes and contained fewer IL2R positive cells in the paracortex than controls. These and other features may have some correlation with disease activity. Lymphadenopathy in rheumatoid arthritis may not just be a manifestation of joint inflammation but an active component of this multisystem disease and may reflect a widespread immunological abnormality.

Large B-cell lymphomas with a high content of reactive T cells

Twenty-one cases of large, B-cell lymphoma with an unusually high content of reactive T lymphocytes are described in this report. Fifteen patients presented with lymphoma in nodal sites and six patients presented with lymphoma in extranodal sites. With two exceptions, all patients were more than 50 years of age. The male to female ratio was 1:2. Histologically, isolated to small groups of large lymphoid cells were intermingled with many small lymphocytes. The large cells were neoplastic and exhibited B-lineage markers; immunoglobulin light chain restriction could be demonstrated in two thirds of the cases. There was a rich infiltrate of immunophenotypically mature T lymphocytes that comprised more than 50% of the cellular population. The T lymphocytes ranged from small cells with dark, round nuclei to slightly larger cells with elongated, irregular nuclei. There were occasional medium-sized blastic cells. There was also a variable infiltrate of histiocytes with or without epithelioid features, eosinophils and plasma cells, and increased vascularity. The peculiar morphologic features were also reproduced in other sites in the four patients for whom additional histologic materials were available for examination. We postulate that the abundance of T cells results either from a florid host reaction or from cytokine secretion by the neoplastic B cells, attracting T cells to the vicinity. The morphologic and immunologic features mimic those of a variety of benign lymphoproliferative diseases, angioimmunoblastic lymphadenopathy and lymphomas arising in angioimmunoblastic lymphadenopathy, peripheral T-cell lymphoma, secondary B-immunoblastic lymphoma, and Hodgkin's disease. Careful morphologic evaluation and immunophenotypic studies using leukocyte antibodies reactive in paraffin-embedded sections are of great assistance in determining a diagnosis.

T cells in follicular centroblastic/centrocytic (cleaved follicular centre cell) lymphomas at diagnosis, relapse and transformation

Although T cells are often a prominent component of follicular (+/- diffuse) centroblastic/centrocytic (cleaved follicular centre cell--FCC) lymphomas (CB/cc/F +/- D), their evolution during the course of the disease and prognostic significance are uncertain. A total of 127 histopathologic and immunophenotypic studies from 77 patients with at least one histologic diagnosis of CB/cc/F +/- D were therefore retrospectively reviewed to address these questions. The proportion of T cells in each biopsy was analysed with reference to both histologic (diagnosis--Kiel and Lukes/Collins classification, presence of transformation, growth pattern, presence of residual mantle zones, biopsy sites) and clinical (biopsy date and number, treatment status) parameters. The actuarial survival for those patients whose first or second biopsy showed CB/cc/F +/- D and had immunophenotypic studies was also compared based on the proportions of T cells present. Among the biopsies which were obtained from 0 to 153 months following diagnosis, the mean proportion of T cells was 25 +/- 18 per cent. The only histopathologic group that showed a significantly different proportion of T cells were lymphomas of large cleaved FCC type (38 +/- 20 per cent). Although the number of T cells present varied greatly between different patients and among different biopsies in the same patients, neither biopsy number nor treatment status affected the mean proportion of T cells in CB/cc/F +/- D. With the exception of those biopsies from 1 to 11 months following diagnosis, the interval time between diagnosis and biopsy also did not affect the number of T cells present. Finally, the proportion of T cells in the lymphomas could not be shown to be of prognostic importance. Thus, the proportion of T cells in de novo CB/cc/F +/- D, at relapse or in transformation does not vary in a consistent fashion. Although extremely variable, the number of T cells present cannot be considered a feature of earlier or later disease and is not of demonstrable prognostic importance. Studies of specific subsets of T cells may provide more definite associations.

A retrospective study of follicular lymphomas

Sixty-four cases of follicular lymphoma followed-up for 10 years have been studied. The influence of age, sex, histological appearance, immunophenotype and T-cell content on prognosis has been examined. Initial evaluation indicated that increasing age, relatively low numbers of intrafollicular T-cells and absence of mantle zones around the neoplastic follicles were associated significantly with mortality. Multiple regression analysis with adjustment for age and sex was performed and the only significant variable was then found to be the histological grade.

