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Attygalle AD, Chan JKC, Coupland SE, Du MQ, Ferry JA, de Jong D, Gratzinger D, Lim MS, Nicolae A, Ott G, Rosenwald A, Schuh A, Siebert R. What is new in the 5th edition of the World Health Organization classification of mature B and T/NK cell tumors and stromal neoplasms? J Hematop 2024; 17:71-89. [PMID: 38683440 DOI: 10.1007/s12308-024-00585-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
The classification of tumors is essential in the diagnosis and clinical management of patients with malignant neoplasms. The World Health Organization (WHO) provides a globally applicable classification scheme of neoplasms and it was updated several times. In this review, we briefly outline the cornerstones of the upcoming 5th edition of the World Health Organization Classification of Haematolymphoid Tumours on lymphoid neoplasms. As is adopted throughout the 5th edition of the WHO classification of tumors of all organ systems, entities are listed by a hierarchical system. For the first time, tumor-like lesions have been included in the classification, and modifications of nomenclature for some entities, revisions of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities are presented along with mesenchymal lesions specific to the stroma of lymph nodes and the spleen. In addition to specific outlines on constitutional and somatic genetic changes associated with given entities, a separate chapter on germline predisposition syndromes related to hematologic neoplasms has been added.
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Affiliation(s)
- Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden Hospital, London, SW3 6JJ, UK
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, ISMIB, University of Liverpool, Liverpool, UK
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Daphne de Jong
- Department of Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alina Nicolae
- Department of Pathology, Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany.
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Cancer Center Mainfranken, Würzburg, Germany
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
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Karube K, Satou A, Kato S. New classifications of B-cell neoplasms: a comparison of 5th WHO and International Consensus classifications. Int J Hematol 2024:10.1007/s12185-024-03781-5. [PMID: 38805112 DOI: 10.1007/s12185-024-03781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/03/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024]
Abstract
In 2024, the World Health Organization (WHO) launched a new classification of lymphoid neoplasms, a revision of the previously used Revised 4th Edition of their classification (WHO-4R). However, this means that two classifications are now in simultaneous use: the 5th Edition of the WHO classification (WHO-5) and the International Consensus Classification (ICC). Instead of a comprehensive review of each disease entity, as already described elsewhere, this review focuses on revisions made in both the WHO-5 and ICC from WHO-4R and discrepancies between them regarding B-cell neoplasms. Similarities include cutaneous marginal zone lymphoma, cold agglutinin disease, non-primary effusion lymphoma-type effusion-based lymphoma, and gray zone lymphoma. Differences include plasma cell neoplasms, high-grade B-cell lymphoma (double hit lymphoma), follicular lymphoma, LPD with immune deficiency and dysregulation, extranodal large B-cell lymphoma, transformations of indolent B-cell lymphomas, and diffuse large B-cell lymphoma, not otherwise specified. Understanding the similarities and differences between the two latest classifications will aid daily diagnostic practice and future research on lymphoid neoplasms.
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Affiliation(s)
- Kennosuke Karube
- Department of Pathology and Laboratory Medicine, Nagoya University, Aichi, Japan.
- Department of Pathology and Laboratory Medicine, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Seiichi Kato
- Center for Clinical Pathology, Fujita Health University, Toyoake, Japan
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3
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Attygalle AD, Chan JKC, Coupland SE, Du MQ, Ferry JA, Jong DD, Gratzinger D, Lim MS, Naresh KN, Nicolae A, Ott G, Rosenwald A, Schuh A, Siebert R. The 5th edition of the World Health Organization Classification of mature lymphoid and stromal tumors - an overview and update. Leuk Lymphoma 2024; 65:413-429. [PMID: 38189838 DOI: 10.1080/10428194.2023.2297939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 01/09/2024]
Abstract
The purpose of this review is to give an overview on the conceptual framework and major developments of the upcoming 5th edition of the World Health Organization (WHO) Classification of Haematolymphoid tumours (WHO-HAEM5) and to highlight the most significant changes made in WHO-HAEM5 compared with the revised 4th edition (WHO-HAEM4R) of lymphoid and stromal neoplasms. The changes from the revised 4th edition include the reorganization of entities by means of a hierarchical system that is realized throughout the 5th edition of the WHO classification of tumors of all organ systems, a modification of nomenclature for some entities, the refinement of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities. For the first time, tumor-like lesions, mesenchymal lesions specific to lymph node and spleen, and germline predisposition syndromes associated with the lymphoid neoplasms are included in the classification.
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Affiliation(s)
- Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden Hospital, London, UK
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, SAR China
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, ISMIB, University of Liverpool, Liverpool, UK
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daphne de Jong
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Megan S Lim
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Kikkeri N Naresh
- Fred Hutchinson Cancer Center, University of Washington, Seattle, USA
| | - Alina Nicolae
- Department of Pathology, University Hospital of Strasbourg, Strasbourg, France
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-UniversitätWürzburg, and Cancer Center Mainfranken, Würzburg, Germany
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
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4
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Camus V, Viailly PJ, Drieux F, Veresezan EL, Sesques P, Haioun C, Durot E, Patey M, Rossi C, Martin L, Rainville V, Bohers E, Ruminy P, Penther D, Kaltenbach S, Bruneau J, Paillassa J, Tournilhac O, Willaume A, Antier C, Lazarovici J, Lévêque E, Decazes P, Becker S, Tonnelet D, Berriolo-Riedinger A, Gaulard P, Tilly H, Molina TJ, Traverse-Glehen A, Jardin F. High PDL1/PDL2 gene expression correlates with worse outcome in primary mediastinal large B-cell lymphoma. Blood Adv 2023; 7:7331-7345. [PMID: 37862676 PMCID: PMC10701594 DOI: 10.1182/bloodadvances.2023011169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/11/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
Primary mediastinal B-cell lymphoma (PMBL) is an uncommon entity of aggressive B-cell lymphoma with an unusually good prognosis, except for 10-15% of chemotherapy-refractory cases. To identify earlier these higher risk patients, we performed molecular characterization of a retrospective multicenter cohort of patients treated with firstline immunochemotherapy. The traits of the patients with gene-expression profiling data (n = 120) were as follows: median age of 34 years (range, 18-67 years); female sex, 58.3%; elevated lactate dehydrogenase, 82.5%; Eastern Cooperative Oncology Group performance status score of 0 to 1, 85.7%; Ann Arbor stage I/II, 55%; International Prognostic Index score of 1 to 2, 64.4%; and median metabolic tumor volume, 290.4 cm3 (range, 15.7-1147.5 cm3). Among all 137 markers tested for correlation with survival data, only programmed death-ligand (PDL) 1 and PDL2 expression showed a prognostic impact. Overall, both PDL1 and PDL2 genes were highly expressed in 37 patients (30.8%; PDL1high/PDL2high). The baseline clinical characteristics of patients with PDL1high/PDL2high were similar to those of other patients. In univariate analysis, PDL1high/PDL2high status was associated with poor progression-free survival (PFS) (hazard ratio [HR], 4.292) and overall survival (OS; HR, 8.24). In multivariate analysis, PDL1high/PDL2high status was an independent prognostic factor of adverse outcomes (PFS: HR, 5.22; OS: HR, 10.368). We validated these results in an independent cohort of 40 patients and confirmed the significant association between PDL1high/PDL2high status and inferior PFS (HR, 6.11). High PDL1/PDL2 gene expression defines a population with strong immune privilege and poorer outcomes from standard chemotherapy who might benefit from firstline checkpoint inhibitor therapy.
