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Gonçalves LSS, Martins KH, Reyes MRT, Catananti IS, Chahud F, León JE. Light-chain-restricted Russell body oral mucositis: an immunohistochemical study and literature review. Leuk Lymphoma 2024; 65:1190-1193. [PMID: 38638066 DOI: 10.1080/10428194.2024.2342564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 12/28/2024] [Accepted: 01/08/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Luana Stefanie Silvino Gonçalves
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Helen Martins
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Magdalena Raquel Torres Reyes
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabella Silva Catananti
- Department of Pediatric Dentistry - Riberão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jorge Esquiche León
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Oral Pathology, Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Avenida do Café, Ribeirão Preto, São Paulo, Brazil
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Ehinger M, Béné MC. Morphology and multiparameter flow cytometry combined for integrated lymphoma diagnosis on small volume samples: possibilities and limitations. Virchows Arch 2024:10.1007/s00428-024-03819-3. [PMID: 38805049 DOI: 10.1007/s00428-024-03819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
The diagnosis of lymphoma relies mainly on clinical examination and laboratory explorations. Among the latter, morphological and immunohistochemical analysis of a tissue biopsy are the cornerstones for proper identification and classification of the disease. In lymphoma with blood and/or bone marrow involvement, multiparameter flow cytometry is useful. This technique can also be applied to fresh cells released from a biopsy sample. For full comprehension of lymphomas, surgical biopsies are best and indeed recommended by the hematopathological community. Currently, however, there is a global trend towards less invasive procedures, resulting in smaller samples such as core needle biopsies or fine needle aspirations which can make the diagnosis quite challenging. In this review, the possibilities and limitations to make an accurate lymphoma diagnosis on such small volume material are presented. After recalling the major steps of lymphoma diagnosis, the respective value of histology, cytology, and flow cytometry is discussed, including handling of small specimens. The benefits of an integrated approach are then evoked, followed by discussion about which attitude to adopt in different contexts. Perhaps contrary to the prevailing view among many pathologists, a full diagnosis on small volume material, combined with relevant ancillary techniques, is often possible and indeed supported by recent literature. A glimpse at future evolutions, notably the merit of artificial intelligence tools, is finally provided. All in all, this document aims at providing pathologists with an overview of diagnostic possibilities in lymphoma patients when confronted with small volume material such as core needle biopsies or fine needle aspirations.
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Affiliation(s)
- Mats Ehinger
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden.
| | - Marie C Béné
- Faculty of Medicine, Nantes University, Nantes, France
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3
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Cheuk W, Bledsoe JR. IgG4-related lymphadenopathy. Semin Diagn Pathol 2024; 41:108-115. [PMID: 38228439 DOI: 10.1053/j.semdp.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
IgG4-related lymphadenopathy is a nodal manifestation of IgG4-related disease (IgG4RD) which is characterized by increased polytypic IgG4+ plasma cells and IgG4+/IgG+ plasma cell ratio in lymph nodes and morphologically manifested as various patterns of reactive lymphadenopathy: Castleman disease-like, follicular hyperplasia, interfollicular expansion, progressive transformation of germinal centers and inflammatory pseudotumor-like. It typically presents with solitary or multiple, mild to moderate lymph node enlargement in otherwise asymptomatic patients. The serum IgG4 level is frequently elevated but C-reactive protein often remains normal. In patients not having a history of IgG4RD or manifestation of extranodal IgG4RD, a diagnosis of IgG4-lymphadenopathy should only be made with great caution given the non-specific morphologic features that can overlap with ANCA-associated vasculitis, interleukin-6 syndromes, Rosai-Dorfman disease, inflammatory myofibroblastic tumor, syphilis, lymphoma, and plasma cell neoplasia. Elevated IgG4 parameters, appropriate morphologies, and clinical correlation are essential to make the diagnosis of IgG4-lymphadenopathy more specific and clinically meaningful.
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Affiliation(s)
- Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China SAR.
| | - Jacob R Bledsoe
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Mariani RA, Courville EL. Reactive Lymphadenopathy in the Pediatric Population with a Focus on Potential Mimics of Lymphoma. Semin Diagn Pathol 2023; 40:371-378. [PMID: 37295994 DOI: 10.1053/j.semdp.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
Benign lymphadenopathy is common in the pediatric population and may be clinically striking. As in adults, lymph node evaluation in pediatric patients requires careful morphologic and immunohistochemical assessment and clinical contextualization of the findings. It is important for the pathologist to be familiar with benign and reactive conditions that may mimic malignancy. This review presents non-neoplastic or indolent processes or patterns of lymphoid hyperplasia that may be confused with or raise the differential of lymphoma, with a focus on those more commonly encountered in the pediatric/adolescent population.
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Affiliation(s)
- Rachel A Mariani
- University of Arizona College of Medicine-Phoenix, Dept. of Pathology & Laboratory Medicine, USA
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5
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Obiorah IE, Aguilera NS, Gru A, Courville EL. Isolated Light Chain-restricted Germinal Centers are Common in Follicular Hyperplasia by Ultrasensitive In Situ Hybridization. Am J Surg Pathol 2023; 47:694-700. [PMID: 36939044 DOI: 10.1097/pas.0000000000002035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Ultrasensitive bright-field RNA in situ hybridization (BRISH) can be used to detect lower levels of light chain expression than immunohistochemical stains or conventional colorimetric RNA in situ hybridization. In this study, we retrospectively reviewed 77 lymph node specimens with follicular hyperplasia and kappa/lambda BRISH performed as part of the diagnostic evaluation. Thirty-two of the specimens had ≥1 germinal center(s) (GC) showing light chain restriction (14 specimens with lambda-restricted GC, 9 with kappa-restricted GC, and 9 with separate kappa-restricted or lambda-restricted GC). In all but 1 specimen, the light chain-restricted GC represented a minority of the total GC (average: 10%, range: 0.2% to 60%). There was no significant difference in age, sex, type of biopsy (core vs. excision), number of GCs, proportion of cases with a light chain-restricted B-cell population by flow cytometry, or proportion of cases with a positive IgH gene rearrangement study between the specimens with and without restricted GCs. In our cohort of follicular hyperplasia cases, BRISH identified light chain-restricted GC more frequently than flow cytometry identified a monotypic B-cell population. Our findings highlight the potential for overinterpretation of light chain restriction in limited samplings such as fine needle aspiration cell blocks or core needle sampling and reinforce that interpretation of BRISH staining needs to occur in the context of the morphologic features including tissue architecture and results of additional immunohistochemical stains.