Limiting dilution analysis of the frequency of IL2 responsive T cells in lymph nodes involved by B-cell non-Hodgkin's lymphomas

Total T lymphocytes separated from twelve lymph nodes involved by B-NHL were studied in limiting dilution experiments for their ability to proliferate in the presence of both R-IL2 used at a final concentration of 40 U/ml and irradiated autologous malignant B cells as feeders. The number of proliferating T-lymphocyte precursors (PTL-P) thus estimated was low in each case (mean: 1/4503; range, 1/200 to 1/11013). Once expanded, proliferation of the IL2 responsive T cells in the presence of autologous malignant B cells remained strictly dependent on the addition of exogenous IL2. Control cases consisted of T lymphocytes separated from peripheral blood of six healthy subjects and cultured in the presence of both R-IL2 (40 U/ml) and irradiated autologous total mononuclear cells as feeders; the mean frequency of PTL-P thus obtained (1/173; range, 1/49 to 1/457) was significantly higher than in malignant lymph nodes (p less than 0.01). These findings do not support the hypothesis that, in this series of patients, expansion of malignant B cells may lead to the activation and growth of T cells sensitized against the tumour.

Histological and immunohistological analysis of human lymphomas

Morphological and immunological characteristics of lymphoproliferative diseases are reviewed. In particular, a basic distinction is made between non-Hodgkin's lymphomas and Hodgkin's disease. As to the non-Hodgkin's lymphomas, emphasis is given to the problems of classification, technical approach, histogenesis, and prognosis. The authors adopt a version of the Kiel Classification modified to take account of new knowledge regarding T-cell lymphomas. The value of immunophenotyping in making an accurate distinction between the various categories is stressed; immunocytochemical detection of the growth fraction is also discussed and then proposed as a new prognostic tool. Finally, the criteria for differential diagnosis between non-Hodgkin's lymphomas, malignant histiocytosis, non-lymphoid large cell tumors, and atypical immune reactions are outlined.

Effects of retinoids on human thymus-dependent and thymus-independent mitogenesis

The effects of all-trans-retinoic acid (RA), 13-cis-retinoic acid, and N-(4-hydroxyphenyl)retinamide on the mitogenic responses of various populations of human lymphocytes have been evaluated. Superoptimal concentrations of mitogens allowed the greatest RA-induced potentiation of lymphocyte proliferation. All three retinoids at concentrations as low as 5 x 10(-14)M significantly potentiated the proliferation of adenoidal and tonsillar lymphocytes stimulated by pokeweed mitogen (PWM). However, the responses of adenoidal and tonsillar lymphocytes to Staphylococcus aureus Cowan strain A were not potentiated by retinoids. Retinoids also caused significant potentiation of proliferation of PWM-stimulated peripheral blood lymphocytes (PBL). However, endpoint concentrations of retinoids required to significantly potentiate PBL proliferative responses to PWM were much higher than required for potentiation of adenoidal or tonsillar lymphocytes. PBL responses to concanavalin A (Con A) were significantly potentiated by retinoid concentrations as low as 10(-8) to 10(-10) M. Retinoid-potentiated responses were also observed wi Con A-stimulated thymocytes, but the endpoint concentrations required for significant potentiation were 10-fold higher than required to potentiate PBL responses to Con A. These data indicate that the sensitivity of lymphocytes to the retinoid-mediated potentiation of mitogenesis depends on the lymphoid compartment from which the cells are obtained. Tonsillar and adenoidal lymphocytes were the most responsive of the lymphocytes tested to the retinoid-induced potentiation of PWM responses. In addition, retinoids appear to selectively potentiate T cell-dependent proliferative activity.