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Affiliation(s)
- Vincent Camus
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | | | - Fanny Drieux
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | | | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Corinne Haioun
- Lymphoid malignancies Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Eric Durot
- Department of Hematology, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - Martine Patey
- Department of Pathology, CHU de Reims, Reims, France
| | - Cédric Rossi
- Department of Hematology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Vinciane Rainville
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Elodie Bohers
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Philippe Ruminy
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Dominique Penther
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
- Department of Genetic Oncology, Centre Henri Becquerel, Rouen France
| | - Sophie Kaltenbach
- Laboratory of Onco-Hematology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julie Bruneau
- Université de Paris, Institut Imagine, Laboratory of Hematological Disorders, INSERM UMR1163, Paris, France
- Department of Pathology, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Necker and Robert Debré, Paris, France
| | - Jérome Paillassa
- Department of Hematology, Angers University Hospital, Angers, France
| | - Olivier Tournilhac
- Department of Hematology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Alexandre Willaume
- Department of Hematology, Lille University Hospital – Hôpital Claude Hurriez, Lille, France
| | - Chloé Antier
- Department of Hematology, University Hospital, Nantes, France
| | - Julien Lazarovici
- Department of Hematology, Institut Gustave Roussy, Villejuif, France
| | - Emilie Lévêque
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Pierre Decazes
- Department of Nuclear Medicine and QuantIF-LITIS-EA4108, University of Rouen, Centre Henri Becquerel, Rouen, France
| | - Stéphanie Becker
- Department of Nuclear Medicine and QuantIF-LITIS-EA4108, University of Rouen, Centre Henri Becquerel, Rouen, France
| | - David Tonnelet
- Department of Nuclear Medicine and QuantIF-LITIS-EA4108, University of Rouen, Centre Henri Becquerel, Rouen, France
| | | | - Philippe Gaulard
- Department of Pathology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Thierry Jo Molina
- Department of Pathology, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Necker and Robert Debré, Paris, France
| | | | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, Rouen, France
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
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Ueda N, Kato H, Kato S, Saito T, Tachibana H, Yanada M, Taji H, Kodaira T, Hosoda W, Yamamoto K. Brentuximab vedotin plus AVD followed by involved-node radiotherapy in a patient with classic Hodgkin lymphoma following gray zone lymphoma after autologous stem-cell transplantation failure. Hematology 2023; 28:2207946. [PMID: 37183912 DOI: 10.1080/16078454.2023.2207946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND No consensus has been reached yet concerning treatment strategies for a sequential classic Hodgkin lymphoma (CHL) following gray zone lymphoma (GZL). Prognosis of GZL after a failed autologous hematopoietic stem-cell transplantation (auto-HCT) is poor and treatment strategy is very limited. As yet there are limited data showing clinical outcomes of brentuximab vedotin (BV) for GZL, especially for sequential CHL after GZL. CASE PRESENTATION We report a case of CHL following primary refractory GZL after a failed auto-HCT and showed favorable response to first-line CHL-directed chemoradiotherapy consisting of BV plus doxorubicin, vinblastine, and dacarbazin (AVD) followed by irradiation. The sequential cases with an early evolution, whose diagnosis of second lymphoma was made within a year, have been recently reported very poor survival shorter than a year. Whether a sequential CHL following GZL should be treated as a primary or relapsed disease has not been clearly elucidated. Our patient showed favorable response to first-line CHL-directed chemoradiotherapy without allogenic hematopoietic stem-cell transplantation and has in continuous remission for 2 years. CONCLUSIONS The management of our case could help for physicians to make better treatment decisions and provide insights for further exploration in future studies.
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Key Words
- BV+AVD, brentuximab vedotin doxorubicin, vinblastine, and dacarbazin
- CHL, classic Hodgkin lymphoma
- FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography-computed tomography
- GZL, Gray zone lymphoma
- Gray zone lymphoma
- R-CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone
- brentuximab vedotin
- involved-node radiotherapy
- sequential relapse
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Affiliation(s)
- Norihiro Ueda
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Hematology, Komaki City Hospital, Komaki, Japan
| | - Harumi Kato
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Centre Hospital, Nagoya, Japan
- Center for Clinical Pathology, Fujita Health University hospital, Toyoake, Japan
| | - Toko Saito
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hirofumi Taji
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Waki Hosoda
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Kazuhito Yamamoto
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
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6
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Jaffe ES. Evolution of Lymphoma Diagnosis in the Era of Personalized Medicine: A Marriage of Pathology and Genomics for Clinical Practice. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1880-1886. [PMID: 37734589 PMCID: PMC10734280 DOI: 10.1016/j.ajpath.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
The modern taxonomy of disease builds a framework for precision medicine, by which traditional pathologic criteria are integrated with clinical and genomic features to define disease entities. Two of the most common subtypes of lymphoma on a worldwide basis are follicular lymphoma (FL) and diffuse large B-cell lymphoma. Although BCL2 translocation is the signature lesion of most nodal FL, recent studies have identified significant diversity among follicle center-derived lesions. BCL2-negative FL is a genetically heterogeneous disease that occurs in both nodal and extranodal sites. Several distinct entities have been recognized in the pediatric age group, including pediatric-type FL, testicular FL, and interferon regulatory factor 4 (IRF4)-rearranged large B-cell lymphoma. Diffuse large B-cell lymphoma is a family of aggressive B-cell neoplasms with marked variation in pathogenesis and clinical features. Gene expression profiling >20 years ago identified the cell of origin as a key discriminator, but more recently high-throughput sequencing has identified highly varied mutational profiles that point the way in the future toward improvements in targeted therapy and patient outcome.
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Affiliation(s)
- Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
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7
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Gibson SE, Dojcinov S, Dotlic S, Hartmann S, Hsi ED, Klimkowska M, Melle F, Pileri SA, Ramsower CA, Rech K, Rimsza LM, Rodriguez-Pinilla SM, Tousseyn TA, de Jong D, Sabattini E. Mediastinal large B cell lymphoma and surrounding gray areas: a report of the lymphoma workshop of the 20th meeting of the European Association for Haematopathology. Virchows Arch 2023; 483:733-749. [PMID: 37530791 DOI: 10.1007/s00428-023-03550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/03/2023] [Accepted: 04/21/2023] [Indexed: 08/03/2023]
Abstract
Session 3 of the 2021 European Association for Haematopathology/Society for Hematopathology Workshop focused on mediastinal large B cell lymphomas and surrounding gray areas. One half of the session was dedicated to primary mediastinal large B cell lymphoma (PMBL) and included cases with classic clinicopathologic features, as well as cases with either morphologic or immunophenotypic variation, and PMBL-like cases with primary extramediastinal disease. The role of additional immunophenotyping and/or molecular testing to aid in the diagnosis of PMBL was discussed. The second half of the session focused on mediastinal and non-mediastinal gray zone lymphomas (GZL) with features intermediate between diffuse large B cell lymphoma (DLBCL) and classic Hodgkin lymphoma (CHL). Several cases illustrating the current challenges in separating this entity from PMBL/DLBCL and CHL were presented. There was discussion regarding the clinical and genetic differences between mediastinal and non-mediastinal GZLs. Rare cases of PMBL and GZL associated with EBV or follicular lymphoma were reviewed. Finally, several cases included in the session highlighted composite or sequential CHL and PMBL/DLBCL and/or GZL, highlighting challenges in separating such cases from GZL.