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6
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B Lymphoproliferative Neoplasms of Uncertain Biological Significance: Report from the IV Workshop of the Italian Group of Hematopathology and Review of the Literature. HEMATO 2022. [DOI: 10.3390/hemato3040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lymphoproliferative neoplasms of uncertain biological significance are increasingly encountered due to widespread usage of immunophenotypic and molecular techniques. Considering that clearer biological criteria and patient management have been established for B-cell lymphoproliferative diseases of undetermined significance occurring in the peripheral blood, many issues are still obscure for early lesions detected in lymphoid tissues. Regardless that some categories of lymphoproliferative neoplasms of uncertain biological significance have been recognized by the 4th edition of the WHO, other anecdotal early lymphoproliferative lesions still remain fully undefined. Some early lesions frequently originate from the germinal center, including atypical germinal centers BCL2-negative, an early pattern of large B-cell lymphoma with IRF4 rearrangement, and “in situ” high-grade B lymphomas. Moreover, other early lymphoproliferative lesions arise outside the germinal center and include those developing within the setting of monocytoid B-cell hyperplasia, but they also can be directly or indirectly associated with chronic inflammations. This review aims to summarize the concepts discussed during the IV Workshop organized by the Italian Group of Hematopathology, focus on the state-of-the-art on B-cell lymphoproliferative neoplasms of uncertain biological significance, and offer operative insights to pathologists and clinicians in routine diagnostics.
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Wang XJ, Moore EM, Swerdlow SH, Aggarwal N. Light Chain-Restricted Plasmacytoid Cells in Hyperplastic Germinal CentersA Clinicopathologic Investigation. Am J Clin Pathol 2021; 156:871-885. [PMID: 34406351 DOI: 10.1093/ajcp/aqab043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/03/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Follicular hyperplasias (FHs) with light chain-restricted (LCR) plasmacytoid/plasma cells (PCs) within germinal centers (GCs) based on immunohistochemistry (IHC)/in situ hybridization (ISH) can potentially lead to diagnostic error. This study aims to better characterize such cases, including their clinical implications. METHODS LC expression by IHC/ISH was quantitatively assessed in GCs of 17 FHs with LCRGCs. BCL2, CD10, BCL6, BCL2, immunoglobulin (Ig) heavy chains, IgG4, and Epstein-Barr encoding region stains were performed. In total, 8 cases had polymerase chain reaction (PCR)-based clonality studies. RESULTS All cases showed FH, including 4 with progressively transformed GCs (PTGCs); 0.8% to 52% (median, 21%) of the GCs were LCR; 13 of 17 had both κ- and λ-LCRGCs, and 4 of 17 had only κ-LCRGCs; 7 of 16 had prominent intrafollicular IgG4-positive cells. One case demonstrated BCL2-positive cells in focal LCRGCs but lacked BCL2 rearrangement. B-cell monoclonality was demonstrated in 3 of 8 cases (only after microdissection). Seven patients had autoimmune disorders, and 1 had had a transplant. Three patients had a history of lymphoma, 1 developed lymphoma, and 1 developed lymphomatoid granulomatosis subsequently. CONCLUSIONS FHs with LCRGC by IHC/ISH are typically not associated with the development of lymphoma, even though they can express BCL2 and show monoclonality by PCR. They may be associated with increased intrafollicular IgG4-positive cells, PTGC, and autoimmunity.
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Affiliation(s)
- Xuan J Wang
- Divisions of Hematopathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Erika M Moore
- Divisions of Hematopathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven H Swerdlow
- Divisions of Hematopathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nidhi Aggarwal
- Divisions of Hematopathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Molecular and Genomics Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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He X, Xu P, Wang X, Jiang S, Gong D, Wu N. The association of gene rearrangement and lymphoma diagnosis: A prospective observational study. Medicine (Baltimore) 2020; 99:e20733. [PMID: 32541525 PMCID: PMC7302616 DOI: 10.1097/md.0000000000020733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION To investigate the gene rearrangement and mutation of lymphoma biomarkers including (Immunoglobulin H (IgH), Immunoglobulin kappa (IGK), Immunoglobulin lambda (IGL), and TCR) in the lymphoma diagnosis. METHODS AND ANALYSIS Paraffin tissue samples from 240 cases diagnosed as suspected lymphoma in the department of pathology, Deyang City People's Hospital from June 2020 to June 2021 will be enrolled. Deoxyribonucleic acid extraction and Polymerase Chain Reaction (PCR) amplification will be performed in these paraffin tissue samples. Immunoglobulin and T cell receptor (TCR) rearrangement will be analyzed by hetero-double chain gel electrophoresis and BioMed-2 standardized immunoglobulin gene rearrangement detection system. In this study protocol IGH gene rearrangement, IGK gene rearrangement, both IGH and IGL gene rearrangement, both IGH and IGK gene rearrangement, both IGK and IGL gene rearrangement, both IGH, IGK and IGL gene rearrangement, TCR gene rearrangement and positive Ig/TCR rearrangement will be analyzed. DISCUSSION In this study, we will use B and T cell lymphoma analysis focusing on IgH, IGK, IGL, and TCR gene rearrangement, so as to provide early guidance for the diagnosis of lymphoma. Second generation sequencing technology is helpful in the differential diagnosis of lymphoma. TRIAL REGISTRATION Chinese Clinical trial registry: ChiCTR2000032366.