Lymphocyte immunophenotyping of B-cell lymphomas: a flow cytometric analysis of neoplastic and nonneoplastic cells in 271 cases

We have reviewed our experience with 271 B-cell lymphomas to determine the effectiveness of flow cytometry in the characterization of these malignancies. Flow cytometric immunophenotyping of the total lymphocyte and/or large lymphocyte populations confirmed the morphologic diagnosis of B-cell lymphoma in 92% of cases, which included 79% monoclonal and 13% surface immunoglobulin (SIg)-negative lymphomas. Light chain monoclonality was most frequent in low grade and follicular center cell (FCC) lymphomas, while SIg-negative cases were most common in high grade and non-FCC types. Low grade lymphomas of all histologic types had high median percentages of neoplastic cells and low T-cell percentages. Conversely, high grade lymphomas exhibited lower and less uniform median percentages of B-cells, with higher numbers of T-cells and lower CD4/CD8 ratios than low grade lymphomas. Several differences in B- and T-cells were observed between specific high grade histologic types. FCC lymphomas with a diffuse pattern had lower percentages of CD4+ cells and lower CD4/CD8 ratios than cases with a follicular pattern. Thus, immunophenotypic differences were observed between histologic types or groups with known differences in clinical course and prognosis. We conclude that flow cytometry provides reliable information on neoplastic and nonneoplastic cells in lymph nodes involved by B-cell lymphomas.

Light chain deposition disease with liver dysfunction

Light and transmission electron microscopic study as well as immunohistochemical investigation were performed on three cases of light chain deposition disease (LCDD) with severe liver dysfunction. In two cases, the amount of light chain deposits in the liver was moderate and did not correlate with the severity of clinical and biological symptoms. Ultrastructural study demonstrated a collagenization of the Disse's space, with basement membrane-like material in association with light chain deposits. Immunohistochemical investigation showed a marked increase of collagen types I, III, and IV, as well as fibronectin and laminin in perisinusoidal space. This study suggests that collagenization of the Disse's space has a minor role in liver dysfunction. The analogy between kidney and liver lesions in diabetes and in LCDD is stressed, but the mechanism of this abnormal accumulation of matrix proteins remains unknown.

Expression in non-Hodgkin's lymphoma of the bcl-2 protein associated with the t(14;18) chromosomal translocation

For many non-Hodgkin's lymphomas, the bcl-2 gene has been implicated as a likely proto-oncogene, since it is consistently located at or near the breakpoint sites of t(14;18) chromosomal translocations. To define the role of the protein product of the bcl-2 gene in lymphoid cancers, we used anti-bcl-2 antibodies to perform immunohistochemical studies of frozen sections of 136 tissue specimens affected by lymphoma or non-neoplastic lymphoid disorders. Immunoreactive bcl-2 protein was observed in the neoplastic cells in almost all the follicular lymphomas, whereas no bcl-2 protein was detected in follicles affected by non-neoplastic processes or in normal lymphoid tissue. Every tumor with molecular-genetic evidence of t(14;18) translocation expressed detectable levels of bcl-2 protein, regardless of whether the breakpoint was located in or at a distance from the bcl-2 gene. These data show consistent expression of a proto-oncogenic protein in a large proportion of non-Hodgkin's lymphomas and provide further support of a role for bcl-2 in the pathogenesis of all lymphomas with the t(14;18) karyotypic abnormality. Increased expression of bcl-2 after t(14;18) translocations may be a specific marker for B-cell cancers, and demonstration of the protein with use of anti-bcl-2 antibodies could be useful in the diagnosis of many non-Hodgkin's lymphomas.

Immunoarchitecture of the "pseudofollicles" of well-differentiated (small) lymphocytic lymphoma: a comparison with true follicles

Some human malignant lymphomas of the B-cell type have morphologic and immunologic similarities to follicles seen in nonneoplastic reactive lymph nodes. In contrast, a peculiar, vaguely nodular pattern of growth called "pseudonodules" or "pseudofollicular proliferation centers," which is morphologically distinguishable from "true" follicles, is seen in malignant lymphoma, well-differentiated (small) lymphocytic type (WDL). To characterize the cellular components of "pseudofollicles," we undertook a detailed, comparative immunohistologic study of the architectural relationship and distribution of T cells, B cells, and follicular dendritic reticulum cells (DRCs) in reactive follicles, neoplastic follicles, and pseudofollicles. We report several observations on the presence of DRCs and T-cell subset topography in pseudofollicles. Immunohistologic staining for the C3d complement receptor on DRCs revealed that DRC networks associated with "true" follicles were present in all cases of reactive follicular hyperplasia (RFH) and malignant lymphoma, nodular, poorly differentiated lymphocytic type (PDL) studied. Surprisingly, DRC networks were also identified in 8 of 23 cases of WDL. Although the size distribution of DRC network diameters was nearly identical in RFH and PDL, the sizes were markedly diminished in WDL. Immunohistologic staining for Leu 3+ and Leu 2+ T-cell subsets confirmed cellular arrangements in RFH and PDL reported by others. In only 2 of 23 cases of WDL could T cells localized to "pseudofollicles" in frozen tissue sections be identified in a nonrandom arrangement.

