Clinical aspects on non-cutaneous T-lymphomas

Peripheral T-cell lymphomas: a clinicopathological and immunological study of 10 cases

Diagnosis and classification of T-cell lymphomas is notoriously difficult. Existing classification schemes are insufficient. Some clinicopathologically well defined T-cell lymphomas exist (mycosis fungoides, Sézary's syndrome, and T-lymphoblastic lymphomas) but the remaining tumours, frequently called peripheral T-cell lymphomas, are a heterogeneous group, clinically, morphologically and immunologically. The data on 10 peripheral T-cell lymphomas are presented and compared to data from the literature. Patients were elderly, had a high frequency of extranodal localizations (notably the skin 75%) and had a poor prognosis: five of 10 patients have died, median survival 22 months. Morphologically and immunophenotypically the group is very heterogeneous. The variety of blast cell morphology is emphasized. No correlations were found between immunophenotype and prognosis, or immunophenotype and morphology.

Immunopathology of non-Hodgkin lymphomas

The immunopathological features of lymphocytic non-Hodgkin lymphomas (NHL), follicular centre cell tumours and "large-cell" NHL are described with particular emphasis on in situ evaluation of cryostat sections using monoclonal antibodies. The immunological phenotypes of tumour cells and the pattern of "reactive" cellular infiltrates with characteristic differences for the various subtypes are summarized. Immunological membrane features of the following lymphocytic NHL of B lymphocyte origin are discussed in detail: B-CLL (most common phenotype of the lymphoma cells: VIB-C5, To-15, Ia, Leu-1), lymphoplasmocytoid NHL (To-15, Ia), B-prolymphocytic leukaemia (VIB-C5, To15, Ia, Leu (+/-), FMC-7(+/-] and hairy-cell leukaemia (HCL: To-15, Ia, FMC-7). NHL of T-lymphocytes detailed in respect of mycosis fungoides and Sézary syndrome (OKT-3, OKT-4, OKT-11), to subtypes of T-CLL with particular emphasis on the "azurophilic" type, to T-zone NHL, and to adult T-cell leukaemia/lymphoma (OKT-3, OKT-4, OKT-11, anti-tac), all of them with the usual immunological phenotype of T-helper (TH) lymphocytes. NHL with a predominance of T-suppressor (TS) lymphocytes include the immunoblastic lymphadenopathy like T-cell lymphoma (OKT-3, OKT-8, OKT-11) and some lymphoepitheloid (Lennert) lymphomas. Immunological features of follicular centre cell tumours are discussed with emphasis on similarities and differences with the normal germinal centre. Tumour cells usually show the following membrane phenotype: centroblastic/centrocytic (cb/cc: To-15, VIL-Al, Ia; meshwork of non-neoplastic R4/23+, To-5 + DRC), centrocytic (VIB-C5, To-15, Leu-1, Ia; R4/23 and To-5 meshwork), centroblastic (cb, To-5, To-15, Ia, VIL-Al +/-). "Large-cell" NHL include the last entity (cb), immunoblastic (B-ib, T-ib) and lymphoblastic (lb) NHL and are discussed in respect to B-ib (Ia, To-15 +/-, VIL-Al +/-), T-lb (WT-1, OKT-6 +/-, OKT-11 +/-), pre-B-lb (VIB-C5, Ia, TdT, VIL-Al +/-) and Burkitt-type NHL (VIB-C5, VIL-Al, Ia, sIg). "Reactive" cellular infiltrates may account for a large fraction of the cellular content of NHL (e.g. the mean TH and TS content amount to about 40% of that seen in normal lymph nodes). In comparison to other NHL B-CLL and cb/cc showed the highest, HCL the lowest number of TH X TS exhibited less typical alterations.(ABSTRACT TRUNCATED AT 400 WORDS)

Epitheliotropic lymphoma of the small bowel. Report of a fatal case with cytotoxic/suppressor T-cell immunotype

The authors report the clinical, pathologic, and immunologic features of a case of jejunal cytotoxic/suppressor T-cell lymphoma associated with intractable malabsorption. Histologically, the tumor exhibited striking involvement of small bowel surface and glandular epithelium, and of epithelium in sites of disease dissemination. This epitheliotropism consisted of both cell clusters resembling Pautrier 's microabscesses and single cells within epithelium. Grossly, the jejunal mucosal fold pattern was completely obliterated by lymphoma which formed miliary nodules and multiple distinct tumor masses. Despite aggressive chemotherapy the patient developed widespread disease, and died 11 months after presentation. At autopsy, in addition to disseminated lymphoma, there was a notable activation of hematopoiesis evidenced by extensive extramedullary hematopoiesis and bone marrow hypercellularity. Many lymph nodes spared by the lymphoma showed a polyclonal proliferation of plasma cells and immunoblasts. In view of recent immunologic evidence that normal cytotoxic/suppressor T-cells selectively home to the gut surface epithelium, striking tumor cell epitheliotropism may be a morphologic marker for visceral lymphomas of cytotoxic/suppressor T-cell origin. This unique case broadens the clinical and morphologic spectrum of T-cell disorders.