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Affiliation(s)
- Sarah E Gibson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Stefan Dojcinov
- Department of Pathology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Snjezana Dotlic
- Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Eric D Hsi
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Monika Klimkowska
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Federica Melle
- Division of Haematopathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano A Pileri
- Division of Haematopathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Karen Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lisa M Rimsza
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Thomas A Tousseyn
- Department of Imaging and Pathology, Translational Cell and Tissue Research Lab, KU Leuven, Louvain, Belgium
| | - Daphne de Jong
- Department of Pathology, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
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8
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Lorenzi L, Lonardi S, Bonezzi M, Zini S, Bugatti M, Valzelli A, Melotti F, Facchetti M, Ghini I, Villanacci V, Balzarini P, Pizzi M, Giustini V, Galvagni A, Chiarini M, Dei Tos AP, Vermi W, Casola S, Facchetti F. Immunoglobulin light chain transcript detection by ultrasensitive RNA in situ hybridization for B-cell lymphoma diagnosis. Virchows Arch 2023:10.1007/s00428-023-03682-8. [PMID: 37884676 DOI: 10.1007/s00428-023-03682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
Evaluation of B-cell clonality can be challenging in the interpretation of lymphoid infiltrates on tissue sections. Clonality testing based on IG gene rearrangements analysis by PCR (IG-PCR) is the gold standard. Alternatively, B-cell clonality can be assessed by the recognition of immunoglobulin light chain (IgLC) restriction, by immunohistochemistry (IHC), chromogenic in situ hybridization (ISH) or flow cytometry (FC). IG-PCR requires molecular facilities, and FC requires cell suspensions, both not widely available in routine pathology units. This study evaluates the performance of B-cell clonality detection by IgLC-RNAscope® (RNAsc) in a group of 216 formalin-fixed, paraffin-embedded samples including 185 non-Hodgkin B-cell lymphomas, 11 Hodgkin lymphomas (HL) and 20 reactive samples. IgLC-RNAsc, performed in parallel with FC in 53 cases, demonstrated better performances (93% vs 83%), particularly in diffuse large B-cell lymphoma (98% vs 71%) and follicular lymphoma (93% vs 83%) diagnosis. IgLC-RNAsc was also superior to IHC and ISH especially in samples with limited tumor cell content, where IG-PCR was not informative. Performed for the first time on mediastinal lymphomas, IgLC-RNAsc identified monotypic IgLC transcripts in 69% of primary mediastinal large B-cell lymphoma (PMBCL) and 67% of mediastinal gray zone lymphomas (MGZL). IGK/L double-negative cells were detected in 1 PMBCL, 2 MGZL, and all classical HL, while monotypic IgLC expression appeared to be a hallmark in nodular lymphocyte-predominant HL. IgLC-RNAsc demonstrates to be a powerful tool in B-cell lymphoma diagnosis, above all in challenging cases with limited tumor cell content, ensuring in situ investigations on mechanisms of Ig regulation across lymphoma entities.
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Affiliation(s)
- Luisa Lorenzi
- Pathology Unit, Department of Molecular and Translational Medicine-DMMT, University of Brescia, Brescia, Italy.
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy.
| | - Silvia Lonardi
- Pathology Unit, Department of Molecular and Translational Medicine-DMMT, University of Brescia, Brescia, Italy
| | - Michela Bonezzi
- Pathology Unit, Department of Molecular and Translational Medicine-DMMT, University of Brescia, Brescia, Italy
| | - Stefania Zini
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Mattia Bugatti
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Arianna Valzelli
- Pathology Unit, Department of Molecular and Translational Medicine-DMMT, University of Brescia, Brescia, Italy
| | - Flavia Melotti
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
| | | | - Iacopo Ghini
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
| | | | - Piera Balzarini
- Pathology Unit, Department of Molecular and Translational Medicine-DMMT, University of Brescia, Brescia, Italy
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Marco Pizzi
- Pathology Department, Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Viviana Giustini
- Flow Cytometry Unit, Clinical Chemistry Laboratory, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Anna Galvagni
- Flow Cytometry Unit, Clinical Chemistry Laboratory, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Marco Chiarini
- Flow Cytometry Unit, Clinical Chemistry Laboratory, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Angelo Paolo Dei Tos
- Pathology Department, Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - William Vermi
- Pathology Unit, Department of Molecular and Translational Medicine-DMMT, University of Brescia, Brescia, Italy
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Stefano Casola
- IFOM-ETS-The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine-DMMT, University of Brescia, Brescia, Italy
- Pathology Unit, ASST Spedali Civili Di Brescia, Brescia, Italy
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9
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Maqboul I, Abatli S, Shbaita S, Daraghmeh L, Younis O, Abu Rass H. Abnormal Presentation and Challenging Diagnosis of Mediastinal Lymphoma: A Case Report. Cureus 2023; 15:e45668. [PMID: 37745738 PMCID: PMC10517235 DOI: 10.7759/cureus.45668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
We describe a rare case of classical Hodgkin lymphoma (HL) in a 20-year-old female patient. She presented to our hospital with chest wall swelling after months of post-chest trauma management. The swelling was initially treated as an infected hematoma, and the patient was referred for surgical evacuation. During the surgery, the swelling was found to be a mass that extended to the mediastinum. A biopsy was taken, which later resulted in the diagnosis of a granular cell tumor (GCT). A decision on surgical resection by video-assisted thoracoscopic surgery (VATS) was taken after discussion with the multidisciplinary team of surgery, cardiothoracic surgery, oncology, pathology, and radiology. During the surgery, a frozen section biopsy was taken, which showed no features of lymphoma or granular cell tumors. The surgery was followed by a midline sternotomy to control the bleeding from an accidentally injured major vessel. The bleeding was controlled, and the mass was dissected and sent for histopathological examination. The histopathology showed nodular classical HL features, and the patient was referred for chemotherapy. In our case, the patient was initially diagnosed with GCT, but with complete resection and an adequate biopsy, the mass was found to be a classical HL. Possible cross-cellularity is questioned, and the possible correlation between the two findings encouraged us to report this case.
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Affiliation(s)
- Iyad Maqboul
- Department of General Surgery, An-Najah National University Hospital, An-Najah National University, Nablus, PSE
| | - Safaa Abatli
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Sara Shbaita
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Laith Daraghmeh
- Department of General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Omar Younis
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Hanood Abu Rass
- Department of Pathology, An-Najah National University Hospital, Nablus, PSE
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Alizadehasl A, Roudini K, Hesami M, Kosari F, Pouraliakbar HR, Mohseni M, Dokhani N. Mediastinal gray zone lymphoma in a pregnant woman presenting with cardiac tamponade. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:27. [PMID: 37259152 DOI: 10.1186/s40959-023-00173-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/12/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Mediastinal gray zone lymphoma is a newly recognized rare B cell neoplasm, which is challenging in diagnosis and treatment. CASE PRESENTATION In the current study, we aimed to report a 25-year-old pregnant woman at 25 weeks of gestation who presented with chronic cough and progressive shortness of breath, hypotension, tachycardia, and tachypnea. A large circumferential pericardial effusion with compressive effect on the right atrium and right ventricle and a large extracardiac mass with external pressure to mediastinal structures were seen on trans thoracic echocardiography. The emergency pericardiocentesis was performed with the diagnosis of cardiac tamponade. Also, CMR revealed a huge heterogeneous anterior mediastinal mass, and the pathology and the immunohistochemistry of the mass biopsy revealed gray zone lymphoma with positive CD3, CD20, CD30, CD45, PAX5, and negative CD15 expression. Three courses of chemotherapy with the CHOP regimen were performed with an acceptable response every three weeks before delivery. A caesarian section was performed at 37 weeks without any problem for the patient and fetus, and chemotherapy will be started three weeks after delivery. CONCLUSION Cardiac tamponade as an emergency condition occurred in this pregnant patient by malignant pericardial effusion and mediastinal mass pressure. Accurate diagnosis and on time interventions caused a significant improvement and a successful delivery.