Immunohistochemical studies on B cell lymphomas with special reference to T cell infiltration and its significance as a prognostic factor

Twenty-eight cases of B cell lymphoma were studied immunohistochemically utilizing a panel of monoclonal antibodies. Of 27 cases tested, 26 were B-1-positive and 22 of 24 cases were HLA-DR positive. There were eight BA-1-positive cases, including one follicular lymphoma, and 10 J-5-positive cases including five diffuse large cell lymphomas. Some of the J-5-positive diffuse large cell lymphomas were considered to be of follicular center cell origin. Infiltration and distribution of non-neoplastic T cell subsets, BA-1-positive B cells, dendritic reticulum cells, Langerhans cells and HNK cells showed close similarity between the structure of follicular lymphomas and that of the reactive follicles. Such similarity to the normal counterpart structure was less apparent in diffuse lymphomas, especially in the large cell type. These findings were interpreted to be an expression of different degrees of neoplastic deviation. There was evidence to suggest that, regardless of the histological classification, a large number of infiltrating non-neoplastic T cells was related to good prognosis.

Angiocentric B-cell lymphoma of the lung in an immunocompromised boy

An angiocentric IgA-kappa bilateral pulmonary lymphoma developed in a 9-year-old boy treated with chemotherapy for 3 1/2 years for acute lymphoblastic leukemia. The tumor was confined to the lungs and had extensive infarction secondary to vascular involvement. This and 2 similar reported cases suggest that compromise of the host's immune system may contribute to the development of pulmonary lymphoma in children, an uncommon site and probably labeled previously as lymphomatoid granulomatosis.

A systematic approach to the immunohistologic classification of lymphoproliferative disorders

From the study of over 3,000 immunologically well characterized cases, we have developed a systematic approach for the immunohistologic evaluation of lymphoproliferative disorders (LPD). By using a basic screening panel of antibodies on fresh-frozen sections, LPD can be reliably immunophenotyped. Fourteen patterns of immunoreactivity have been identified that can be used in differential diagnosis and the establishment of the correct diagnosis. A comprehensive table has been developed for systematically recording for each case the results of immunohistologic evaluation of fresh-frozen sections. The information recorded is easily computerized for later studies of large numbers of cases. We also propose a strategy for the further characterization of rare cases that are not easily defined with the basic screening panel of immunologic reagents. The proposed systematic approach allows the rapid recognition of the predominant immunologic pattern, the determination of the differential diagnoses, and the establishment of the correct diagnosis. In many cases, the final diagnosis can be predicted on the basis of patterns of immunoreactivity in the fresh-frozen section prior to the evaluation of the paraffin-embedded histologic material. Moreover, this systematic approach may provide an additional method to classify LPD more precisely and reproducibly.

Lymphoid stromal reaction in gastrointestinal lymphomas: immunohistochemical study of 14 cases

The lymphoid stromal reaction, particularly the T lymphoid reaction, was studied immunohistochemically on cryostat sections in 14 cases of primary gastrointestinal B lymphomas, and compared with the type and distribution of lymphoid cells in three cases of gastric lymphoid hyperplasia. A pronounced T lymphoid reaction, mainly of the T helper phenotype, occurred in both lesions. Most of these T cells bore HLA-DR antigens, but only a few of them had the receptor for interleukin 2. The T lymphoid reaction was observed inside the lymphomas in seven of a total of 14 cases, and around the lymphomas in four of the six cases clinically classified as stage I. Perivascular mucosal and submucosal nodules, entirely composed of T cells, seemed characteristic of gastric lymphoid hyperplasias. A T lymphoid reaction in lymphoid hyperplasias suggests an amplification of the cell mediated immune response; in lymphomas it could represent a host reaction against the lymphomatous infiltrate, therefore favouring a better prognosis.

