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Tomoka T, Powers E, van der Gronde T, Amuquandoh A, Dhungel BM, Kampani C, Kamiza S, Montgomery ND, Fedoriw Y, Gopal S. Extranodal natural killer/T-cell lymphoma in Malawi: a report of three cases. BMC Cancer 2017; 17:633. [PMID: 28877678 PMCID: PMC5588687 DOI: 10.1186/s12885-017-3612-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/28/2017] [Indexed: 12/04/2022] Open
Abstract
Background Extranodal NK/T-cell lymphoma (ENKTCL) reports from sub-Saharan Africa (SSA) are remarkably rare, despite early childhood acquisition and high prevalence of the causative infectious agent, Epstein-Barr virus (EBV), and frequent occurrence of other lymphoproliferative disorders causally associated with EBV. Case presentations At a national teaching hospital in Malawi, three patients of African descent were seen with ENKTCL between 2013 and 2014. Patients were aged between 29 and 60 years, two with craniofacial involvement and one with a primary abdominal tumor, and all were HIV-negative. All had systemic B symptoms, and two severely impaired performance status. On histologic review, morphology and immunophenotyping demonstrated classical ENKTCL features in all cases, including diffuse proliferations of intermediate-to-large atypical lymphocytes with high mitotic activity and extensive background necrosis, positivity for CD3 and CD56, and negativity for CD20. By in situ hybridization, all three tumors were positive for EBV-encoded RNA (EBER). Baseline plasma EBV DNA was also markedly elevated for all three patients. Due to radiotherapy and chemotherapy limitations, patients were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) with rapid disease progression. All three patients died from progressive lymphoma within 3 months of initial diagnosis. Conclusions Our experience with these three patients in Malawi can highlight that ENKTCL does indeed occur in SSA, increase familiarity with ENKTCL among clinicians and pathologists throughout the region, and emphasize the need for better diagnosis and treatment for this neglected population.
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Affiliation(s)
- Tamiwe Tomoka
- UNC Project-Malawi, Private Bag A104, Lilongwe, Malawi. .,University of Malawi College of Medicine, Blantyre, Malawi.
| | - Eric Powers
- University of North Carolina, Chapel Hill, USA
| | | | | | | | | | - Steve Kamiza
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | | | - Satish Gopal
- UNC Project-Malawi, Private Bag A104, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, USA.,University of Malawi College of Medicine, Blantyre, Malawi
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2
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Bellan C, Lazzi S, Hummel M, Palummo N, de Santi M, Amato T, Nyagol J, Sabattini E, Lazure T, Pileri SA, Raphael M, Stein H, Tosi P, Leoncini L. Immunoglobulin gene analysis reveals 2 distinct cells of origin for EBV-positive and EBV-negative Burkitt lymphomas. Blood 2005; 106:1031-6. [PMID: 15840698 DOI: 10.1182/blood-2005-01-0168] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractThe normal counterpart of the neoplastic B cells in Burkitt lymphoma (BL) is still unclear. Based on immunoglobulin gene rearrangement studies, some authors suggest an origin from germinal center cells and others from memory B cells. However, most of these studies rely on cell lines or on a small series of cases. To help clarify the cell of origin of BL, semi-nested polymerase chain reaction (PCR) was performed to amplify the VDJ rearrangements of the immunoglobulin heavy chain (VH) genes, and the resultant amplificates were sequenced for comparison with known germline VH segments. The results of this approach revealed that all cases (15 endemic BL [eBL], 10 sporadic BL [sBL], and 6 AIDS-related BL) harbor mutated VH genes, with different mutation ranges among the 3 types of BL. The eBL and AIDS-related forms showed considerably higher mutation rates than the sBL form (5.1%, 5.4%, and 1.5%, respectively). The mutations in eBL and AIDS-related BL also showed signs of antigen selection, whereas no signs of antigen selection were found in sBL. Finally, after subcloning the amplificates, sequence analysis revealed no signs of ongoing mutations in any of the cases analyzed. Given that one of the main differences between eBL and AIDS-related BL on the one hand and sBL on the other hand is the association with Epstein-Barr virus (EBV), we compared EBV-positive and EBV-negative BLs independently of their geographic origin and HIV status. The differences in the number of somatic mutations and antigen selection were even more evident when this approach was used. According to our molecular results, it appears that EBV-positive and EBV-negative BL may originate from 2 distinct subsets of B cells, pointing to a particular role for the germinal-center reaction in the pathogenesis of these tumors. The different types of C-MYC translocation reported in BL may also be related to the different stages of B-cell maturation.