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Affiliation(s)
- Azin Alizadehasl
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Roudini
- Department of Internal Medicine, Hematology and Medical Oncology Ward, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Hesami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Kosari
- Department of Pathology, School of Medicine Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Department of Radiology, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Mohseni
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Dokhani
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Labat-de-Hoz L, Rubio-Ramos A, Correas I, Alonso MA. The MAL Family of Proteins: Normal Function, Expression in Cancer, and Potential Use as Cancer Biomarkers. Cancers (Basel) 2023; 15:2801. [PMID: 37345137 DOI: 10.3390/cancers15102801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/06/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
The MAL family of integral membrane proteins consists of MAL, MAL2, MALL, PLLP, CMTM8, MYADM, and MYADML2. The best characterized members are elements of the machinery that controls specialized pathways of membrane traffic and cell signaling. This review aims to help answer the following questions about the MAL-family genes: (i) is their expression regulated in cancer and, if so, how? (ii) What role do they play in cancer? (iii) Might they have biomedical applications? Analysis of large-scale gene expression datasets indicated altered levels of MAL-family transcripts in specific cancer types. A comprehensive literature search provides evidence of MAL-family gene dysregulation and protein function repurposing in cancer. For MAL, and probably for other genes of the family, dysregulation is primarily a consequence of gene methylation, although copy number alterations also contribute to varying degrees. The scrutiny of the two sources of information, datasets and published studies, reveals potential prognostic applications of MAL-family members as cancer biomarkers-for instance, MAL2 in breast cancer, MAL2 and MALL in pancreatic cancer, and MAL and MYADM in lung cancer-and other biomedical uses. The availability of validated antibodies to some MAL-family proteins sanctions their use as cancer biomarkers in routine clinical practice.
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Affiliation(s)
- Leticia Labat-de-Hoz
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Armando Rubio-Ramos
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Isabel Correas
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Department of Molecular Biology, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Miguel A Alonso
- Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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12
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Kurz KS, Ott M, Kalmbach S, Steinlein S, Kalla C, Horn H, Ott G, Staiger AM. Large B-Cell Lymphomas in the 5th Edition of the WHO-Classification of Haematolymphoid Neoplasms-Updated Classification and New Concepts. Cancers (Basel) 2023; 15:cancers15082285. [PMID: 37190213 DOI: 10.3390/cancers15082285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The family/class of the large B-cell lymphomas (LBCL) in the 5th edition of the World Health Organization (WHO) classification of haematolymphoid tumors (WHO-HAEM5) features only a few major changes as compared to the 4th edition. In most entities, there are only subtle changes, many of them only representing some minor modifications in diagnostic terms. Major changes have been made in the diffuse large B-cell lymphomas (DLBCL)/high-grade B-cell lymphomas (HGBL) associated with MYC and BCL2 and/or BCL6 rearrangements. This category now consists of MYC and BCL2 rearranged cases exclusively, while the MYC/BCL6 double hit lymphomas now constitute genetic subtypes of DLBCL, not otherwise specified (NOS) or of HGBL, NOS. Other major changes are the conceptual merger of lymphomas arising in immune-privileged sites and the description of LBCL arising in the setting of immune dysregulation/deficiency. In addition, novel findings concerning underlying biological mechanisms in the pathogenesis of the different entities are provided.
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Affiliation(s)
- Katrin S Kurz
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Michaela Ott
- Department of Pathology, Marienhospital, 70199 Stuttgart, Germany
| | - Sabrina Kalmbach
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Sophia Steinlein
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Claudia Kalla
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Heike Horn
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
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13
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[Classification of Hodgkin lymphoma and related entities : News and open questions]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:184-192. [PMID: 36930284 DOI: 10.1007/s00292-023-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 03/18/2023]
Abstract
Two new classifications were recently released: the 5th edition of the WHO classification of hematolymphoid tumors and the International Consensus Classification (ICC) drafted by the Clinical Advisory Committee. In the preparation of both classifications, the previously existing lymphoma categories were reevaluated according to recently obtained data on clinical, morphological, and molecular findings. In this review we summarize the current placements of classic and nodular lymphocyte predominant Hodgkin lymphoma and their relevant differential diagnoses.
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Targeted Mutational Profiling Reveals Clonal Relationships in Metachronous Occurrence of Classic Hodgkin and Mediastinal Large B-Cell Lymphomas. Am J Surg Pathol 2023; 47:81-90. [PMID: 36001451 DOI: 10.1097/pas.0000000000001956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Classic Hodgkin lymphoma (CHL) patients may infrequently present with a prior or recurrent disease with discordant histology resembling non-Hodgkin lymphomas. These include primary mediastinal large B-cell lymphoma (PMBL), diffuse large B-cell lymphoma (DLBCL), or mediastinal gray-zone lymphoma (MGZL). Such patients are often refractory to standard therapy and their diagnosis is hampered by significant morphologic and immunophenotypic overlap and insufficient molecular data. Among 509 CHL patients seen at an academic medical center, 6 patients had a prior or subsequent diagnosis different from CHL. Paired tissue samples were evaluated by targeted mutational analysis using a 164-gene panel. Our findings show multiple shared variants indicative of a clonal relationship between the CHL and the PMBL, DLBCL, or MGZL diagnoses. Most frequent mutated genes included TNFAIP3 (4 of 6, 66.7%), STAT6 (3 or 6, 50%), ARID1A (3 of 6, 50%), and XPO1 (3 of 5, 60%). Three patients showed the same oncogenic variant within the XPO1 gene (E571K), and mutations in TNFAIP3 and B2M were observed in 2 of the 5 patients with shared variants. In addition, differences in the mutation profile between the lymphoma pairs were also observed, which could represent clonal evolution. Mutational profiling could be of benefit in patients with recurrent/refractory disease with discordant histology, where the clonal relationship could be helpful to inform and guide therapeutic decisions. These findings provide further evidence of a true biological continuum surrounding CHL, PMBL, DLBCL, and MGZL and shed light on underlying genetic events and their clinical impact.
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15
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Tousseyn TA, King RL, Fend F, Feldman AL, Brousset P, Jaffe ES. Evolution in the definition and diagnosis of the Hodgkin lymphomas and related entities. Virchows Arch 2023; 482:207-226. [PMID: 36274093 DOI: 10.1007/s00428-022-03427-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023]
Abstract
Hodgkin lymphoma was the first of the lymphomas to be recognized as a specific disease entity. However, recent studies have highlighted the heterogeneity of the diseases associated with this eponym warranting clarification and refinement of diagnostic terminology. While classic Hodgkin lymphoma (CHL) remains an essentially unchanged diagnostic entity in the 2022 International Consensus Classification of Mature Lymphoid Neoplasms (2022 ICC), nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is now renamed nodular lymphocyte predominant B cell lymphoma (NLPBL) in recognition of the distinct pathologic, biologic, and clinical differences. Fan patterns A, B, and C (sharing the presence of evident follicular structures, and retention of a B cell rich background) will be combined in "typical" or grade 1, while the other "variant" patterns, D, E, and F, are considered grade 2. T-cell/histiocyte-rich large B cell lymphoma (THRBCL) is considered part of the "variant" NLPHL continuum.The entity previously known as "B cell lymphoma, unclassifiable (BCLU), with features intermediate between diffuse large B cell lymphoma (DLBCL) and CHL" has been renamed "mediastinal gray zone lymphoma" (MGZL) in recognition of the importance of the thymic niche in the biology of this tumor. The diagnostic criteria for MGZL have been refined and require both a high tumor cell density and a strongly preserved B cell program.This article will describe updates on CHL, NLPBL, and MGZL in the recently published 2022 ICC and provide some useful differential diagnostic clues in cases with atypical morphology or immunophenotype.