Identification and quantification of subsets of mononuclear inflammatory cells in melanocytic and other human tumors

We used monoclonal antibodies and an indirect immunoperoxidase technique to identify mononuclear inflammatory cells associated with human tumors. The absolute number of the different types of inflammatory cells was assessed by using a point-counting technique. We studied tissues from six primary cutaneous melanomas, six metastatic melanomas, eight melanocytic nevi, 14 breast cancers, seven examples of fibrocystic disease of the breast, 11 lung cancers, and six colon cancers. Virtually all tumors were associated with substantial numbers of T lymphocytes (Leu3a-positive T helper-inducer cells predominating) and macrophages. Primary melanomas contained significantly more T lymphocytes (P less than .002), macrophages (P less than .005), and Langerhans/dendritic cells (P less than .002) than nevi or normal skin and had a higher proportion of T cells than metastatic melanomas (P less than .01). Breast cancers contained more T lymphocytes and macrophages than occur with fibrocystic disease (P less than .0001 and P less than .002, respectively) and more B lymphocytes. Cancers of the lung and colon contained moderate numbers of T lymphocytes and macrophages; however, colon cancers contained a higher proportion of B cells. Leu7-positive NK/K cells were noted in small numbers in all tumors examined.

Influence of immunoglobulin isotypes and lymphoid cell phenotype on the transfer of immune complexes to follicular dendritic cells

Follicular dendritic cells (FDC) are located only inside lymph follicles and are characterized mainly by their capacity to retain high amounts of immune complexes by their Fc or C3b receptors. In this work, we examine the influence of immunoglobulin isotypes and the subset of lymphoid cells (B or T) upon the transfer of immune complexes from lymphocytes to FDC. FDC isolated from mice lymph nodes by enzymatic digestion are able to fix, through Fc receptors, gold-labeled immune complexes presented by lymphoid cells. As demonstrated by electron microscopy, this transfer requires the establishment of close contacts between both cell types. Using different cell selection techniques we show that B lymphoid cells take up immune complexes more efficiently than do T lymphoid cells and transfer a larger number of them to FDC. This transfer mechanism is dependent on the immunoglobulin isotype: immune complexes constituted of IgG2a, IgG2b, and IgG1 isotypes are better transferred to FDC than those constituted of IgG3 and IgM.

In situ characterization of the cell-surface antigens of the mononuclear cell infiltrate and bile duct epithelium in primary biliary cirrhosis

To analyze the tissue distribution of mononuclear cells and HLA antigens in primary biliary cirrhosis, we studied liver biopsies of 12 patients at different stages of the disease, using the avidin-biotin-peroxidase technique and monoclonal antibodies directed against T and B lymphocytes, T-cell subsets, macrophages, NK/K cells, dendritic cells, and HLA class I and II antigens. To evaluate the proportion of activated T cells we used anti-interleukin-2-receptor antibodies and a double-staining technique for T cells and class II HLA antigens. In all biopsies activated T cells predominated in the portal areas and around the damaged bile ducts. T4 cells almost always outnumbered T8 cells. While B cells, NK/K cells, and dendritic cells were always scarce, macrophages constituted about 30% of the cellular infiltrate. Biliary epithelium, which normally expresses HLA class I antigens, displayed mainly HLA class II antigens. The predominance of T4 cells around the bile ducts, which express class II antigens, suggests that class II-restricted T4 lymphocytes may mediate liver damage in primary biliary cirrhosis.

The extracellular matrix in "sclerosing" follicular center cell lymphomas: an immunohistochemical and ultrastructural study

"Sclerosis" is frequently seen in follicular center cell (FCC) lymphomas. The mechanism of its deposition, as well as its composition and significance, are unknown. Several clinical studies have suggested that the course of these lymphomas is more indolent than that of lymphomas of the same histologic type without sclerosis. Nine immunologically characterized cleaved FCC lymphomas with sclerosis and 14 reactive lymph nodes with follicular hyperplasia were investigated by special staining methods, electron microscopy, and immunohistochemical studies with antibodies to types I, III, IV, and V collagen, laminin, and fibronectin. The sclerotic tissue in FCC lymphomas stained uniformly with periodic acid-Schiff (PAS) and Masson's stain, with the patterns ranging from delicate filamentous strands to dense doubly refractile bands. Ultrastructurally, the bands of connective tissue were continuous with the adventitia of vessels and composed of varying amounts of banded collagen (types I and III) admixed with filamentous and flocculent material. In all cases the neoplastic lymphocytes were separated from the extra-cellular matrix by fibroblasts and myofibroblasts with long cell processes. Immunohistochemical studies demonstrated intense staining of sclerotic bands with antibodies to fibronectin and type I collagen and, usually, weaker marking with antibodies to types III and V collagen. No significant staining of sclerotic bands was found with antibodies to type IV collagen or with laminin. Weak pericellular staining for type V collagen was present in eight of nine lymphomas and half of the control lymph nodes. These studies suggest that the increased amounts of extracellular matrix in cleaved FCC lymphomas are produced primarily by fibroblasts and myofibroblasts and represent predominantly fibronectin and types I, III, and V collagen. The composition of the sclerotic areas of FCC lymphomas is similar immunohistochemically to that of the capsule and trabeculae of reactive lymph nodes, which are also intimately associated with fibroblasts and myofibroblasts.