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Affiliation(s)
- Xiaoyan He
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Pei Xu
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Xianwei Wang
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Shuming Jiang
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Daoyin Gong
- Department of Pathology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Ning Wu
- Department of Pathology, Deyang People's Hospital, Deyang City
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9
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Chapman J, Vega F. Monotypic and IgH-rearranged lymphoplasmacytic cells restricted to the light zone of germinal centers: an early (in situ?) marginal zone lymphoma? Ann Hematol 2018; 97:1999-2000. [PMID: 29725761 DOI: 10.1007/s00277-018-3345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/22/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jennifer Chapman
- Department of Pathology, Division of Hematopathology, University of Miami/Sylvester Comprehensive Cancer Center, 1400 NW 12th Avenue, Suite 4066, Miami, FL, 33136, USA.
| | - Francisco Vega
- Department of Pathology, Division of Hematopathology, University of Miami/Sylvester Comprehensive Cancer Center, 1400 NW 12th Avenue, Suite 4066, Miami, FL, 33136, USA
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10
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Kojima M, Nakamura N, Murayama K, Igarashi T, Matsumoto M, Matsuda H, Masawa N, Miura I, Morita Y. Reactive Lymphoid Hyperplasia with Giant Follicles Associated with a Posttherapeutic State of Hematological Malignancies. A Report of Eight Cases. TUMORI JOURNAL 2018; 96:143-8. [DOI: 10.1177/030089161009600123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To further clarify the clinicopathological, molecular genetic and karyotypic findings of reactive lymph node hyperplasia with giant follicles (RLHGF) associated with a posttherapeutic state of hematological malignancies, we studied eight such cases. Methods Using formalin-fixed, paraffin-embedded sections, histological, immunohistochemical, in situ hybridization (ISH), and polymerase chain reaction (PCR) were performed. Results Six patients had a history of malignant lymphoma (diffuse large B-cell lymphoma [DLBCL] = 4, marginal zone B-cell lymphoma = 2), and two had acute myeloid leukemia (AML). Six patients initially presented with lymphadenopathy of the head and neck area and the remaining one presented with swelling of the tonsil. All seven cases demonstrating analyzable metaphases showed a normal karyotype. Histologically, all eight lesions were characterized by numerous enlarged, bizarre-shaped coalescing lymphoid follicles with follicular lysis. Immunohistochemical and flow cytometry study demonstrated the reactive nature of the B cells in all eight lesions. However, three of our eight cases demonstrated immunoglobulin heavy-chain (IgH) gene rearrangement on PCR study. Different clonal bands were detected in the initial lymphomatous tissue and RLHGF in one of the studied cases. There was no development of B-cell lymphoma or recurrence of B-cell lymphoma in any of the three lesions demonstrating IgH rearrangement. There were no human herpes virus type-8+ or human immunodeficiency virus type-1+ cells in any of the eight lesions. ISH demonstrated Epstein-Barr virus (EBV)-encoded small RNA (EBER)+ cells in only two lesions. PCR analyses demonstrated that there was no Toxoplasma gondii DNA in any of the eight lesions. Conclusions As suggested in RLHGF posttransplant, RLHGF arising after therapy for hematological malignancies is also a consequence of chronic stimulation in the setting of immune deregulation rather than various infectious agents. It is important for pathologists and clinicians to be aware of this type of lesion in diagnostic practice.
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Affiliation(s)
- Masaru Kojima
- Department of Pathology, Dokkyo University School of Medicine, Mibu, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Kayoko Murayama
- Department of Hematology and Oncology, Gunma Cancer Hospital, Ohta, Japan
| | - Tadahiko Igarashi
- Department of Hematology and Oncology, Gunma Cancer Hospital, Ohta, Japan
| | - Morio Matsumoto
- Department of Hematology, National Nishigunma Hospital, Shibukawa, Japan
| | - Hazuki Matsuda
- Department of Pathology, Dokkyo University School of Medicine, Mibu, Japan
| | - Nobuhide Masawa
- Department of Pathology, Dokkyo University School of Medicine, Mibu, Japan
| | - Ikuo Miura
- Department of Hematology and Oncology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Yukio Morita
- Laboratory of Food Hygiene, Tokyo Kasei University, College of Nutritional Science, Tokyo, Japan
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Mitteldorf C, Rongioletti F, Kempf W, Tronnier M. Papular mucinosis with monotypic plasma cells in a child. J Eur Acad Dermatol Venereol 2016; 31:e89-e90. [PMID: 27358105 DOI: 10.1111/jdv.13784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- C Mitteldorf
- Department of Dermatology, Venereology and Allergology, HELIOS-Klinikum Hildesheim, Hildesheim, Germany
| | - F Rongioletti
- Clinica Dermatologica, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - W Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Research unit, Zürich, Switzerland
| | - M Tronnier
- Department of Dermatology, Venereology and Allergology, HELIOS-Klinikum Hildesheim, Hildesheim, Germany
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Nybakken GE, Bala R, Gratzinger D, Jones CD, Zehnder JL, Bangs CD, Cherry A, Warnke RA, Natkunam Y. Isolated Follicles Enriched for Centroblasts and Lacking t(14;18)/BCL2 in Lymphoid Tissue: Diagnostic and Clinical Implications. PLoS One 2016; 11:e0151735. [PMID: 26991267 PMCID: PMC4798531 DOI: 10.1371/journal.pone.0151735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
Abstract
We sought to address the significance of isolated follicles that exhibit atypical morphologic features that may be mistaken for lymphoma in a background of reactive lymphoid tissue. Seven cases that demonstrated centroblast-predominant isolated follicles and absent BCL2 staining in otherwise-normal lymph nodes were studied. Four of seven cases showed clonal B-cell proliferations amid a polyclonal B cell background; all cases lacked the IGH-BCL2 translocation and BCL2 protein expression. Although three patients had invasive breast carcinoma at other sites, none were associated with systemic lymphoma up to 44 months after diagnosis. The immunoarchitectural features of these highly unusual cases raise the question of whether a predominance of centroblasts and/or absence of BCL2 expression could represent a precursor lesion or atypical reactive phenomenon. Differentiating such cases from follicular lymphoma or another mimic is critical, lest patients with indolent proliferations be exposed to unnecessarily aggressive treatment.