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Affiliation(s)
- Cristiana Bellan
- Department of Human Pathology and Oncology, University of Siena, Italy
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3
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Bellan C, Lazzi S, Zazzi M, Lalinga AV, Palummo N, Galieni P, Marafioti T, Tonini T, Cinti C, Leoncini L, Pileri SA, Tosi P. Immunoglobulin gene rearrangement analysis in composite hodgkin disease and large B-cell lymphoma: evidence for receptor revision of immunoglobulin heavy chain variable region genes in Hodgkin-Reed-Sternberg cells? DIAGNOSTIC MOLECULAR PATHOLOGY : THE AMERICAN JOURNAL OF SURGICAL PATHOLOGY, PART B 2002; 11:2-8. [PMID: 11854595 DOI: 10.1097/00019606-200203000-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunoglobulin heavy chain gene (IgH) rearrangement was studied in a patient showing the occurrence of classical Hodgkin disease and large B-cell lymphoma (LBCL) in the same lymph node. The VHDHJH region was amplified by polymerase chain reaction, the template being the DNA extracted from single Hodgkin and Reed-Sternberg and LBCL cells, microdissected on hematoxylin-eosin-stained sections by laser capture. A repeated VH4DH3JH4 segment was found in Reed-Sternberg cells, whereas a repeated VH3DH3JH4 segment was observed in LBCL cells. Rearranged VH genes carried somatic mutations in both populations, indicating a common germinal center cell origin. The IgH rearrangement found in clonally related Reed-Sternberg cells differed from the one of LBCL cells in the VH region but showed the same JH and DH segments with no variation from the respective germline sequence. The DH-JH junction is the first immunoglobulin gene segment rearranged in precursor B cells. Because the possibility of secondary Ig gene rearrangement in peripheral lymphoid organs has recently been reported, in the patient described here Reed-Sternberg and LBCL cells might originate from a common precursor in which secondary VH replacement took place during the germinal center reaction, giving rise to two different clonally related lymphomas.
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MESH Headings
- Adult
- Biomarkers, Tumor/metabolism
- DNA, Neoplasm/analysis
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Hodgkin Disease/genetics
- Hodgkin Disease/metabolism
- Hodgkin Disease/pathology
- Humans
- Immunoglobulin Variable Region/genetics
- Immunoglobulin Variable Region/metabolism
- Immunohistochemistry
- Lymph Nodes/metabolism
- Lymph Nodes/pathology
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/pathology
- Mutation
- Polymerase Chain Reaction
- Receptors, Antigen, B-Cell/genetics
- Receptors, Antigen, B-Cell/metabolism
- Reed-Sternberg Cells/immunology
- Reed-Sternberg Cells/metabolism
- Reed-Sternberg Cells/pathology
- Sequence Analysis, DNA
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Affiliation(s)
- Cristiana Bellan
- Institute of Pathologic Anatomy and Histopathology, University of Siena, Italy
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4
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Vera-Sempere F, Burgos J, Botella MS, Morera C. Comparative analysis of Epstein-Barr virus (EBV) detection by nested-PCR and non-isotopic in situ hybridization in nasopharyngeal carcinoma (NPC). Clin Chim Acta 1998; 271:119-32. [PMID: 9565328 DOI: 10.1016/s0009-8981(97)00209-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aims of this study were two-fold: first, to assess the relative diagnostic performance of non-isotopic in situ hybridization (ISH) and the nested polymerase chain reaction (nested-PCR) applied to Epstein-Barr virus (EBV) detection in a series of 55 unselected nasopharyngeal carcinoma (NPC) cases and, secondly, to correlate these data with histopathological classification. Our study shows that in 76.36% of NPC cases positive nuclear signals were observed using EBV-ISH. Overall, EBV-ISH positivity varied according to histological type, in that undifferentiated carcinomas showed a higher proportion of positive cases than differentiated cell carcinomas, although ISH results do not show significant differences in relation to histological types when employing two different schemes (WHO and Micheau). However, in adequate quality DNA samples (54 NPC cases), EBV-DNA was detected in 100% of cases using a nested-PCR, supporting the previous view that all histological types of NPC are in reality variants of EBV-infected neoplasia. ISH-negative cases probably reflect a lower sensitivity than PCR, particularly when a small number of viral copies are present, as well as a variable technical effectiveness for detected EBV, independent of the NPC histological type.