An immunohistochemical study of non-Hodgkin's lymphomas: correlation of morphological appearances and immunophenotype in 148 cases

An unselected series of 148 cases of non-Hodgkin's lymphoma has been studied by immunohistological methods. In each case, the morphological features displayed in paraffin sections were correlated with the immunophenotype, determined using a panel of monoclonal antibodies. Of the lymphomas 82% were B-cell type, 28% of follicle centre cell origin, 17% lymphocytic or immunocytic and 30% of large cell type. All the B-cell tumours expressed pan-B antigen, and nearly all HLA-DR. In most, light chain monoclonality was demonstrable. Nearly all had moderate to large numbers of T-cells of both subtypes interspersed amongst the B-lymphocytes. Follicle centre cell tumours expressed surface IgM and IgD and had numerous dendritic reticulum cells. Lymphocytic and immunocytic lymphoma expressed IgM but less IgD, and had fewer or no dendritic reticulum cells. Large cell lymphoma expressed either no immunoglobulin or only IgM, and contained ragged dendritic reticulum cells, giving the appearance of 'burnt-out' follicles. T-cell lymphomas usually showed a clear preponderance of either helper or suppressor subtype. Additionally, they contained residual B-cells and sometimes germinal centres. Only 3% of this series were 'non-B, non-T', and only one case HLA-DR negative, so the 'null' or 'unclassifiable' group is very small when information from antibody markers is available.

Can peripheral T-cell lymphomas be morphologically subclassified? A morphometric approach to 21 cases

Morphometric analysis of nuclear sizes and shapes was carried out on semithin sections of lymph node for 21 patients suffering from non-Hodgkin's peripheral T-cell malignant lymphoma (ML) (excluding mycosis and Sézary syndrome). Twenty cases of B-cell ML and three cases of Sézary syndrome with massive lymph node infiltration were also studied as references. Wright and Isaacson's recent proposals were applied to classify the peripheral T-cell MLs into monomorphic medium-cell ML (eight cases), pleomorphic ML (nine cases), and monomorphic large-cell ML (four cases). These three classes were readily distinguishable by morphometric analysis of nuclear sizes. Nuclear areas and their coefficients of variation were higher in pleomorphic MLs than in monomorphic medium-cell MLs (p less than 0.01). Large-cell monomorphic MLs were set apart by the histograms of their nuclear sizes. The mitoses were evaluated on histological sections and found to be more numerous in pleomorphic ML than in monomorphic medium-cell ML (p less than 0.05). Nuclear irregularity in the 21 cases of peripheral T-cell ML was lower than in Sézary cells. Morphometry clearly demonstrates the morphological distinctiveness of the subclasses of peripheral T-cell ML. Their biological significance has yet to be determined.

Intermediate lymphocytic lymphoma of the thyroid. An immunologic and immunohistologic study

Four cases of thyroid lymphomas are presented showing curious histologic difficult to distinguish from severe lymphocytic thyroiditis by routine histologic study alone. The age of the patients ranged from 39 to 63 years. Three female patients suffered from autoimmune (lymphocytic) thyroiditis for 2 to 20 years until the present illness. A male patient had no history of thyroiditis. Rapid growth of struma in these patients suggested an evolution of malignant lymphomas. Histologic study results showed that small atypical lymphoid cells with slightly irregular and indented nuclear contour surrounded randomly distributed secondary follicles as a wide mantle. Immunohistologic staining showed that these atypical small lymphoid cells expressed surface properties intermediate between mantle-zone lymphocytes and germinal center cells with a restricted expression of kappa chain in three cases. Stages of tumors were stage I in three cases and stage II in one case. The findings demonstrated were intermediate lymphocytic lymphomas of the thyroid.