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Affiliation(s)
- Grant E. Nybakken
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - Rajeev Bala
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - Carol D. Jones
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - James L. Zehnder
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - Charles D. Bangs
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - Athena Cherry
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - Roger A. Warnke
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America
- * E-mail:
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Arora K, Chebib I, Zukerberg L, Gandhi M, Rivera M, Ting D, Deshpande V. Branched-chain in situ hybridization for κ and λ light chains: A powerful ancillary technique for determining B-cell clonality in cytology samples. Cancer Cytopathol 2015; 124:203-12. [PMID: 26524200 DOI: 10.1002/cncy.21629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/30/2015] [Accepted: 08/31/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current immunohistochemical and in situ hybridization (ISH) assays are generally inconclusive for clonality unless plasmacytic differentiation is present. This study examined a series of cytology specimens and explored the ability of a branched-chain RNA (bRNA) ISH assay for immunoglobulin κ constant (IGKC) and immunoglobulin λ constant (IGLC) to detect a clonal population of B lymphocytes. METHODS Pathology databases were used to identify fine-needle aspiration biopsies (n = 28) and exfoliative cytology samples (n = 20). Demographic, flow cytometry, and excision biopsy results were recorded. bRNA ISH was performed on the Leica Bond platform with the following probes: IGKC, IGLC, immunoglobulin λ-like polypeptide 5 (IGLL5), and a housekeeping gene (HKG). RESULTS The bRNA ISH assay was validated with 30 surgical biopsies. On bRNA ISH, a clonal B-cell population (light-chain ratio > 10:1) was detected in 22 of 28 cases with a final diagnosis of lymphoma. In 2 cases, a κ predominance was present, although the ratio was <10:1. Eleven of the 17 κ-clonal lymphomas also expressed IGLL5, the latter recognized by the presence of an intranuclear signal. Two B-cell lymphomas lacked IGKC and IGLC, whereas 2 cases were negative for the HKG. In 12 of the 20 cases with reactive lymphoid tissue, bRNA ISH identified a polyclonal lymphoid population. No light-chain messenger RNA was detected in 6 cases (typically those associated with very few B cells). CONCLUSIONS The automated bRNA ISH platform is a robust technique for detecting a clonal B-cell population in cytology material.
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Affiliation(s)
- Kshitij Arora
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lawrence Zukerberg
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Miguel Rivera
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David Ting
- Division of Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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14
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The many faces of small B cell lymphomas with plasmacytic differentiation and the contribution of MYD88 testing. Virchows Arch 2015; 468:259-75. [PMID: 26454445 DOI: 10.1007/s00428-015-1858-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/23/2015] [Indexed: 12/11/2022]
Abstract
Plasmacytic differentiation may occur in almost all small B cell lymphomas (SBLs), although it varies from being uniformly present (as in lymphoplasmacytic lymphoma (LPL)) to very uncommon (as in mantle cell lymphomas (MCLs)). The discovery of MYD88 L265P mutations in the vast majority of LPLs has had a major impact on the study of these lymphomas. Review of the cases contributed to the 2014 European Association for Haematopathology/Society for Hematopathology slide workshop illustrated how mutational testing has helped refine the diagnostic criteria for LPL, emphasizing the importance of identifying a clonal monotonous lymphoplasmacytic population and highlighting how LPL can still be diagnosed with extensive nodal architectural effacement, very subtle plasmacytic differentiation, follicular colonization, or uncommon phenotypes such as CD5 or CD10 expression. MYD88 L265P mutations were found in 11/11 LPL cases versus only 2 of 28 other SBLs included in its differential diagnosis. Mutational testing also helped to exclude other cases that would have been considered LPL in the past. The workshop also highlighted how plasmacytic differentiation can occur in chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, SOX11 negative MCL, and particularly in marginal zone lymphomas, all of which can cause diagnostic confusion with LPL. The cases also highlighted the difficulty in distinguishing lymphomas with marked plasmacytic differentiation from plasma cell neoplasms. Some SBLs with plasmacytic differentiation can be associated with amyloid, other immunoglobulin deposition, or crystal-storing histiocytosis, which may obscure the underlying neoplasm. Finally, although generally indolent, LPL may transform, with the workshop cases suggesting a role for TP53 abnormalities.
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Caltharp SA, Qayed M, Park SI. Atypical Marginal Zone Hyperplasia Is a Mimic for Lymphoma in Pediatric Transplant Recipients: Report of Two Patients. Pediatr Dev Pathol 2015; 18:416-21. [PMID: 25955878 DOI: 10.2350/15-01-1596-cr.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Atypical marginal zone hyperplasia (AMZH) of mucosa-associated lymphoid tissue (MALT) closely resembles lymphoma in that it shows expansion of the marginal zones with prominent intraepithelial B lymphocytes, is immunoglobulin light-chain restricted, and may show aberrant CD43 expression. However, unlike lymphoma, it does not show rearrangement of the immunoglobulin heavy chain gene (immunoglobulin H [IgH]) by polymerase chain reaction (PCR), and it behaves in a benign fashion. We identified AMZH in 2 pediatric solid organ transplant recipients who presented with adenotonsillar hypertrophy. To date, the patients have experienced a self-limited course in the absence of treatment or reduction of immunosuppression. Atypical marginal zone hyperplasia is a pitfall for posttransplant lymphoproliferative disorder and MALT lymphoma in the pediatric solid organ transplant population. In transplant patients with a lambda-restricted B-cell clone and marginal zone hyperplasia in native MALT sites, PCR for IgH and IgK gene rearrangement is essential to prevent misdiagnosis.
