SP4, a Novel Anti-Cyclin D1 Rabbit Monoclonal Antibody, Is a Highly Sensitive Probe for Identifying Mantle Cell Lymphomas Bearing the t(11;14)(q13;q32) Translocation

Prognostic Significance of Cyclin D1 Expression in Small Intestinal Adenocarcinoma

Cyclin D1, a critical cyclin-dependent kinase (CDK) 4/6-dependent regulator of G1/S transition, has attracted much interest as a therapeutic target. The cyclin D1 expression in small intestinal adenocarcinomas (SIACs) has not yet been comprehensively studied, owing to the rarity of this tumor. We investigated the clinicopathological and prognostic significance of the cyclin D1 expression in 232 surgically resected primary SIACs through a multi-institutional study. A high expression of cyclin D1 (cyclin D1High) was detected in 145 SIAC cases (63%), which was significantly higher than that in normal small intestinal mucosa (11%). Cyclin D1High was more commonly found in SIACs with a lower T-category and disease stage and KRAS mutation and predicted better patient survival. Multivariate analysis revealed that cyclin D1High, the absence of retroperitoneal seeding and lymphovascular invasion, and the lower N-category were identified as independent prognostic indicators for patients with SIACs. Specifically, cyclin D1High affected patient survival in the lower stage group (stages I and II). In conclusion, cyclin D1 was commonly overexpressed in SIACs, and cyclin D1High acted as a favorable prognostic indicator in patients with SIACs. These findings in SIACs may, thus, be important to further comprehend the mechanism of cyclin D1 in carcinogenesis and to strategize appropriate patient therapies.

From rabbit antibody repertoires to rabbit monoclonal antibodies

In this review, we explain why and how rabbit monoclonal antibodies have become outstanding reagents for laboratory research and increasingly for diagnostic and therapeutic applications. Starting with the unique ontogeny of rabbit B cells that affords highly distinctive antibody repertoires rich in in vivo pruned binders of high diversity, affinity and specificity, we describe the generation of rabbit monoclonal antibodies by hybridoma technology, phage display and alternative methods, along with an account of successful humanization strategies.

The Pathology of Reactive Lymphadenopathies: A Discussion of Common Reactive Patterns and Their Malignant Mimics

Context.—Distinguishing between a reactive and a neoplastic lymphoid proliferation is a clinically significant task frequently performed by the surgical pathologist in routine practice.

Objectives.—To highlight common situations in lymph node pathology where reactive changes and lymphoma may be misdiagnosed.

Data Sources.—Data sources are peer-reviewed journal articles, textbooks, and clinical experience.

Conclusions.—This review aims to refresh and enhance the surgical pathologist's awareness of the shared and distinguishing features of select reactive and neoplastic lymphoproliferations, which in turn will allow the surgical pathologist to make more accurate diagnoses and avoid the pitfalls of misdiagnosis. This will be done by describing a selection of commonly encountered reactive histologic changes observed in lymph nodes, present the lymphomas with which they share overlapping features, outline the features that distinguish them, and describe an approach to making an accurate diagnosis and avoiding a misdiagnosis in each scenario.

Selective immunophenotyping for diagnosis of B-cell neoplasms: immunohistochemistry and flow cytometry strategies and results

Determining the immunophenotype of hematologic malignancies is now an indispensable part of diagnostic classification, and can help to guide therapy, or to predict clinical outcome. Diagnostic workup should be guided by morphologic findings and evaluate clinically important markers, but ideally should avoid the use of overly broad panels of immunostains that can reveal incidental findings of uncertain significance and give rise to increased costs. Here, we outline our approach to diagnosis of B-cell neoplasms, combining histologic and clinical data with tailored panels of immunophenotyping reagents, in the context of the 2008 World Health Organization classification. We present data from cases seen at our institution from 2004 through 2008 using this approach, to provide a practical reference for findings seen in daily diagnostic practice.

Immunohistochemical surrogates for genetic alterations of CCDN1, PML, ALK, and NPM1 genes in lymphomas and acute myeloid leukemia

The World Health Organization (WHO) classification of lympho-hemopoietic neoplasms is increasingly based on genetic criteria. Detection of tumor-associated primary genetic lesions is usually performed using the polymerase chain reaction (PCR) and/or fluorescence in-situ hybridization (FISH). This review focuses on alternative techniques for detecting genetic lesions in biopsy samples. Immunohistochemical surrogates for the detection of genetic alterations involving the CCND1, PML, anaplastic lymphoma kinase (ALK) and nucleophosmin (NPM1) genes are presented as examples for this approach. Because of their high specificity, rapidity, low costs and ease of performance, these assays have the potential for being extensively applied in developing countries. In some instances (e.g. detection of ALK protein) immunohistochemistry has fully replaced molecular studies for routine diagnosis in paraffin-embedded specimens. Genome wide based discovery of new tumor-associated genetic lesions that are suitable for antibody targeting promises to further expand the application of immunohistochemistry for the molecular classification of hematological neoplasms.

