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Okuni M, Yakushijin K, Sakai Y, Suto H, Ichikawa H, Sakai R, Kakiuchi S, Kurata K, Mizutani Y, Kitao A, Miyata Y, Saito Y, Kawamoto S, Yamamoto K, Ito M, Matsuoka H, Minami H. A Case of Classical Hodgkin Lymphoma with Total Lymph Node Infarction. J Clin Exp Hematop 2018; 58:24-26. [PMID: 29415974 DOI: 10.3960/jslrt.17026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lymph node infarction is very rare, and is frequently associated with neoplasms, such as malignant lymphoma and non-neoplastic disease, or interventions such as fine-needle aspiration (FNA). A 76-year-old-man presented with cervical lymph node swelling. Although FNA was performed, the findings were insufficient for a definitive diagnosis. Consequently, surgical biopsy of the cervical lymph node was performed, which revealed total infarction; a diagnosis of classical Hodgkin lymphoma was made later. Both lymphoma itself and FNA may cause total lymph node infarction, which makes diagnosis confusing. Therefore, it is important to repeat the biopsy rather than repeat FNA to correctly diagnose malignant lymphoma, including Hodgkin lymphoma.
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Affiliation(s)
- Marika Okuni
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Kimikazu Yakushijin
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Yasuhiro Sakai
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Hirotaka Suto
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Hiroya Ichikawa
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Rina Sakai
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Seiji Kakiuchi
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Keiji Kurata
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Yu Mizutani
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Akihito Kitao
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Yoshiharu Miyata
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Yasuyuki Saito
- Division of Molecular and Cellular Signaling, Department of Biochemistry and Molecular Biology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichiro Kawamoto
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Katsuya Yamamoto
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Mitsuhiro Ito
- Laboratory of Hematology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroshi Matsuoka
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
| | - Hironobu Minami
- The Division of Medical Oncology and Hematology, the Department of Medicine, Kobe University Hospital, Kobe, Japan
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Kalaivani S, Saranya GD, Kar R, Basu D. Role of Immunohistochemistry in Acute Leukemias with Myelonecrosis. Indian J Hematol Blood Transfus 2018; 34:643-647. [PMID: 30369734 DOI: 10.1007/s12288-018-0918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/02/2018] [Indexed: 11/25/2022] Open
Abstract
Myelonecrosisis a rare antemortem finding most commonly seen in haematopoeitic neoplasms, especially in acute leukemia. When myelonecrosis occurs at the time of presentation, it imposes certain diagnostic issues in sub categorization of leukemias which is necessary for therapeutic as well as prognostic purposes. Flow cytometry, though is a powerful modality, has its own limitations especially when the cells are not fresh and viable; and when the specimen is not of adequate cellularity which is usual in cases of myelonecrosis. In such situations, immunocytochemistry (ICC) or immunohistochemistry (IHC) may play a major role in lineage specification in leukemias as the necrosed marrow with the ghost cells can still retain the antigenicity for certain immunomarkers. Four such interesting cases of common B acute lymphoblastic leukemia (ALL) where IHC was used for diagnosis were included. ICC and IHC done on the necrosed marrow contributed to the diagnosis of ALL in all the four cases and contributed to subsequent management. ICC and IHC if contributory can play a major role in identifying the primary cause of myelonecrosis as the ghost cells can retain the antigenicity despite being morphologically non-viable.
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Affiliation(s)
- Subramanian Kalaivani
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Gurusamy Dharma Saranya
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Rakhee Kar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Debdatta Basu
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
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Comparison of Immune Profiles in Fetal Hearts with Idiopathic Dilated Cardiomyopathy, Maternal Autoimmune-Associated Dilated Cardiomyopathy and the Normal Fetus. Pediatr Cardiol 2016; 37:353-63. [PMID: 26481221 DOI: 10.1007/s00246-015-1284-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/09/2015] [Indexed: 12/17/2022]
Abstract
The etiology of idiopathic dilated cardiomyopathy (iDCM) remains unknown. Immune therapies have improved outcome in fetuses with DCM born to mothers with autoimmune disease (aDCM). The purpose of this retrospective study was to compare the myocardial B and T cell profiles in fetuses and neonates with idiopathic DCM (iDCM) versus autoimmune-mediated DCM (aDCM) and to describe the normal cell maturation within the human fetal myocardium. Of 60 fetal autopsy cases identified from institutional databases, 10 had aDCM (18-38 weeks), 12 iDCM (19-37 weeks) and 38 had normal hearts (11-40 weeks). Paraffin-embedded myocardium sections were stained for all lymphocyte (CD45), B cells (CD20, CD79a), T cells (CD3, CD4, CD7, CD8) and monocyte (CD68) surface markers. Two independent, blinded cell counts were performed. Normal hearts expressed all B and T cell markers in a bimodal fashion, with peaks at 22 and 37 weeks of gestation. The aDCM cohort was most distinct from normal hearts, with less overall T cell markers [EST -9.1 (2.6) cells/mm(2), p = 0.001], CD4 [EST -2.0 (0.6), p = 0.001], CD3 [EST -3.9 (1.0), p < 0.001], CD7 [EST -3.0 (1.1), p = 0.01] overall B cell markers [EST -4.9 (1.8), p = 0.01] and CD79a counts [EST -2.3 (0.9), p = 0.01]. The iDCM group had less overall B cell markers [EST -4.0 (1.8), p = 0.03] and CD79a [EST -1.7 (0.9), p = 0.05], but no difference in T cell markers. Autoimmune-mediated DCM fetuses have less B and T cell markers, whereas iDCM fetuses have less B cell markers compared with normal fetal hearts. The fetal immune system may play a role in the normal development of the heart and evolution of dilated cardiomyopathy.
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Mori E, Enomoto Y, Nakamine H, Kasai T, Takeda M, Takano M, Morita K, Koizumi T, Nonomura A. Lymph node infarction in classical Hodgkin's lymphoma. J Clin Exp Hematop 2012; 52:35-9. [PMID: 22706529 DOI: 10.3960/jslrt.52.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Among lymphoproliferative disorders, lymph node infarction appears to be most frequently seen in diffuse large B-cell lymphoma, followed by follicular lymphoma, with other types being rare. We experienced one such case, classical Hodgkin's lymphoma (cHL) associated with lymph node infarction, in which Reed-Sternberg (RS) cells were positive for CD15, CD30, fascin, PAX-5, p53, latent membrane protein-1 (LMP-1), Bcl-2, and EBV-encoded small non-polyadenylated RNAs. Furthermore, RS cells in the infarcted area were still positive for CD30, fascin, p53, and Bcl-2. For definitive diagnosis of nodal lymphomas including Hodgkin's lymphoma, identification of the effacement of normal nodal architecture is essential. Although this could not be evaluated in our case because of predominant reactive follicular hyperplasia with interfollicular distribution of RS cells, the presence of large cells with RS cell-related molecules together with the distorted distribution of cCD3-positive cells and CD20-positive cells led us to make a definitive diagnosis of cHL. It is, therefore, considered that immunohistochemical evaluation of the infarcted lymph node is, at least on some occasions, still informative for more accurate diagnosis of lymphoid neoplasia. Hodgkin's lymphoma should also be considered when one encounters lymph node infarction.
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Affiliation(s)
- Eiichiro Mori
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
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