Lymphocyte subpopulations in patients with alcoholic liver disease

To determine whether abnormalities of the lymphocyte populations are associated with alcoholic liver disease, we have characterized the subpopulations of lymphocytes in 30 alcoholic patients with and without liver disease. Total T lymphocytes were decreased in patients with alcoholic hepatitis and alcoholic cirrhosis. However, T4 (helper) and T8 (suppressor/cytotoxic) cells and the T4 and T8 cell ratio were similar to the values in controls. In these patients, the sums of T4/T8 cells exceeded that of total T cells, an alteration apparently related to severe liver damage. Cells reacting with antisera to immunoglobulins (B lymphocytes) and to Dr determinants were also within the normal range. In contrast, NK/K (natural killer/killer) cells were increased in the group of patients with steatosis or without liver alteration. Increase of NK/K cells was not observed in patients who were abstinent from alcohol for a period of two weeks or more, suggesting that alcohol may have been responsible for the increase in this lymphocyte population.

Phenotyping of mononuclear cells from tonsils and corresponding biopsies using a cytofluorimeter. A comparative study

A series of B, T, natural killer cell (NK) and monocyte-specific monoclonal antibodies was used to determine the distribution of lymphocyte subpopulations in cell suspensions obtained from whole tonsils as well as their corresponding biopsies. The majority of the mononuclear cells stained with OKB-7 and anti-Dr. A consistent lower percentage of the B lymphocytes stained with OKB-2. The T lymphocytes were composed of a majority of OKT4+ lymphocytes. Only a minority of the lymphocytes stained with Leu-7, whereas Leu-llb+ lymphocytes were virtually absent. A significant proportion of the mononuclear cells stained with OKM-1. There was a highly significant correlation between the distribution of the cells stained with the different monoclonal antibodies obtained from the whole tonsil and the corresponding biopsy (r2 = 0.95). This study shows that biopsies offer a reliable source to study the lymphocyte subsets in tonsils and that cytofluorimetry can be applied to study the lymphocyte distribution in this organ.

Lymphocyte populations and TAC-antigen in diffuse B-cell lymphomas

Immune cell populations in 8 diffuse histology B-cell lymphomas were analysed in frozen tissue sections by indirect immunofluorescence to gain insight into their possible modulating influence in these tumors. Use of monoclonal antibodies to identify cellular and extracellular antigens combined with nuclear counterstaining allowed precise quantitation, localization and comparison of T- and B-lymphocyte populations. T lymphocytes clustered in non-random fashion. Areas of high T-lymphocyte density manifested higher T4:T8 ratios than locales with fewer T lymphocytes (p less than 0.05). Few cells had surface antigens (Leu 7, 73.1, OKM1) associated with natural killing. Cells strongly reactive with anti-TAC (Interleukin-2 receptor, associated with T-lymphocyte activation) were also T11 reactive and were usually helper (Leu 3) phenotype. In addition, B-lineage lymphoma cells in some tissues reacted with anti-TAC. The pattern of tumor cell reactivity with anti-TAC correlated with Rappaport histologic classification. These findings suggest that non-malignant T lymphocytes modulate B-lymphoma cell growth in situ, and that in some lymphomas the T-cell product IL-2 may be an important local growth factor.

Nuclear morphologic and morphometric analyses of nodular poorly differentiated lymphocytic lymphoma: assessment of small cleaved nuclei

