Relationship between eosinophil density and T-cell activation markers in lymph nodes of patients with Hodgkin's disease

Tissue eosinophilia in relation to immunopathological and clinical characteristics in Hodgkin's disease

Eosinophils frequently infiltrate tissues involved by Hodgkin's disease (HD), and blood eosinophilia is frequently observed. However, the clinical significance and the mechanisms underlying eosinophilia need further elucidation. In this study the grade of eosinophilic infiltration (EoI) was evaluated in biopsies from 259 HD-patients. In a selected group (n=32), the numbers of Hodgkin-Reed-Sternberg (HRS)-cells were counted, and the phenotype of small lymphocytes, the expression of cytotoxic lymphocyte-associated proteins, CD3-zeta-chain, HLA-DR, proliferation markers, latent membrane protein 1 (LMP-1) and blood lymphocyte function were evaluated. Samples from 88 HD patients (34%) showed high EoI. Significantly higher EoI was seen in nodular sclerosis 2 (NS2; p<0.001), bulky disease (p<0.05) and in patients <50 years (p<0.05). Patients with high EoI did not differ from the remainder with regard to distribution of sex, stage, B-symptoms, blood lymphocyte function and outcome. HRS-cells were significantly more frequent in NS HD as compared to mixed cellularity (MC) (p<0.001) irrespective of EoI. LMP-1-expression, proliferative fraction and phenotypes of small lymphocytes did not differ between the cases with low and high EoI, respectively. MC HD samples had significantly higher numbers of small cells positive for CD8 (p<0.01), T-cell intracellular antigen-1 (p<0.01) and Granzyme B (p<0.05) than NS. LMP-1-positive cases had significantly higher frequency of CD8-positive cells than LMP-1-negative. In conclusion, high EoI remains a feature of certain clinical subgroups of HD. However, there was no association between the degree of EoI and numbers of HRS-cells, phenotypes of small lymphocytes, EBV status and clinical outcome. Determination of EoI is of limited diagnostic and prognostic clinical value in HD. However, the differences in small cell distribution of CD8, TIA-1, GrB and CD57 between the histopathological groups and between LMP-1-expressing/non-expressing cases may contribute to our understanding of the biology of the disease.

Molecular morphology of Hodgkin lymphoma

No other disease entity has provided greater impetus for the development of the concept of "molecular morphology" than Hodgkin lymphoma. Efforts to understand the etiology of this enigmatic disease have stimulated the application and refinement of almost every mode of biomedical scientific exploration. Notwithstanding the vast amount of data generated, much is still unknown about this remarkable disease, serving as an ongoing inducement to the development and application of new technologies for the analysis of cells and molecules in a morphologic environment.

Clinically-occult mixed cellularity Hodgkin's disease with Charcot-Leyden crystals

Charcot-Leyden crystals (CLC) are rarely described in tissue. Because of the derivation of CLC from eosinophils, and the antineoplastic functions that eosinophils effect, it is plausible that CLC in neoplastic tissue specimens may be significant. We recently encountered a case in which Hodgkin's disease and CLC were unexpectedly found. We reviewed 31 cases of Hodgkin's disease for CLC and sought relationships between CLC incidence and morbidity or mortality. While various grades of eosinophilia were represented, CLC were encountered only in the case reported. The role of eosinophils and CLC in Hodgkin's disease is enigmatic. With clinicopathologic correlations from additional patients, it may be determined that CLC play a role in the natural history or prognosis of Hodgkin's disease.

Infiltration of eosinophils in Hodgkin's disease involved lymph nodes predicts prognosis

The number of infiltrating eosinophils were counted in tumour specimens from an unselected material of 140 cases of primary Hodgkin's disease (HD) and divided in three groups. Twenty-six cases (19 per cent) showed heavy infiltration (> 200 eosinophils/10 vision fields (VF)), 51 (36 per cent) moderate infiltration (11-200 eosinophils/10 VF and 63 virtually no infiltration (< 10 eosinophils/10 VF). The eosinophilic infiltration was significantly more pronounced in the nodular sclerosis subtype. Cases with heavy infiltration had a significantly worse disease-free survival compared to other cases. In a multivariate analysis, heavy eosinophilic infiltration was the most important factor for determining disease-free survival in all patients and also when patients above and below 60 were analysed separately.

IgE, Reed-Sternberg cells, and eosinophilia in Hodgkin's disease

Tissues containing Hodgkin's disease tumors of the nodular sclerosis and mixed cellularity subtypes are frequently infiltrated by numerous degranulating eosinophils that release granule proteins such as eosinophil peroxidase and major basic protein. Until recently, the causes of the eosinophil infiltration and degranulation in Hodgkin's disease tumors were unknown. Analysis of Hodgkin's disease tissues by a sensitive and specific immunoperoxidase technique has now demonstrated the extensive presence of IgE in the Reed-Sternberg cells and adjacent cells of Hodgkin's disease tumors. Because eosinophils express a cell-surface receptor (CD23) for IgE and degranulate in the presence of IgE deposits, the extensive eosinophilia that is frequently present in Hodgkin's disease tumors is, at least in part, attributable to the IgE deposits within the tumor. In this review, we discuss the possible mechanisms and biological significance of IgE-related eosinophilia in Hodgkin's disease.

Hypofibrinogenemia due to fibrin formation in subserosal type eosinophilic gastroenteropathy

A 33-year-old woman presented with abdominal pain and distention, diarrhoea and marked eosinophilia in blood and ascites. As other causes could be excluded, the subserosal type of eosinophilic gastroenteropathy was diagnosed. The low plasma fibrinogen level (less than 100 mg/100 ml) found in this patient is an as yet undescribed feature. During prednisolone therapy it increased concurrently with the fall of blood eosinophils and the relief of clinical symptoms. Interest was further directed to the ascitic fluid where not only the presence of eosinophils (74%) enveloped in fibrin yarn and of basophils (2%) but also of 24% T lymphocytes (among them 75% CD4+, 24% CD8+, 4% CD25+, less than 1% CD19+, less than 1% natural killer cells) could be demonstrated. These lymphocytes are likely to be the source for lymphokine production chemoattracting eosinophils into the intestine. In addition they seem to be involved in IgE hyperproduction, which after adequate therapy and complete resolution of the clinical symptoms, tended to decrease slowly.