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Affiliation(s)
- F Vera-Sempere
- Laboratory of Molecular Pathology, University Hospital La Fe, Medical School of Valencia University, Spain
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5
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Leoncini L, Spina D, Megha T, Gallorini M, Tosi P, Hummel M, Stein H, Pileri S, Kraft R, Laissue JA, Cottier H. Cell kinetics, morphology, and molecular IgVH gene rearrangements in Hodgkin's disease. Leuk Lymphoma 1997; 26:307-16. [PMID: 9322893 DOI: 10.3109/10428199709051780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present study dealt with the question of whether any cellular kinetic patterns correlate with clonal rearrangement of the IgVH gene as revealed by polymerase chain reaction on DNA extracted from lymph nodes with classical Hodgkin's disease (HD) and/or from single CD30+ cells (Hodgkin [H] and Reed-Sternberg [RS] cells). In 15/4 cases with H-RS cells of B or Null phenotype, signs of such monoclonality could be detected (group I) but not in the others (group II). CD30+/H-RS cells in group I differed slightly but significantly from those in group II in that they a) exhibited a larger fraction of cells attaining the anaphase/telophase stage of mitosis, and b) produced relatively more mononucleated cells (H) at the expense of multinucleated (RS) cells. In addition, reactive lymphoid cell (CD30-) infiltrates were considerably less dense in group I that in group II. These findings suggest that the cytokinesis of H-RS cells in group I was moderately more efficient than in group II. However, signs of monoclonality were not associated with the normalization of the mitotic process, which also proved to be disturbed in group I.
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Affiliation(s)
- L Leoncini
- Institute of Pathologic Anatomy and Histology, University of Siena, Italy
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6
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Spina D, Leoncini L, Megha T, Gallorini M, Disanto A, Tosi P, Abinya O, Nyong'O A, Pileri S, Kraft R, Laissue JA, Cottier H. Cellular kinetic and phenotypic heterogeneity in and among Burkitt's and Burkitt-like lymphomas. J Pathol 1997; 182:145-50. [PMID: 9274523 DOI: 10.1002/(sici)1096-9896(199706)182:2<145::aid-path819>3.0.co;2-p] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study asks whether the known genotypic heterogeneity within and between endemic or sporadic Burkitt's lymphomas (eBLs and sBLs, n = 10 each), and Burkitt-like lymphomas (BLLs, n-12), is reflected in divergent cytokinetics and related immunophenotypes. There was strong evidence that eBL and BLL grow markedly faster than sBL, as shown by differences in mitotic and apoptotic indices. Furthermore, in BLL, the median percentage of neoplastic cells immunoreactive for the bcl-2 protein was much higher than that observed in eBL and sBL. The reverse was true for the median fraction of cells containing c-myc protein. In eBL and sBL, the median fraction of bcl-6 protein-positive cells reached values above 50 per cent, while cells of 8/12 BLLs did not contain detectable amounts of this protein. This observation indicates that in this respect, eBL and sBL resemble normal germinal centres of lymphatic tissue much more than do BLL. Evidence for infection of neoplastic cells by the Epstein-Barr virus (EBV) was observed in 9/10 cases of eBL and in 3/10 of sBL, but not in BLL. EBV-positive lymphomas were associated with distinctly lower apoptotic indices and smaller median percentages of bcl-6-positive cells than EBV-negative tumours.
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Affiliation(s)
- D Spina
- Institute of Pathologic Anatomy and Histology, University of Siena, Italy
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7
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Leoncini L, Spina D, Close P, Minacci C, Megha T, De Luca F, Tosi P, Pileri S, Kraft R, Laissue JA, Cottier H. Mitotic activity and nuclear DNA damage of large cells in Hodgkin's disease: comparison with the expression of p53 and bcl-2 proteins and the presence of Epstein-Barr virus. Leuk Lymphoma 1997; 25:153-61. [PMID: 9130623 DOI: 10.3109/10428199709042505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The roles of the bcl-2 and p53 proteins in Hodgkin's disease (HD) are poorly understood. We therefore compared their detected presence in Hodgkin and Reed-Sternberg/large atypical (H-RS/LA) cells immunohistochemically with the percentages of these cells double-labeled for CD30 and DNA strand breaks (DNA fragmentation index, DFI); mitotic indices (MI); and the EBV infection status. We found a highly significant inverse correlation between the fractions per case of H-RS/LA cells expressing bcl-2/p53 proteins and the DFI of CD30+ elements. No marked effect of these two oncoproteins on MI was noticed, although these parameters and DFI of CD30+ cells were linearly related. EBV infection of H-RS/LA cells exerted only a limited effect on the parameters tested. The results of this study suggest that overexpressed bcl-2 and, to some extent, p53 proteins in H-RS/LA cells of HD primarily counteract deletion of these cells.