Comparative analytic measurements of nuclear parameters in normal and neoplastic lymphocytes are limited. In the present morphometric study lymphocyte nuclear features in 21 cases of nodular poorly differentiated lymphocytic lymphoma (NPDLL) were assessed with respect to the theoretical aspects of some non-Hodgkin's lymphoma (NHL) classifications. The mean nuclear area of the lymphocytes in NPDLL is generally within the range of the areas of unstimulated (mature) lymphocytes of mantle and follicular regions of lymph nodes with reactive hyperplasia. On this basis, the neoplastic lymphocytes in NPDLL do not reflect, at least cytologically, the antigen-activated, transforming lymphocytes of normal follicular centers. All measured nuclear parameters of small, unstimulated lymphocytes of neoplastic follicles suggest that major proportions of this component are also part of the neoplastic cohort. Sectional nuclear profiles in NPDLL are much more irregular in shape and have a higher percentage of invaginations than normal lymphocytes. However, only 4 to 5 per cent of nuclear profiles in NPDLL are of sufficient depth to be termed clefted. Serial section reconstruction of both normal and neoplastic lymphocytes indicates the degree to which the numbers of invaginated or clefted nuclei are underestimated in the examination of histologic sections. For example, the 4 to 5 per cent of nuclear profiles with clefts in histologic sections of NPDLL actually represent about 25 to 30 per cent of the lymphocyte population. On the basis of computer modeling of stylized nuclei with simple invaginations of varying depths and serial section reconstruction of normal and neoplastic nuclei, it is likely that all lymphocyte nuclei have some form of nuclear membrane invagination and that in poorly differentiated lymphomas these invaginations may be single and multiple discrete indentations or linear, branching grooves. Assessment of the ratio of nuclear invagination depth to nuclear diameter in normal and neoplastic lymphocytes indicates that transforming normal lymphocytes in follicular centers do not undergo a phase of increased nuclear clefting and that this ratio is somewhat greater in lymphocytes in NPDLL than in follicular center lymphocytes. However, the latter effect is not due to increased depth of nuclear invaginations in NPDLL, but rather results from the fact that mean nuclear diameter in this subtype of NHL is considerably smaller than that of normal lymphocytes.(ABSTRACT TRUNCATED AT 400 WORDS)

B- and T-cell subsets in follicular centroblastic/centrocytic (cleaved follicular center cell) lymphoma: an immunohistologic analysis of 26 lymph nodes and three spleens

Follicular centroblastic/centrocytic (CB/cc/F), or cleaved follicular center cell, lymphomas are known to contain admixtures of B cells and, often, numerous T cells. To analyze the presence and distribution of B and T cells and their subsets in CB/cc/F lymphomas, 26 lymph nodes and three spleens (from 24 patients) were studied with a panel of monoclonal antibodies and peanut lectin by the avidin-biotin immunoperoxidase technique on frozen sections. Immunoglobulin studies revealed monoclonal neoplastic follicles in most cases, although cells of the nondominant light chain were occasionally present. Rarely, the follicles showed both kappa and lambda light chains or were immunoglobulin-negative. Although monoclonal mantles were observed in only one case, more than half of the nodes demonstrated monoclonal interfollicular infiltrates. In most cases the phenotype of the follicular cells was similar to that of the predominant cells in the normal follicles. Interfollicular lymphomatous cells had variable phenotypes that, unlike the normal situation, sometimes resembled those in the follicles. Phenotypic variation was present within single neoplastic clones and sometimes suggested more mantle-like differentiation. Phenotypic changes were also observed in repeat biopsies. T cells, usually predominantly of the T-helper phenotype, were present in variable numbers in all cases. Although present in the neoplastic follicles, they were usually more common in the interfollicular areas. Six nodes and two spleens had definite rims composed predominantly of T cells around neoplastic follicles. Apparently "activated" (Tac-positive) T cells were often present and showed accentuation around the follicles in some cases. Thus, CB/cc/F lymphoma is a malignant lymphoma that closely resembles follicular hyperplasia but that also has distinctive features.

Neoplastic B cells with cerebriform nuclei in follicular lymphomas

Three cases of follicular lymphoma in which the follicular center cells exhibited pronounced nuclear irregularities, i.e., convoluted and cerebriform shapes, are described. The cytoplasm in B5-fixed sections was scanty to abundant and showed pale to clear staining, with interlocking cell borders. Although the architectural pattern in these cases suggested B-cell lymphoma, the cytologic features suggested a T-cell phenotype. Immunologic studies of frozen sections by immunohistochemical techniques in all three cases, as well as cell suspension studies in two cases, showed that the follicular center cells, including those with convoluted and cerebriform nuclei, were clearly monoclonal B cells, as evidenced by the presence of only one immunoglobulin light chain on the surfaces. The results of this study suggest that the follicular architectural pattern is a more reliable predictor of the immunologic phenotype than are the cytologic features.