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Affiliation(s)
- Thomas A Tousseyn
- Department of Pathology, UZ Leuven, University Hospitals, Herestraat 49, B-3000, Leuven, Belgium. .,Translational Cell and Tissue Research Laboratory, KU Leuven, Leuven, Belgium.
| | - Rebecca L King
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, Tübingen University Hospital, Tübingen, Germany
| | | | - Pierre Brousset
- Department of Pathology, IUCT-Oncopole, Labex TOUCAN, Toulouse, France
| | - Elaine S Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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16
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Trecourt A, Donzel M, Fontaine J, Ghesquières H, Jallade L, Antherieu G, Laurent C, Mauduit C, Traverse-Glehen A. Plasticity in Classical Hodgkin Composite Lymphomas: A Systematic Review. Cancers (Basel) 2022; 14:cancers14225695. [PMID: 36428786 PMCID: PMC9688742 DOI: 10.3390/cancers14225695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
The co-occurrence of several lymphomas in a patient defines composite/synchronous lymphoma. A common cellular origin has been reported for both contingents of such entities. In the present review, we aimed to gather the available data on composite lymphomas associating a classical Hodgkin lymphoma (cHL) with another lymphoma, to better understand the plasticity of mature B and T-cells. This review highlights that >70% of patients with a composite lymphoma are ≥55 years old, with a male predominance. The most reported associations are cHL with follicular lymphoma or diffuse large B-cell lymphoma, with over 130 cases reported. The cHL contingent is often of mixed cellularity type, with a more frequent focal/weak CD20 expression (30% to 55.6%) compared to de novo cHL, suggesting a particular pathophysiology. Moreover, Hodgkin cells may express specific markers of the associated lymphoma (e.g., BCL2/BCL6 for follicular lymphoma and Cyclin D1 for mantle cell lymphoma), sometimes combined with common BCL2/BCL6 or CCND1 rearrangements, respectively. In addition, both contingents may share similar IgH/IgK rearrangements and identical pathogenic variants, reinforcing the hypothesis of a common clonal origin. Finally, cHL appears to be endowed with a greater plasticity than previously thought, supporting a common clonal origin and a transdifferentiation process during lymphomagenesis of composite lymphomas.
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Affiliation(s)
- Alexis Trecourt
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon 1, UR 3738—CICLY, 69921 Oullins, France
- Correspondence: ; Tel.: +33-(0)4-7886-1186; Fax: +33-(0)4-7886-5713
| | - Marie Donzel
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
| | - Juliette Fontaine
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Hervé Ghesquières
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
- Service d’Hématologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Laurent Jallade
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
- Laboratoire d’Hématologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Gabriel Antherieu
- Service d’Hématologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Camille Laurent
- Service de Pathologie, Centre de Recherche en Cancérologie de Toulouse-Purpan, Institut Universitaire du Cancer, Oncopole de Toulouse, 31100 Toulouse, France
| | - Claire Mauduit
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Institut National de la Santé et de la Recherche Médicale, Centre Méditerranéen de Médecine Moléculaire (C3M), Unité 1065, Equipe 10, 06000 Nice, France
| | - Alexsandra Traverse-Glehen
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
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17
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Hodgkin Lymphoma: Biology and Differential Diagnostic Problem. Diagnostics (Basel) 2022; 12:diagnostics12061507. [PMID: 35741318 PMCID: PMC9221773 DOI: 10.3390/diagnostics12061507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022] Open
Abstract
Hodgkin lymphomas (HLs) are lymphoid neoplasms that are morphologically defined as being composed of dysplastic cells, namely, Hodgkin and Reed–Sternberg cells, in a reactive inflammatory background. The biological nature of HLs has long been unclear; however, our understanding of HL-related genetics and tumor microenvironment interactions is rapidly expanding. For example, cell surface overexpression of programmed cell death 1 ligand 1 (CD274/PD-L1) is now considered a defining feature of an HL subset, and targeting such immune checkpoint molecules is a promising therapeutic option. Still, HLs comprise multiple disease subtypes, and some HL features may overlap with its morphological mimics, posing challenging diagnostic and therapeutic problems. In this review, we summarize the recent advances in understanding the biology of HLs, and discuss approaches to differentiating HL and its mimics.
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Armitage JO, Gale RP, Jaffe ES. Lymphoma Nomenclature - What's in a name? Br J Haematol 2022; 197:539-543. [PMID: 35544408 DOI: 10.1111/bjh.18063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/30/2022]
Affiliation(s)
- James O Armitage
- Department of Medicine, University of Nebraska, Omaha, New Brunswick, USA
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Elaine S Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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Bosch-Schips J, Granai M, Quintanilla-Martinez L, Fend F. The Grey Zones of Classic Hodgkin Lymphoma. Cancers (Basel) 2022; 14:cancers14030742. [PMID: 35159009 PMCID: PMC8833496 DOI: 10.3390/cancers14030742] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Classic Hodgkin lymphoma (CHL) is a well-defined lymphoid neoplasm with a minority of characteristic neoplastic cells of B cell origin, namely Hodgkin and Reed–Sternberg cells immersed in a rich reactive inflammatory infiltrate in the background. Although CHL has always been set apart from non-Hodgkin lymphomas, cases with morphological and phenotypic features intermediate between CHL and other lymphomas have been described. Whereas some of these lymphomas only represent morphological mimics, others exhibit mutational and gene expression profiles which overlap with CHL, indicating that these cases, frequently termed grey zone lymphomas, reside on the biological boundary between CHL and large B-cell lymphomas. In the present review, we aim to describe the current knowledge of these rare lymphomas, address diagnostic issues and summarize today’s concepts on the classification of grey zone lymphomas and related tumors. Abstract Classic Hodgkin lymphoma (CHL) is a well-defined neoplasm characterized by the presence of a minority of pathognomonic Hodgkin and Reed–Sternberg (HRS) cells in a reactive inflammatory background. Although genotypically of B cell origin, HRS cells exhibit a downregulated B cell program and therefore are set apart from other B cell lymphomas in the current WHO classification. However, cases with morphological and phenotypic features overlapping with CHL have been recognized, and the category of B cell lymphoma—unclassifiable—with features intermediate between diffuse large B cell lymphoma (DLBCL) and CHL, also termed grey zone lymphoma, was first introduced into the WHO classification in 2008 as provisional entity. These cases, as well as others raising a differential diagnosis of CHL can present diagnostic problems, as well as therapeutic challenges. Whereas some of these lymphomas only represent biologically unrelated morphological mimics, others, especially mediastinal grey zone lymphoma, exhibit genetic and gene expression profiles which overlap with CHL, indicating a true biological relationship. In this review, we address areas of diagnostic difficulties between CHL and other lymphoma subtypes, discuss the biological basis of true grey zone lymphoma based on recent molecular studies and delineate current concepts for the classification of these rare tumors.