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Affiliation(s)
- L Leoncini
- Institute of Pathologic Anatomy and Histology, University of Siena, Italy
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8
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Petrella T, Delfau-Larue MH, Caillot D, Morcillo JL, Casasnovas O, Portier H, Gaulard P, Farcet JP, Arnould L. Nasopharyngeal lymphomas: further evidence for a natural killer cell origin. Hum Pathol 1996; 27:827-33. [PMID: 8760018 DOI: 10.1016/s0046-8177(96)90457-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors report four cases of sinonasal lymphomas with immunophenotypic (four cases) and genotypic (three cases) studies. These lymphomas are frequent in Oriental countries, but unusual in Western populations, particularly in France. Although they have been originally considered as T-cell lymphomas, their origin remains unclear, and several authors have recently suggested that they are a natural killer (NK)-cell proliferation. The tumor cells of the four cases reported here showed characteristics of NK cells. On cryostat sections, they were CD3 negative, but CD2 and CD56 positive. The cytoplasm of the tumor cells exhibited azurophilic granulations. Using polymerase chain reaction (PCR), no clonal rearrangement of the T-cell receptor gamma gene was present. Furthermore, clinically, two presented a pharyngeal involvement, and two were also characterized by hepatosplenic involvement at the time of the diagnosis. Thus, the present cases provide additional evidence toward the NK-cell origin of these rare lymphomas. Many sinonasal lymphomas, including the present cases, are positive for Epstein-Barr virus (EBV) (LMP-1 antibody and EBER-messenger RNA probes). This may suggest an important role of EBV as a local factor in their pathogenesis.
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Affiliation(s)
- T Petrella
- Laboratoire d'Anatomie Pathologique, Dijon, France
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9
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Kanavaros P, Briere J, Lescs MC, Gaulard P. Epstein-Barr virus in non-Hodgkin's lymphomas of the upper respiratory tract: association with sinonasal localization and expression of NK and/or T-cell antigens by tumour cells. J Pathol 1996; 178:297-302. [PMID: 8778335 DOI: 10.1002/(sici)1096-9896(199603)178:3<297::aid-path469>3.0.co;2-e] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fifty-five cases of non-Hodgkin's lymphoma (NHL) of the upper respiratory tract, comprising 27 sinonasal (SN) and 28 Waldeyer's ring (WR) NHL, were investigated for expression of Epstein-Barr virus (EBV)-encoded EBER transcripts and latent membrane protein-1 (LMP-1) by RNA in-situ hybridization (RISH) and immunohistochemistry, respectively. Thirty-two cases were B-cell tumours (10 SNHLs and 22 WRNHLs) and 23 cases expressed natural killer (NK) and/or T-cell antigens (17 SNHLs and 6 WRNHLs). EBER transcripts were detected in tumour cells in 19 lymphomas expressing NK and/or T-cell antigens (16/17 SHNHLs and 3/6 WRNHLs) but in only 2/32 B-NHLs (1/10 SNHLs and 1/22 WRNHLs). LMP-1 expression was found in tumour cells in the 19 EBER-positive tumours expressing NK and/or T-cell antigens but in none of the B-cell lymphomas. All the LMP-1-positive lymphomas expressed the CD30 molecule in tumour cells. These results indicate that in lymphomas of the upper respiratory tract, EBV is strongly associated with sinonasal localization and expression of NK and/or T-cell antigens by tumour cells. EBV can also be detected in some cases of WRNHLs expressing NK and/or T-cell antigens, whereas it is rarely found in B-cell SNHLs and WRNHLs. Furthermore, the detection of the LMP-1 protein in tumour cells in most SNHLs and some WRNHLs expressing NK and/or T-cell antigens, in view of the LMP-1 transforming potential, suggests that EBV may play a role in the pathogenesis of these lymphomas.
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MESH Headings
- Antigens, Differentiation, T-Lymphocyte/immunology
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/immunology
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunoenzyme Techniques
- Immunophenotyping
- In Situ Hybridization
- Killer Cells, Natural/immunology
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/virology
- Paranasal Sinus Neoplasms/immunology
- Paranasal Sinus Neoplasms/virology
- RNA, Messenger/analysis
- RNA, Viral/analysis
- T-Lymphocytes/immunology
- Tonsillar Neoplasms/immunology
- Tonsillar Neoplasms/virology
- Viral Matrix Proteins/analysis
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Affiliation(s)
- P Kanavaros
- Department of Pathology, Hopital Henri Mondor, Creteil, France
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