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Affiliation(s)
- Shelley A Caltharp
- 1 Children's Healthcare of Atlanta, 1405 Clifton Road NE, Egleston Children's Hospital, Department of Pathology, First Floor, Tower One, Atlanta, GA 30322, USA
| | - Muna Qayed
- 2 AFLAC Cancer and Blood Disorders Center and Emory University, 2015 Upper Gate Dr NE, 4th Floor, Atlanta, GA 30322, USA
| | - Sunita I Park
- 1 Children's Healthcare of Atlanta, 1405 Clifton Road NE, Egleston Children's Hospital, Department of Pathology, First Floor, Tower One, Atlanta, GA 30322, USA
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Martinez-Lopez A, Montes-Moreno S, Ramos R, Afonso-Martin JL, Mazorra F, Gonzalez de Villambrosia S, Batlle A, Grogan TM, Piris MA. Childhood florid follicular hyperplasia with immunoglobulin light-chain restriction in the gastrointestinal tract. Histopathology 2014; 65:805-13. [PMID: 25131212 DOI: 10.1111/his.12511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/16/2014] [Indexed: 12/22/2022]
Abstract
AIMS Immunoglobulin light-chain expression is used routinely as an indirect marker of clonality for recognizing B cell lymphoproliferative disorders. METHODS AND RESULTS Here we describe four floral follicular hyperplasia cases in the gastrointestinal tract (appendix and rectum) of children (4 to 6 years). Immunohistochemical studies revealed lambda light-chain restriction that was associated with polyclonal IgH pattern. Clinical features and follow-up of the patients did not reveal any other systemic symptoms, laboratory abnormalities or organ alterations. CONCLUSIONS Recognition of this phenomenon is useful in the diagnosis of nodular lymphoid hyperplasia of the gastrointestinal tract, for avoiding overdiagnosis of lymphoid malignancies, and raises concerns that the identification of light-chain restriction is not necessarily a marker of monoclonality.
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Affiliation(s)
- Azahara Martinez-Lopez
- Department of Pathology, Hospital Virgen de la Salud, Toledo, Spain; Department of Pathology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
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18
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Stacchini A, Aliberti S, Pacchioni D, Demurtas A, Isolato G, Gazzera C, Veltri A, Maletta F, Molinaro L, Novero D. Flow cytometry significantly improves the diagnostic value of fine needle aspiration cytology of lymphoproliferative lesions of salivary glands. Cytopathology 2013; 25:231-40. [DOI: 10.1111/cyt.12084] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2013] [Indexed: 12/11/2022]
Affiliation(s)
- A. Stacchini
- Flow Cytometry Unit; Diagnostic Laboratory Department; Citta' della Salute e della Scienza; Turin Italy
| | - S. Aliberti
- Flow Cytometry Unit; Diagnostic Laboratory Department; Citta' della Salute e della Scienza; Turin Italy
| | - D. Pacchioni
- Pathology Service; Diagnostic Laboratory Department; Citta' della Salute e della Scienza; Turin Italy
| | - A. Demurtas
- Flow Cytometry Unit; Diagnostic Laboratory Department; Citta' della Salute e della Scienza; Turin Italy
| | - G. Isolato
- Diagnostic Imaging Department; Citta' della Salute e della Scienza; Turin Italy
| | - C. Gazzera
- Diagnostic Imaging Department; Citta' della Salute e della Scienza; Turin Italy
| | - A. Veltri
- Diagnostic Imaging Department; San Luigi Gonzaga University Hospital; Orbassano Turin Italy
| | - F. Maletta
- Pathology Service; Diagnostic Laboratory Department; Citta' della Salute e della Scienza; Turin Italy
| | - L. Molinaro
- Pathology Service; Diagnostic Laboratory Department; Citta' della Salute e della Scienza; Turin Italy
| | - D. Novero
- Pathology Service; Diagnostic Laboratory Department; Citta' della Salute e della Scienza; Turin Italy
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Abstract
The differential diagnosis between neoplastic and reactive lymphoid proliferations is a relatively common situation, which in most cases is resolved using conventional morphological and phenotypic criteria. In the last years, a number of studies have identified different types of lymphoid lesions sharing pathological and molecular features of both benign and malignant processes that are difficult to interpret. A group of these lesions correspond to atypical lymphoid hyperplasias, including follicular hyperplasias, atypical marginal zone hyperplasias, and florid reactive lymphoid hyperplasias of the lower female genital tract in which immunoglobulin light chain restriction with or without clonal IGH rearrangements may be found in some cases. However, these lesions are usually self-limited and do not evolve to an overt lymphoid neoplasia. A second group of lesions are clonal expansions of cells with phenotypic or molecular features of well-defined lymphoid neoplasias, such as chronic lymphocytic leukemias, follicular lymphomas, or mantle cell lymphomas, occurring in otherwise healthy individuals or in the context of reactive lymphoid tissues. In this review, we discuss the criteria to distinguish these lesions from overt lymphomas and the current recommendations for the management of the individuals in which these lesions are found.
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Abstract
Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. It may be separated into major morphologic patterns, each with its own differential diagnosis with certain types of lymphoma. Most cases of reactive follicular hyperplasia is easy to diagnosis, but some cases may be confused with follicular lymphoma, but key morphologic, immunohistochemical, and molecular findings may usually distinguish between the two, particularly assessment of bcl-2 staining. Molecular studies to demonstrate B-cell clonality, as well as the t(14;18), may also be of great use in difficult cases. IgG4-associated sclerosing disease is discussed, as one recently described example of a specific type of reactive follicular hyperplasia in which the etiology may be suggested based on pathologic studies. While overlapping with the other types of hyperplasia, a high index of suspicion as well as IgG and IgG4 immunostains will help raise the possibility of the diagnosis that can be confirmed by further clinical studies. Reactive paracortical/interfollicular hyperplasia is another pattern of reactive hyperplasia, which may easily be confused with Hodgkin and non-Hodgkin lymphoma, particularly T-cell lymphoma. Epstein-Barr virus-associated infectious mononucleosis is an example of reactive paracortical/interfollicular hyperplasia, which may often simulate a malignant lymphoma. Attention to clinical findings, as well as a combination of immunohistochemical stains and in situ hybridization studies for Epstein-Barr early RNA (EBER) will usually allow a definitive diagnosis. In addition, lymph nodes with extensive necrosis may simulate malignant lymphoma. Kikuchi necrotizing histiocytic lymphadenitis is an example of a benign process with extensive necrosis, which may easily be confused with non-Hodgkin lymphoma. Clinical and morphologic features, particularly the presence of abundant karyorrhectic debris along with a paucity of granulocytes, as well as immunohistochemical studies to rule out lymphoma, are most helpful in establishing the correct diagnosis.