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Affiliation(s)
- Jan Bosch-Schips
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
- Department of Pathology, Hospital Universitari de Bellvitge—Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Massimo Granai
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
| | - Falko Fend
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany; (J.B.-S.); (M.G.); (L.Q.-M.)
- Correspondence: ; Tel.: +49-7071-2982266
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In-depth cell-free DNA sequencing reveals genomic landscape of Hodgkin’s lymphoma and facilitates ultrasensitive residual disease detection. MED 2021; 2:1171-1193.e11. [DOI: 10.1016/j.medj.2021.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/12/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
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21
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Sakakibara A, Kohno K, Ishikawa E, Suzuki Y, Tsuyuki Y, Shimada S, Shimada K, Satou A, Takahara T, Ohashi A, Takahashi E, Kato S, Nakamura S, Asano N. Diagnostic utility of programmed cell death ligand 1 (clone SP142) immunohistochemistry for malignant lymphoma and lymphoproliferative disorders: A brief review. J Clin Exp Hematop 2021; 61:182-191. [PMID: 34511582 PMCID: PMC8808108 DOI: 10.3960/jslrt.21003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The programmed cell death 1 (PD1)/PD1 ligand (PD-L1) axis plays an important role in tumor cell escape from immune control and has been most extensively investigated for therapeutic purposes. However, PD-L1 immunohistochemistry is still not used widely for diagnosis. We review the diagnostic utility of PD-L1 (by clone SP142) immunohistochemistry in large-cell lymphomas, mainly consisting of classic Hodgkin lymphoma (CHL) and diffuse large B-cell lymphoma (DLBCL). Neoplastic PD-L1 (nPD-L1) expression on Hodgkin and Reed-Sternberg cells is well-established among prototypic CHL. Of note, EBV+ CHL often poses a challenge for differential diagnosis from peripheral T-cell lymphoma with EBV+ non-malignant large B-cells; their distinction is based on the lack of PD-L1 expression on large B-cells in the latter. The nPD-L1 expression further provides a good diagnostic consensus for CHL with primary extranodal disease conceivably characterized by a combined pathogenesis of immune escape of tumor cells and immunodeficiency. Compared with CHL, the nPD-L1 expression rate is much lower in DLBCL, highlighting some specific subgroups of intravascular large B-cell lymphoma, primary mediastinal large B-cell lymphoma, and EBV+ DLBCL. They consist of nPD-L1-positive and -negative subgroups, but their clinicopathological significance remains to be elucidated. Microenvironmental PD-L1 positivity on immune cells may be associated with a favorable prognosis in extranodal DLBCL. PD-L1 (by SP142) immunohistochemistry has helped us to understand the immune biology of lymphoid neoplasms possibly related by immune escape and/or immunodeficiency. However, knowledge of these issues remains limited and should be clarified for diagnostic consensus in the future.
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Affiliation(s)
- Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Eri Ishikawa
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yuta Tsuyuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Akiko Ohashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Emiko Takahashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Naoko Asano
- Department of Clinical Laboratory, Nagano Prefectural Suzaka Hospital, Nagano, Japan
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22
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Maracaja DLV, Puthenpura V, Pels SG, O'Malley DP, Sklar JL, Finberg KE, Xu ML. EBV-Positive Primary Large B-Cell Lymphoma: The Role of Immunohistochemistry and XPO1 in the Diagnosis of Mediastinal Lymphomas. Appl Immunohistochem Mol Morphol 2021; 28:725-730. [PMID: 31789821 DOI: 10.1097/pai.0000000000000820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Primary mediastinal (thymic) large B-cell lymphoma (PMBL) is described as almost always negative for Epstein-Barr virus (EBV). In the context of a mediastinal lymphoma, the distinction between PMBL, classical Hodgkin lymphoma, diffuse large B-cell lymphoma, and mediastinal gray-zone lymphoma can be very difficult; hence, EBV positivity often argues against PMBL. We present a 19-year-old man with mediastinal mass morphologically consistent with PMBL. The tumor expressed classic immunophenotype, including positivity for CD20, CD19, MAL, OCT2, BOB1, BCL6, CD79a, and subset positivity for CD30. However, the tumor was EBV-positive by in situ hybridization. Next-generation sequencing detected somatic mutations in XPO1 (E571K), SMARCB1 (L356fs), and MYCC (T73A). Although the immunophenotype and XPO1 mutation are characteristic of PMBL, EBV expression is uncommon. Since EBV positivity can occur in rare PMBLs, it should not be the deciding factor in the diagnosis. This is the first EBV-positive PMBL in which mutational profiling has been reported. Aside from providing diagnostic support, the finding of the XPO1 E571K mutation may suggest a targeted therapeutic option.
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MESH Headings
- Adult
- Biomarkers, Tumor/metabolism
- Diagnosis, Differential
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/genetics
- Epstein-Barr Virus Infections/pathology
- Herpesvirus 4, Human/physiology
- High-Throughput Nucleotide Sequencing
- Humans
- Immunohistochemistry
- Immunophenotyping
- Karyopherins/genetics
- Karyopherins/immunology
- Karyopherins/metabolism
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Mediastinal Neoplasms/diagnosis
- Mutation/genetics
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/immunology
- Receptors, Cytoplasmic and Nuclear/metabolism
- Thymus Neoplasms/diagnosis
- Thymus Neoplasms/genetics
- Thymus Neoplasms/pathology
- Young Adult
- Exportin 1 Protein
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Affiliation(s)
| | - Vidya Puthenpura
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Salley G Pels
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | | | | | | | - Mina L Xu
- Departments of Pathology and Laboratory Medicine
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23
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Dubois S, Ruminy P, Bohers E, Viailly P, Veresezan L, Picquenot J, Bobée V, Viennot M, Penther D, Camus V, Thieblemont C, Pouaty C, Tilly H, Jardin F. Concomitant occurrence of genetically distinct Hodgkin lymphoma and primary mediastinal lymphoma. Clin Case Rep 2021; 9:e04504. [PMID: 34429980 PMCID: PMC8365538 DOI: 10.1002/ccr3.4504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/15/2022] Open
Abstract
Synchronous Hodgkin Lymphoma and Primary Mediastinal B-cell Lymphoma is possible, with molecular analyses proving the absence of clonal filiation between both entities. This suggests a common etiology but the existence of two divergent clones.
