[The molecular pathogenesis of classical Hodgkin lymphoma]

Image database analysis of Hodgkin lymphoma

Hodgkin lymphoma (HL) is a special type of B cell lymphoma, arising from germinal center B-cells. Morphological and immunohistochemical features of HL as well as the spatial distribution of malignant cells differ from other lymphoma and cancer types. Sophisticated protocols for immunostaining and the acquisition of high-resolution images become routine in pathological labs. Large and daily growing databases of high-resolution digital images are currently emerging. A systematic tissue image analysis and computer-aided exploration may provide new insights into HL pathology. The automated analysis of high resolution images, however, is a hard task in terms of required computing time and memory. Special concepts and pipelines for analyzing high-resolution images can boost the exploration of image databases. In this paper, we report an analysis of digital color images recorded in high-resolution of HL tissue slides. Applying a protocol of CD30 immunostaining to identify malignant cells, we implement a pipeline to handle and explore image data of stained HL tissue images. To the best of our knowledge, this is the first systematic application of image analysis to HL tissue slides. To illustrate the concept and methods we analyze images of two different HL types, nodular sclerosis and mixed cellularity as the most common forms and reactive lymphoid tissue for comparison. We implemented a pipeline which is adapted to the special requirements of whole slide images of HL tissue and identifies relevant regions that contain malignant cells. Using a preprocessing approach, we separate the relevant tissue region from the background. We assign pixels in the images to one of the six predefined classes: Hematoxylin(+), CD30(+), Nonspecific red, Unstained, Background, and Low intensity, applying a supervised recognition method. Local areas with pixels assigned to the class CD30(+) identify regions of interest. As expected, an increased amount of CD30(+) pixels is a characteristic feature of nodular sclerosis, and the non-lymphoma cases show a characteristically low amount of CD30(+) stain. Images of mixed cellularity samples include cases of high CD30(+) coloring as well as cases of low CD30(+) coloring.

Three-dimensional Telomere Signatures of Hodgkin- and Reed-Sternberg Cells at Diagnosis Identify Patients with Poor Response to Conventional Chemotherapy

In classic Hodgkin lymphoma (HL) the malignant mononuclear Hodgkin (H) and multinuclear Reed-Sternberg (RS) cells are characterized by a distinct three-dimensional nuclear telomere organization with shortening of the telomere length and the formation of telomeric aggregates. We asked if the severity of these telomere changes correlates with the clinical behavior of the disease. We retrospectively evaluated three-dimensional telomere organization by quantitative fluorescent in situ hybridization (Q-FISH) of diagnostic biopsies from 16 patients who were good responders and compared them with 16 diagnostic biopsies of 10 patients with refractory or relapsing HL (eight initial biopsies, four confirming progressions, and four confirming relapses). The H cells from patients with refractory/relapsing disease contained a significantly higher percentage of very small telomeres (P = .027) and telomere aggregates (P = .032) compared with H cells of patients entering rapid remission. These differences were even more significant (P = .002 and P = .013, respectively) when comparing the eight initial diagnostic biopsies of refractory/relapsing HL with diagnostic biopsies of eight patients with ongoing long-lasting remission (mean of 47 months). This specific three-dimensional telomere Q-FISH signature identifies these highly aggressive mononuclear H cells at the first diagnostic biopsy and thus may offer a new molecular marker to optimize initial treatment.

Intracellular heavy metal nanoparticle storage: progressive accumulation within lymph nodes with transformation from chronic inflammation to malignancy

A 25-year-old man had complained of sudden fever spikes for two years and his blood tests were within the normal range. In 1993, a surgical biopsy of swollen left inguinal lymph nodes was negative for malignancy, but showed reactive lymphadenitis and widespread sinus histiocytosis. A concomitant needle biopsy of the periaortic lymph nodes and a bone marrow aspirate were also negative. In 1994, after an emergency hospital admission because of a sport-related thoracic trauma, a right inguinal lymph node biopsy demonstrated Hodgkin’s lymphoma Stage IVB (scleronodular mixed cell subtype). Although it was improved by chemotherapy, the disease suddenly relapsed, and a further lymph node biopsy was performed in 1998 confirming the same diagnosis. Despite further treatment, the patient died of septic shock in 2004, at the age of 38 years. Retrospective analysis of the various specimens showed intracellular heavy metal nanoparticles within lymph node, bone marrow, and liver samples by field emission gun environmental scanning electron microscopy and energy dispersive spectroscopy. Heavy metals from environmental pollution may accumulate in sites far from the entry route and, in genetically conditioned individuals with tissue specificity, may act as cofactors for chronic inflammation or even malignant transformation. The present anecdotal report highlights the need for further pathologic ultrastructural investigations using serial samples and the possible role of intracellular nanoparticles in human disease.