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EuroClonality/BIOMED-2 guidelines for interpretation and reporting of Ig/TCR clonality testing in suspected lymphoproliferations. Leukemia 2012; 26:2159-71. [PMID: 22918122 PMCID: PMC3469789 DOI: 10.1038/leu.2012.246] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PCR-based immunoglobulin (Ig)/T-cell receptor (TCR) clonality testing in suspected lymphoproliferations has largely been standardized and has consequently become technically feasible in a routine diagnostic setting. Standardization of the pre-analytical and post-analytical phases is now essential to prevent misinterpretation and incorrect conclusions derived from clonality data. As clonality testing is not a quantitative assay, but rather concerns recognition of molecular patterns, guidelines for reliable interpretation and reporting are mandatory. Here, the EuroClonality (BIOMED-2) consortium summarizes important pre- and post-analytical aspects of clonality testing, provides guidelines for interpretation of clonality testing results, and presents a uniform way to report the results of the Ig/TCR assays. Starting from an immunobiological concept, two levels to report Ig/TCR profiles are discerned: the technical description of individual (multiplex) PCR reactions and the overall molecular conclusion for B and T cells. Collectively, the EuroClonality (BIOMED-2) guidelines and consensus reporting system should help to improve the general performance level of clonality assessment and interpretation, which will directly impact on routine clinical management (standardized best-practice) in patients with suspected lymphoproliferations.
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22
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Diss TC, Molina TJ, Cabeçadas J, Langerak AW. Molecular diagnostics in lymphoma: why, when and how to apply. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.mpdhp.2011.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood 2011; 117:5019-32. [PMID: 21300984 DOI: 10.1182/blood-2011-01-293050] [Citation(s) in RCA: 1379] [Impact Index Per Article: 106.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The World Health Organization classification of lymphoid neoplasms updated in 2008 represents a worldwide consensus on the diagnosis of these tumors and is based on the recognition of distinct diseases, using a multidisciplinary approach. The updated classification refined the definitions of well-recognized diseases, identified new entities and variants, and incorporated emerging concepts in the understanding of lymphoid neoplasms. However, some questions were unresolved, such as the extent to which specific genetic or molecular alterations define certain tumors, and the status of provisional entities, categories for which the World Health Organization working groups felt there was insufficient evidence to recognize as distinct diseases at this time. In addition, since its publication, new findings and ideas have been generated. This review summarizes the scientific rationale for the classification, emphasizing changes that have had an effect on practice guidelines. The authors address the criteria and significance of early or precursor lesions and the identification of certain lymphoid neoplasms largely associated with particular age groups, such as children and the elderly. The issue of borderline categories having overlapping features with large B-cell lymphomas, as well as several provisional entities, is reviewed. These new observations chart a course for future research in the field.
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Stacchini A, Carucci P, Pacchioni D, Accinelli G, Demurtas A, Aliberti S, Bosco M, Bruno M, Balbo Mussetto A, Rizzetto M, Bussolati G, De Angelis C. Diagnosis of deep-seated lymphomas by endoscopic ultrasound-guided fine needle aspiration combined with flow cytometry. Cytopathology 2011; 23:50-6. [PMID: 21219488 DOI: 10.1111/j.1365-2303.2010.00842.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although endoscopic ultrasound combined with fine needle aspiration (EUS-FNA) is rapidly becoming the preferred diagnostic approach for the sampling and diagnosis of gastrointestinal and mediastinal malignancies, there are limited data as to its use in the diagnosis of lymphoproliferative disorders. Therefore, we carried out a retrospective evaluation of the performance of EUS-guided FNA combined with flow cytometry (FC) as a tool to improve overall sensitivity and specificity in the diagnosis of lymphoma. METHODS Of 1560 patients having EUS-guided FNA during the period of the study, a total of 56 patients were evaluated by cytology with FC after EUS-FNA. There was adequate material to perform FC analysis for all but one case. RESULTS EUS-FNA-FC gave a diagnosis of lymphoma in 11 cases and of reactive lymphadenopathy in 20. A specific histological type was defined by FC alone in eight cases. The remaining cases were diagnosed later by cytology and cell block sections: 13 carcinomas, nine granulomatous lymphadenopathies and one mediastinal extramedullary haematopoiesis. One case was considered only suspicious for lymphoma on cytology and FC but was not confirmed on molecular analysis and one had insufficient material for FC. CONCLUSIONS Our results show that a combination of EUS-FNA-FC is a feasible and highly accurate method, which may be used for the diagnosis and subtyping of deep-seated lymphoma, providing a significant improvement to cytomorphology alone both for diagnosis and treatment planning, as long as immunocytochemistry is available for non-lymphoma cases.
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Affiliation(s)
- A Stacchini
- Flow Cytometry Unit, Department of Pathology, Molinette Hospital, Turin, Italy.
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Nodal and extranodal plasmacytomas expressing immunoglobulin a: an indolent lymphoproliferative disorder with a low risk of clinical progression. Am J Surg Pathol 2010; 34:1425-35. [PMID: 20871216 DOI: 10.1097/pas.0b013e3181f17d0d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Plasmacytomas expressing immunoglobulin A are rare and not well characterized. In this study, 9 cases of IgA-positive plasmacytoma presenting in lymph node and 3 in extranodal sites were analyzed by morphology, immunohistochemistry, and polymerase chain reaction examination of immunoglobulin heavy and κ light chain genes. Laboratory features were correlated with clinical findings. There were 7 males and 5 females; age range was 10 to 66 years (median, 32 y). Six of the patients were younger than 30 years of age, 5 of whom had nodal disease. About 67% (6 of 9) of the patients with nodal disease had evidence of immune system dysfunction, including human immunodeficiency virus infection, T-cell deficiency, autoantibodies, arthritis, Sjögren syndrome, and decreased B cells. An IgA M-spike was detected in 6 of 11 cases, and the M-protein was nearly always less than 30 g/L. All patients had an indolent clinical course without progression to plasma cell myeloma. Histologically, nodal IgA plasmacytomas showed an interfollicular or diffuse pattern of plasma cell infiltration. The plasma cells were generally of mature Marschalko type with little or mild pleomorphism and exclusive expression of monotypic IgA. There was an equal expression of κ and λ light chains (ratio 6:6). Clonality was showed in 9 of 12 cases: by polymerase chain reaction in 7 cases, by cytogenetic analysis in 1 case, and by immunofixation in 1 case. Clonality did not correlate with pattern of lymph node infiltration. Our results suggest that IgA plasmacytomas may represent a distinct form of extramedullary plasmacytoma characterized by younger age at presentation, frequent lymph node involvement, and low risk of progression to plasma cell myeloma.