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Affiliation(s)
- Sydney Dubois
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | - Philippe Ruminy
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | - Elodie Bohers
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | | | - Liana Veresezan
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | | | | | - Mathieu Viennot
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | - Dominique Penther
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | - Vincent Camus
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | | | - Camille Pouaty
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | - Hervé Tilly
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
| | - Fabrice Jardin
- Department of Clinical HematologyCentre Henri Becquerel, INSERM U1245RouenFrance
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24
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Tao Y, Chen H, Liu D, Dai X. Survival among patients with composite and sequential lymphoma between primary mediastinal lymphoma/diffuse large B-cell lymphoma and classical Hodgkin lymphoma: A population-based study. Leuk Res 2021; 111:106669. [PMID: 34333276 DOI: 10.1016/j.leukres.2021.106669] [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: 06/06/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data on composite and sequential lymphoma between primary mediastinal lymphoma/diffuse large B-cell lymphoma (LBCL) and classical Hodgkin lymphoma (cHL) are rare. METHODS We identified 25 cases with composite lymphoma (CL), 116 cases developing LBCL as a second primary cancer after cHL (cHL-LBCL), and 74 cases developing cHL as a second primary cancer after LBCL (LBCL-cHL) from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Comparisons of overall survival (OS) and lymphoma cause-specific survival (CSS) between patients with cHL-LBCL or cHL-LBCL and their de novo counterparts were performed. RESULTS The 5-year OS of patients with CL was 74.8 %. No significant difference in unadjusted OS and lymphoma CSS were observed between patients with de novo LBCL (LBCL-1 group) and patients with cHL-LBCL. However, the age- and stage-adjusted cHL-LBCL group had inferior OS and lymphoma CSS compared with that in the LBCL-1 group. The unadjusted and adjusted OS and lymphoma CSS in the LBCL-cHL group were significantly worse than patients with de novo cHL. CONCLUSIONS CL between LBCL and cHL may have good outcomes. cHL survivors had poorer outcomes after a LBCL diagnosis versus patients with LBCL-1. Significantly poor outcomes were observed in patients with LBCL-cHL compared with patients with de novo cHL.
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Affiliation(s)
- Yunxia Tao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Dan Liu
- Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, China
| | - Xiumei Dai
- Department of Medical Oncology, Xuzhou Central Hospital, Clinical School of Xuzhou Medical University, Xuzhou, China.
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25
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Abstract
Twenty-five years after the Revised European American Classification of Lymphoid Neoplasms classification was published, its principle of an integrative approach to disease definition based on several parameters still prevails and has been adopted and expanded in the following World Health Organization classifications of tumors of the hematopoietic organs. The latest World Health Organization classification revised in 2017 comprises more than 80 entities of mature lymphoid neoplasms (B-cell, T-cell, and Hodgkin lymphomas), which are defined according to their morphology, immunophenotype, genetic lesions and molecular profiles, clinical features, and cellular derivation. The classification also recognizes both incipient and indolent lymphoid neoplasms with a low potential of progression. In this review, we highlight some of the new data and recent modifications introduced in the 2017 classification.
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26
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Rubio-Ramos A, Labat-de-Hoz L, Correas I, Alonso MA. The MAL Protein, an Integral Component of Specialized Membranes, in Normal Cells and Cancer. Cells 2021; 10:1065. [PMID: 33946345 PMCID: PMC8145151 DOI: 10.3390/cells10051065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
The MAL gene encodes a 17-kDa protein containing four putative transmembrane segments whose expression is restricted to human T cells, polarized epithelial cells and myelin-forming cells. The MAL protein has two unusual biochemical features. First, it has lipid-like properties that qualify it as a member of the group of proteolipid proteins. Second, it partitions selectively into detergent-insoluble membranes, which are known to be enriched in condensed cell membranes, consistent with MAL being distributed in highly ordered membranes in the cell. Since its original description more than thirty years ago, a large body of evidence has accumulated supporting a role of MAL in specialized membranes in all the cell types in which it is expressed. Here, we review the structure, expression and biochemical characteristics of MAL, and discuss the association of MAL with raft membranes and the function of MAL in polarized epithelial cells, T lymphocytes, and myelin-forming cells. The evidence that MAL is a putative receptor of the epsilon toxin of Clostridium perfringens, the expression of MAL in lymphomas, the hypermethylation of the MAL gene and subsequent loss of MAL expression in carcinomas are also presented. We propose a model of MAL as the organizer of specialized condensed membranes to make them functional, discuss the role of MAL as a tumor suppressor in carcinomas, consider its potential use as a cancer biomarker, and summarize the directions for future research.
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Affiliation(s)
- Armando Rubio-Ramos
- Centro de Biología Molecular “Severo Ochoa”, Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.R.-R.); (L.L.-d.-H.); (I.C.)
| | - Leticia Labat-de-Hoz
- Centro de Biología Molecular “Severo Ochoa”, Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.R.-R.); (L.L.-d.-H.); (I.C.)
| | - Isabel Correas
- Centro de Biología Molecular “Severo Ochoa”, Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.R.-R.); (L.L.-d.-H.); (I.C.)
- Department of Molecular Biology, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Miguel A. Alonso
- Centro de Biología Molecular “Severo Ochoa”, Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.R.-R.); (L.L.-d.-H.); (I.C.)
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27
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Patel I, Akoluk A, Upadhyaya V, Makadia S, Douedi S, Farooq T, Flynn D, Levitt M, Hossain MA. "Do Not Ignore Musculoskeletal Pain"-Initial Presentation of a Rare Malignant Disease: Case Report and Literature Review. J Investig Med High Impact Case Rep 2021; 8:2324709620941316. [PMID: 32660277 PMCID: PMC7361477 DOI: 10.1177/2324709620941316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Gray zone lymphoma, also known as B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma, is a rare malignancy with overlapping features of both diffuse large B-cell lymphoma and classical Hodgkin lymphoma. Most commonly mediastinal involvement is seen. Extranodal involvement is rare. In this case report, we present the case of a 59-year-old male who presented with stress-related left shoulder pain, ultimately diagnosed with gray zone lymphoma. The patient was treated with etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin-rituximab (EPOCH-R) regimen followed by consolidation radiotherapy resulting in complete response. We are highlighting this case as rare and atypical presentation of a rare disease.
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Affiliation(s)
- Ishan Patel
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Arda Akoluk
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | | | | | - Steven Douedi
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Taliya Farooq
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Daniel Flynn
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Michael Levitt
- Jersey Shore University Medical Center, Neptune, NJ, USA
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28
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Terao T, Yuda J, Yamauchi N, Guo YM, Shimada K, Sugano M, Ishii G, Minami Y. Brentuximab vedotin maintenance after autologous stem cell transplantation for refractory gray zone lymphoma with long-term remission. Mol Clin Oncol 2021; 14:125. [PMID: 33936598 PMCID: PMC8082227 DOI: 10.3892/mco.2021.2287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 12/21/2022] Open
Abstract
Gray zone lymphoma (GZL) is a rare type of B-cell lymphoma characterized by features of both diffuse large B-cell lymphoma and classical Hodgkin lymphoma (cHL). The prognosis of GZL is poorer than that of cHL and mediastinal large B-cell lymphoma. However, an optimal treatment strategy for relapsed/refractory (R/R) GZL has not been established in the clinical setting. The current study reported an excellent clinical response in a patient with R/R CD30-positive GZL who received brentuximab vedotin (BV) maintenance after autologous stem cell transplantation (ASCT). Although the patient was resistant to prior treatments, BV maintenance after ASCT achieved long-term remission. Hence, BV was determined to be a safe and effective therapeutic option for CD30-positive R/R GZL.
