The lymph node in mycosis fungoides: a light and electron microscopy and immunohistological study supporting the Langerhans' cell-retrovirus hypothesis

Epidermal Langerhans' cell densities influence survival in mycosis fungoides and Sézary syndrome

Because Langerhans' cells (LC) (CD1a-positive epidermal cells) have been discussed to be involved in the pathogenesis of mycosis fungoides and Sézary syndrome, the authors examined the influence of densities of Langerhans' cells and, concurrently, of other phenotypes retrospectively on survival of 35 patients. Cell densities were assessed on cryostat sections (alkaline phosphatase antialkaline phosphatase-technique) of the respective diagnostic biopsy specimens. Additionally, two clinical parameters (age, stage of disease) were evaluated. CD1a-positive epidermal cells were demonstrated to be the only cell population being significantly associated (P = 0.011) with survival. Death resulting from mycosis fungoides and Sézary syndrome was significantly (P = 0.003) less frequent in patients with epidermal CD1a-positive cell densities higher than 90 cells/mm2 (optimal break point) as compared with patients with lower numbers. These results suggest that Langerhans' cells have a significant impact on prognosis of patients with mycosis fungoides and Sézary syndrome. They play an important role in the host defense mechanisms against these lymphomas rather than to favor their progression as proposed recently.

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.

Cutaneous T cell lymphoma: immunocytochemical study on activation/proliferation and differentiation associated antigens in lymph nodes, skin, and peripheral blood

The expression of activation/proliferation antigens (CD 25, CD 30, Ki 67, transferrin receptor) in lymph nodes and skin were compared in nine patients with mycosis fungoides (MF) with patients with erythroderma not related to MF, and patients with reactive lymphofollicular hyperplasias (a total of 14 patients). A panel of differentiation antigens was analyzed in addition. Reactivities were revealed by the APAAP technique. Activation/proliferation antigen scores in lymph nodes were related to the clinical stages of MF in most instances (low scores in cases of MF stage I/II, high scores in 3/4 cases of MF stage III/IV). They differed markedly in cases of non-MF-erythrodermia with the exception of one patient, and in all cases of reactive lymphofollicular hyperplasia. Expression of activation/proliferation antigens in lymph nodes were different in most cases from those in skin and peripheral blood. For diagnostic use, the activation/proliferation antigen scores were superior to the cell differentiation antigen profiles. Among cellular differentiation antigens, only the extent of CD1+ cells provided some diagnostic information, since the number of these cells were markedly increased in all cases of dermatopathic lymphadenitis with/without MF when compared with reactive lymphofollicular hyperplasia. In the diagnosis of MF, immunohistochemistry of activation/proliferation or differentiation antigens cannot replace routine paraffin histology, but may provide supplement any data in equivocal cases.

A comparative microphotometric analysis of adult T-cell leukemia/lymphoma (ATLL) in the skin and mycosis fungoides (MF)

In the skin lesions of 16 adult T-cell leukemia/lymphoma (ATLL) and 13 mycosis fungoides (MF), morphological features of cutaneous infiltrates and their cell kinetics were evaluated through microphotometry of nuclear DNA content and nuclear size on Feulgen-stained sections. Lymphomas comprising some giant cells with irregular-shaped nuclei were found only in ATLL and these cells revealed aneuploid high DNA values. In contrast, neoplastic cells with pale cytoplasm in the Giemsa stain were seen more frequently in MF (69.5%) than in ATLL (12.5%). Patterns of the cutaneous infiltration according to skin microenvironments such as perivascular areas, dermal papillae, and periadnexal areas, were similar in the both entities. In the perivascular areas a mixed proliferation of lymphoma cells and non-neoplastic lymphocytes was conspicuous. The lymphoma cells were determined by high DNA values and large nuclear sizes. But the ratio of lymphoma cells to non-neoplastic cells in the infiltrates in the perivascular areas was higher in ATLL than in MF. In the dermal papillae and around the skin appendages, lymphoma cells predominated. Lymphoma cells which formed a plaque or tumor in the dermis contained many actively proliferating cells having higher DNA values and larger nuclear sizes than the lymphoma cells without tumor formation. One case of ATLL intermediate cell type showed, however, few proliferating cells inspite of tumor formation, suggesting a pooling or a long life-span in the skin.

Humoral response to wheat protein in patients with coeliac disease and enteropathy associated T cell lymphoma

Features that might distinguish uncomplicated coeliac disease from enteropathy associated T cell lymphoma were investigated. Of 76 patients with coeliac disease, 71 (93%) had raised levels of alpha gliadin antibody and all responded clinically and histologically to treatment with a gluten free diet. In contrast, none of 16 patients with enteropathy associated T cell lymphoma had raised levels of alpha gliadin antibody, and treatment with a gluten free diet resulted in histological improvement in one and transient clinical improvement in six patients. The ratio of women to men was 2.2:1 in the group with coeliac disease and 1:1.6 in the patients with enteropathy associated T cell lymphoma. Thus patients with enteropathy associated T cell lymphoma do not display a humoral immune response to wheat protein (alpha gliadin), rarely respond to a gluten free diet, and are often men. Patients with uncomplicated coeliac disease usually have raised levels of alpha gliadin antibody, always respond to a gluten free diet, and are frequently women. These findings suggest the presence of two separate forms of enteropathy: one is benign and sensitive to wheat protein whereas the other runs a malignant course.

Severe cutaneous reactions to captopril and enalapril; histological study and comparison with early mycosis fungoides

A severe non-dose related skin eruption attributable to treatment with captopril was recently reported: this is distinct from the dose related rashes that have been widely described. Ultrastructural and immunohistochemical studies were carried out to determine in detail the histological features of this eruption: the histological appearances were similar to those found in early mycosis fungoides, so that this disease was erroneously diagnosed in one case. Unlike most other complications resulting from treatment with Captopril, an indistinguishable rash can result from treatment with enalapril, a newer angiotensin converting enzyme inhibitor.