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Presence of immunoglobulin heavy chain rearrangement in so-called "plasma cell granuloma of the lung". Pathol Res Pract 2010; 206:83-7. [PMID: 19954895 DOI: 10.1016/j.prp.2009.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 08/03/2009] [Accepted: 09/03/2009] [Indexed: 11/23/2022]
Abstract
Inflammatory pseudotumor of the lung appears to be a set of heterogeneous disorders. Histologically, three subtypes of pulmonary IPTs have been delineated. Among these, plasma cell granuloma (PCG) is characterized by prominent lymphoplasmacytic infiltration, and PCG has been added to the list of differential diagnostic problems of mucosa-associated lymphoid tissue (MALT) type lymphoma. To investigate the presence or absence of monoclonal B-cell proliferation, we analyzed the immunohistological and genotypic findings in three cases of pulmonary PCGs. Histologically, the three lesions were characterized by severe infiltration of mature plasma cells, plasmacytoid cells, and small lymphocytes intermixed. Scattered Russell bodies (intracytoplasmic inclusions) were present in all three cases, but there were no Dutcher bodies (intranuclear inclusions) or centrocyte-like cells. Immunohistochemical studies of light chain determinants demonstrated the polytypic nature of B-cells. There was no CD5(+), CD43(+) or cyclin D1(+) B-lymphocytes in any of the three lesions. There were no lymphoepithelial lesions detected within any of the three lesions even by immunostaining for cytokeratin. However, polymerase chain assay for immunoglobulin heavy chain gene demonstrated a clonal band in one of the three cases. It currently remains unclear whether this one case, demonstrating IgH gene rearrangement in our series, could be a sign of the prelymphomatous stage (e.g. incipient MALT type lymphoma) or merely represents an exaggeration of normal B-cell clonal response.
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Zeppa P, Vigliar E, Cozzolino I, Troncone G, Picardi M, De Renzo A, Grimaldi F, Pane F, Vetrani A, Palombini L. Fine needle aspiration cytology and flow cytometry immunophenotyping of non-Hodgkin lymphoma: can we do better? Cytopathology 2010; 21:300-10. [PMID: 20132132 DOI: 10.1111/j.1365-2303.2009.00725.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the diagnostic efficiency of fine needle aspiration cytology/flow cytometry (FNAC/FC) in the diagnosis and classification of non-Hodgkin lymphoma (NHL) in a series of 446 cases and to compare the results with those of previous experiences to evaluate whether there had been an improvement in FNAC/FC diagnostic accuracy. METHODS FNAC/FC was used to analyse 446 cases of benign reactive hyperplasia (BRH), NHL and NHL relapse (rNHL) in 362 lymph nodes and 84 extranodal lesions. When a diagnosis of NHL was reached, a classification was attempted combining FC data and cytological features. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of FNAC/FC in the diagnosis and classification of NHL were calculated and compared with those available in the literature. RESULTS FNAC/FC provided a diagnosis of NHL and rNHL in 245 cases and of BRH in 188 cases. In nine cases, the diagnosis was 'suggestive of NHL' (sNHL) and in four cases was inadequate. Histology and clinical follow-up confirmed 102 cases of NHL and detected one false positive. In 18 cases of BRH diagnosed by FNAC/FC, histological examination revealed 14 BRH and four NHL (false negatives). All nine cases diagnosed as sNHL were confirmed by histology. Including sNHL cases as false negatives, statistical analysis showed 94.9% sensitivity, 99.4% specificity, 99.6% PPV and 93.4% NPV in the diagnosis of NHL. A specific subtype was diagnosed in 125 cases and confirmed in 67 of 70 cases that had histological biopsies. Statistical analysis did not demonstrate significant improvements between the present series and previous studies either in diagnosis or in classification of NHL. CONCLUSIONS FNAC/FC is a fundamental tool in the diagnosis and classification of NHL but the exiguity of diagnostic material and other technical and clinical limitations will probably continue to limit further improvement of the technique.
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Affiliation(s)
- P Zeppa
- Dipartimenti di Scienze Biomorfologiche e Funzionali, Facoltà di Medicina e Chirurgia, Università di Napoli "Federico II", Napoli, Italia.
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Kojima M, Nakamura N, Sakamoto K, Sakurai S, Tsukamoto N, Itoh H, Ikota H, Enomoto Y, Shimizu K, Motoori T, Hoshi K, Igarashi T, Masawa N, Nakamine H. Progressive transformation of the germinal center of extranodal organs: a clinicopathological, immunohistochemical, and genotypic study of 14 cases. Pathol Res Pract 2010; 206:235-40. [PMID: 20092960 DOI: 10.1016/j.prp.2009.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 11/16/2009] [Accepted: 12/01/2009] [Indexed: 10/19/2022]
Abstract
Progressive transformation of germinal center (PTGC) usually affects the peripheral lymph nodes. Little is known about the extranodal PTGC. To clarify the clinicopathological and molecular findings of extranodal PTGC, we studied 14 such cases. Using formalin-fixed, paraffin-embedded sections, we carried out histological and immunohistochemical examinations, as well as in situ hybridization (ISH) and polymerase chain reaction (PCR). Eleven patients were female, and three were male. They were between 44 and 77 years old, with a mean age of 62 years. The large intestine (n=7) was the most frequently involved tissue, followed by skin (n=2) and subcutaneous soft tissue (n=2). Oral cavity, Waldeyer ring, and orbit were affected in one case each. Histologically, 13 cases contained both early stage PTGC and late stage PTGC. The remaining 14th case contained only late stage PTGC. Expansion of the marginal zone was identified in three cases. Immunohistochemical study demonstrated the reactive nature of the B-cells in all 14 lesions. However, PCR study revealed immunoglobulin heavy chain (IgH) gene rearrangement in one of our 14 cases. There was no development of B-cell lymphoma in one lesion with IgH rearrangement. ISH study demonstrated Epstein-Barr virus-encoded small RNA+ cells in three lesions. Compared with PTGC of the peripheral lymph node, PTGC of extranodal sites was characterized by a female predominance, an older age group, and the presence of numerous PTGC at the affected sites. However, the histological findings of extranodal PTG were similar to those of lymph node PTGC. The clinicopathological findings of the extranodal PTGCs appeared to be different from those of lymph node PTGC.