The WHO classification of lymphomas: cost-effective immunohistochemistry using a deductive reasoning "decision tree" approach: part II: the decision tree approach: diffuse patterns of proliferation in lymph nodes

The 2008 World Health Organization Classification of Tumors of the Haematopoietic and Lymphoid Tissues defines current standards of practice for the diagnosis and classification of malignant lymphomas and related entities. More than 50 different types of lymphomas are described. Faced with such a broad range of different lymphomas, some encountered only rarely, and a rapidly growing armamentarium of 80 or more pertinent immunohistochemical (IHC) "stains," the challenge to the pathologist is to use IHC in an efficient manner to arrive at an assured and timely diagnosis. This review uses deductive reasoning following a decision tree or dendrogram model, combining basic morphologic patterns and common IHC markers to classify node-based malignancies by the World Health Organization schema. The review is divided into 2 parts, the first addressing those lymphomas that produce a follicular or nodular pattern of lymph nodal involvement appeared in the previous issue of AIMM. The second part addresses diffuse proliferations in lymph nodes. Emphasis is given to the more common lymphomas and the more commonly available IHC "stains" for a pragmatic and practical approach that is both broadly feasible and cost-effective. By this method, an assured diagnosis may be reached in the majority of nodal lymphomas, at the same time developing a sufficiency of data to recognize those rare or atypical cases that require referral to a specialized center.

Expression of sphingosine-1-phosphate receptor 1 in mantle cell lymphoma

The distribution and pathological significance of sphingosine-1-phosphate receptor 1 expression are still unclear. In this study, we evaluated sphingosine-1-phosphate receptor 1's suitability as a diagnostic marker for malignant lymphoma by immunostaining formalin-fixed paraffin-embedded sections using a well-defined commercial anti-sphingosine-1-phosphate receptor 1 antibody. Sphingosine-1-phosphate receptor 1 was strongly expressed on the surface of small lymphocytes forming primary lymphoid follicles and in the mantle zone of secondary lymphoid follicles. Microarray-based immunohistochemistry with tissue samples from 85 lymphoid malignancy cases demonstrated that sphingosine-1-phosphate receptor 1 was expressed on the surface of mantle cell lymphoma cells. Strong expression was observed in all classical mantle cell lymphoma cases involving the lymph node (19 out of 19), gastrointestinal tract (10 out of 10), bone marrow (9 out of 9), and orbita (1 out of 1). Good results were obtained even in sections where cyclin D1 signals were lost because of over-fixation and/or decalcification. One aggressive variant of mantle cell lymphoma displayed a weaker membranous staining than classical mantle cell lymphoma in the lymph node and bone marrow. In a cyclin D1-negative mantle cell lymphoma of the orbita, no conclusive result was obtained. No cases of follicular lymphoma, marginal zone lymphoma, B lymphoblastic leukemia/lymphoma, or Burkitt's lymphoma showed any significant expression, whereas 2 out of 6 chronic lymphocytic leukemia/small lymphocytic lymphomas in bone marrow, 1 out of 3 lymphoplasmacytic lymphomas in the lymph node, and 2 out of 37 diffuse large B-cell lymphomas exhibited staining. A quantitative reverse transcription polymerase chain reaction-based analysis of mantle cell lymphoma lines revealed the sphingosine-1-phosphate receptor 1 mRNA expression level to be well correlated with the results of immunocytochemistry, flow cytometry, and western blotting. Thus, sphingosine-1-phosphate receptor 1 immunohistochemistry may be useful in the histological diagnosis of mantle cell lymphoma with formalin-fixed and paraffin-embedded sections. The antigen may be particularly valuable in cases where cyclin D1 immunostaining is not successful.

Use of commercially available rabbit monoclonal antibodies for immunofluorescence double staining

Immunohistochemistry, that is, the use of polyclonal and monoclonal antibodies to detect cell and tissue antigens at a microscopical level is a powerful tool for both research and diagnostic purposes. Especially in the field of hematologic disease, there is often a need to detect several antigens synchronously, and we report here a fast and easy technique for demonstrating more than 1 antigen in 1 slide using immunofluorescence. We have used commercially available rabbit monoclonal antibodies (Cyclin D1, CD3, CD5, CD23, etc.) paired with mouse monoclonal antibodies (CD7, CD20, CD79a, Pax-5, etc.) for double immunofluorescence labeling on paraffin-embedded tissue sections. Commercially available rabbit monoclonal antibodies in combination with mouse monoclonal antibodies proved useful in double immunofluorescence labeling on paraffin-embedded tissue, and all combinations used yielded excellent results.

The critical role of histology in an era of genomics and proteomics: a commentary and reflection

The role of histologic examination in lymphoma diagnosis has been called into question by proponents of new technologies, such as genomics and proteomics. We review the history and salient features of morphologic evaluation in lymphoid diseases, and discuss the general and specific limitations of mature ancillary techniques, such as immunohistochemistry, flow cytometry, and molecular studies. We then speculate on the future relationship between morphology and the new genomic and proteomic technologies as they become integrated into clinical practice.