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Affiliation(s)
- Masaru Kojima
- Department of Anatomic and Diagnostic Pathology, Dokkyo University School of Medicine, Tochigi, Japan.
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Cozzolino I, Nappa S, Picardi M, De Renzo A, Troncone G, Palombini L, Zeppa P. Clonal B-cell population in a reactive lymph node in acquired immunodeficiency syndrome. Diagn Cytopathol 2010; 37:910-4. [PMID: 19582804 DOI: 10.1002/dc.21127] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 40-year-old female, HIV positive, stage C, since 4 years, complained of a right cervical lymph node swelling. Two years before, the patient had been diagnosed with follicular B-cell non-Hodgkin lymphoma (FL); she had been treated with four cycles of multiagent chemotherapy plus rituximab, the last cycle being administered 10 months before coming to our attention. An ultrasound (US) guided fine-needle cytology (FNC) showed an atypical lymphoid cell proliferation. The phenotype evidenced by flow cytometry (FC) analysis was D5: 10%, CD19: 49%, CD23: 10%, FMC7: 0%, CD10: 40%, CD10/19: 40%, lambda light chain 40%, kappa light chain 0%. FDG-positron emission tomography (PET/CT) scan showed positivity in the corresponding cervical area. Since low LDH values and a reduced lymph node size were observed, the lymph node was therefore excised; the histology revealed a reactive hyperplastic lymph node with florid follicular pattern. A subsequent PCR analysis, performed on DNA extracted from a whole histological section, did not evidence IgH rearrangement. The patient is currently undergoing strict clinical and instrumental follow-up, including PET every 3 months; after 13 months, she is alive without recurrence of lymphoma. Clonal B-cell populations in non-lymphomatous processes have been described in mucosa-associated lymphoid cell populations and reactive lymph nodes, and are considered non-malignant, antigen driven, proliferations of B-lymphocytes determined by an abnormal response to bacterial or viral antigen stimulation. The present case occurred in an HIV patient and was clinically complex because of the patient's history of FL. This experience suggests much attention in the evaluation of radiological, cytological, and FC data and in clinical correlation in patients suffering from autoimmune or immunodeficiency syndromes.
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Affiliation(s)
- Immacolata Cozzolino
- Department of Pathological Anatomy and Cytopathology, University of Naples "Federico II," Naples, Italy
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30
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Abstract
The distinction between reactive and neoplastic lymphoid infiltrates is a common problem in clinical practice and can be problematic. The clinical implications for both the patient and the treating clinician are profound. In this article, we discuss six of the common entities that can present as atypical lymphoid hyperplasia and thus can mimic malignant lymphomas, with emphasis on morphologic features, immunophenotypic findings, and molecular correlates that help distinguish these disorders from neoplastic conditions. The six conditions to be discussed in detail include reactive follicular hyperplasia versus follicular lymphoma; progressive transformation of germinal centers versus nodular lymphocyte predominant Hodgkin lymphoma; immunoblastic proliferations versus diffuse large B-cell lymphomas; variant forms of Castleman disease that may mimic a number of lymphoid cancers; Kikuchi's disease versus large cell lymphomas; and finally, dermatopathic lymphadenopathy and its distinction from lymph nodes showing early involvement by cutaneous T-cell lymphoma (Mycosis fungoides).
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Affiliation(s)
- David J Good
- Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, BC, Canada
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31
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van Krieken JHJM. New developments in the pathology of malignant lymphoma: a review of the literature published from January to April 2008. J Hematop 2009; 1:37-45. [PMID: 19669203 PMCID: PMC2712329 DOI: 10.1007/s12308-008-0010-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- J Han J M van Krieken
- Department of Pathology, Nijmegen Medical Centre, Radboud University, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands,
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32
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Kojima M, Nakamura N, Itoh H, Motoori T, Hoshi K, Enomoto Y, Johshita T, Nakamine H. Histological Variety of Localized Lymphoid Hyperplasia of the Large Intestine: Histopathological, Immunohistochemical and Genotypic Findings of 16 Cases. J Clin Exp Hematop 2009; 49:15-21. [DOI: 10.3960/jslrt.49.15] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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33
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Bagg A. Malleable immunoglobulin genes and hematopathology - the good, the bad, and the ugly: a paper from the 2007 William Beaumont hospital symposium on molecular pathology. J Mol Diagn 2008; 10:396-410. [PMID: 18687793 DOI: 10.2353/jmoldx.2008.080061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Immunoglobulin gene rearrangement analysis is one of the more commonly performed assays available on the hematopathology menu of clinical molecular pathology laboratories. The analysis of these rearrangements provides useful information on a number of different levels in the evaluation of lymphoproliferations. An appreciation of the various mechanisms involved in the numerous physiological pathways affecting the immunoglobulin genes, and hence antibody molecules, is central to an understanding of B-cell development vis-à-vis the generation of immunological diversity. Knowledge about the intricate complexities of these mechanisms is also germane to an evaluation of testing methodologies. With this information, it is easier to develop an understanding of how contemporary molecular testing of immunoglobulin gene rearrangements has evolved, from historically quite heterogeneous, fairly flawed, and rather ugly approaches to current more-standardized protocols. In addition, recognition of how such genetic changes with good intentions can turn bad has fostered increasing insights into the pathogenesis of B-cell lymphomas and leukemias. Despite the significant improvements in the design of immunoglobulin gene rearrangement assays, numerous pitfalls and caveats remain. Accordingly, it is crucial to consider such testing a tool, and although most useful, it is one of many tools that may be required to build cogent diagnoses.
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Affiliation(s)
- Adam Bagg
- Hematology, Department of Pathology and Laboratory Medicine, University of Pennsylvania, 7.103 Founders Pavilion, 3400 Spruce St., Philadelphia, PA 19104-4283, USA.
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