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Affiliation(s)
- Toshiki Terao
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan.,Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba 296-8604, Japan
| | - Junichiro Yuda
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Nobuhiko Yamauchi
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Yong-Mei Guo
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Kaoru Shimada
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Masato Sugano
- Department of Pathology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Genichiro Ishii
- Department of Pathology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Yosuke Minami
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
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29
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30
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Simon Z, Virga B, Pinczés L, Méhes G, Miltényi Z, Barna S, Szabó R, Illés Á. Transition Between Diffuse Large B-Cell Lymphoma and Classical Hodgkin Lymphoma- Our Histopathological and Clinical Experience With Patients With Intermediate Lymphoma. Pathol Oncol Res 2021; 27:625529. [PMID: 34257590 PMCID: PMC8262174 DOI: 10.3389/pore.2021.625529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/26/2021] [Indexed: 12/21/2022]
Abstract
Even though information about the pathophysiology and clinical features of grey-zone lymphoma, an entity intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma, is growing, there are still a number of unanswered questions. The disease has no easily reproducible diagnostic criteria, which makes identification challenging. Uncommon, mixed histological picture and unusual clinical presentation should raise suspicion for grey-zone lymphoma. In this retrospective analysis we present 9 gray zone lymphoma patients, who were diagnosed in our institute between 2008 and 2018. The histological diagnoses was oftentime challenging, we asked for a revision in three cases due to the unusual clinical behavior and in other three cases only the relapse of the disease proved to be grey-zone lymphoma. Based on the initial histopathological diagnoses we applied adriablastine-bleomycine-vinblastine and procarbasine or cyclophosphamide-vincristine-adriablastine and prednisolon as first line chemotherapy regime with additional rituximab in six cases and brentuximab-vedotine in one patient. In six of the nine patients due to the primary refractory disease we used rituximab plus cisplatine, cytosine-arabinoside, prednisolone salvage treatment and five of these patients responded well enough to become eligible for autologous stem cell transplantation. One young male patient was refractory for various treatments and died due to the progression of his lymphoma. As a rare disease grey-zone lymphoma has no existing diagnostic criteria or guiedlines for its standard of care, which makes the everyday practice rather challenging for the clinicians, and emphasize the importance of unique decision making in every case and the repeated consultation between the pathologist and hematologist.
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Affiliation(s)
| | | | | | - Gábor Méhes
- Institutes of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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31
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Geladari E, Dimopoulou G, Margellou E, Paraskevas A, Kafetzis G, Rontogianni D, Vadiaka M. Coexistence of Hodgkin and Non-Hodgkin Lymphoma; Composite Lymphoma [CL] in a Patient Presenting with Waxing and Waning Lymphadenopathy. Cardiovasc Hematol Disord Drug Targets 2021; 20:160-163. [PMID: 31633478 DOI: 10.2174/1871529x19666191014111118] [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: 12/06/2018] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The coexistence of two or more types of lymphoma within the same organ at the same time of diagnosis is defined as composite lymphoma, a rare disease that has recently been identified in the literature. Pointedly, the concurrence may be Hodgkin lymphoma with a Non-Hodgkin lymphoma [NHL], either B or T cells, or two different entities of NHLs. Furthermore, this condition has been described concurrently or sequentially. In order for the diagnosis to be established, two or more distinct clones should be proven by morphological and laboratory tests. CASE PRESENTATION Herein, we cite a seventy-three-year old female patient with low-grade fever, waxing and waning cervical lymphadenopathy, whose biopsy of an axillary lymph node demonstrated the rare coexistence of Hodgkin and NHL, known as composite lymphoma. CONCLUSION Composite lymphomas pose a particular diagnostic challenge, and currently, there are no agreed standards for treatment.
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Affiliation(s)
- Eleni Geladari
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
| | - Georgia Dimopoulou
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
| | - Evangelia Margellou
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
| | | | - Georgios Kafetzis
- 4th Surgical Department, Evaggelismos General Hospital, Athens, Greece
| | | | - Maria Vadiaka
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
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32
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Shah A, Ross C, Sur M. An approach to small lymph node biopsies: pearls and pitfalls of reporting in the real world. J Am Soc Cytopathol 2021; 10:328-337. [PMID: 33812794 DOI: 10.1016/j.jasc.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022]
Abstract
Recent advances in interventional radiology have resulted in the utilization of small lymph node biopsies, including fine-needle aspiration (FNA) and core needle biopsy (CNB) as an initial diagnostic tool in hematopathology. A major challenge to the utilization of FNA and CNB is the limited-to-scant tissue often available. We propose delegation of the task of handling biopsy specimens to the laboratory staff by the biopsy operators, in order to optimize the utilization of the specimen. Furthermore, in order to effectively diagnose hematolymphoid neoplasms a variety of ancillary tests including immunohistochemistry, flow cytometry, molecular analysis, florescence in situ hybridization (FISH) are necessary. We propose morphological evaluation coupled with careful utilization of ancillary studies along with clinical correlation to approach the correct diagnosis. Our morphological assessment considers the types of proliferating cell population: mainly small cells, sheets of large cells, or scattered large cells among small cells. This is followed by employment of the corresponding immunopanel to assess the differential diagnosis in each of the three categories. We also elaborate on the importance for pathologists to become proficient in understanding the limitations of small tissue biopsies as well as the differences in interpretation, and wording their reports to help clinicians and direct them to further investigate and/or to re-biopsy when necessary.
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Affiliation(s)
- Ahmed Shah
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - Catherine Ross
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - Monalisa Sur
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON.
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33
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Camus V, Jardin F. Cell-Free DNA for the Management of Classical Hodgkin Lymphoma. Pharmaceuticals (Basel) 2021; 14:ph14030207. [PMID: 33801462 PMCID: PMC7998645 DOI: 10.3390/ph14030207] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Cell-free DNA (cfDNA) testing, is an emerging “liquid biopsy” tool for noninvasive lymphoma detection, and an increased amount of data are now available to use this technique with accuracy, especially in classical Hodgkin lymphoma (cHL). The advantages of cfDNA include simplicity of repeated blood sample acquisition over time; dynamic, noninvasive, and quantitative analysis; fast turnover time; reasonable cost; and established consistency with results from tumor genomic DNA. cfDNA analysis offers an easy method for genotyping the overall molecular landscape of pediatric and adult cHL and may help in cases of diagnostic difficulties between cHL and other lymphomas. cfDNA levels are correlated with clinical, prognostic, and metabolic features, and may serve as a therapeutic response evaluation tool and as a minimal residual disease (MRD) biomarker in complement to positron emission tomography (PET). Indeed, cfDNA real-time monitoring by fast high-throughput techniques enables the prompt detection of refractory disease or may help to address PET residual hypermetabolic situations during or at the end of treatment. The major recent works presented and described here demonstrated the clinically meaningful applicability of cfDNA testing in diagnostic and theranostic settings, but also in disease risk assessment, therapeutic molecular response, and monitoring of cHL treatments.
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Affiliation(s)
- Vincent Camus
- Correspondence: ; Tel.: +33(0)-2-32-08-29-47; Fax: +33-(0)-2-32-08-22-83
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34
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Ahluwalia A, Bondili L, Salamera J, Cholankeril M. Unraveling the Mystery of Gray Zone Lymphoma in Human Immunodeficiency Virus-Seropositive Patients: Two Cases. J Hematol 2020; 9:132-136. [PMID: 33224393 PMCID: PMC7665863 DOI: 10.14740/jh554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022] Open
Abstract
Gray zone lymphoma (GZL) is an uncommon neoplasm with intermediate features of both classic Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL). It was identified in the World Health Organization (WHO) classification as its own neoplasm in 2008. Patients infected with human immunodeficiency virus (HIV) have been rarely diagnosed with this type of lymphoma and treatment strategies for this subset of patients is not well described. Here we present two cases of patients with HIV that were diagnosed with GZL in a single community-based institution. A 68-year-old male with HIV/acquired immunodeficiency syndrome (AIDS) on highly active antiretroviral therapy (HAART) presented with 6-month history of dyspnea and weight loss. Computed tomography (CT) of the chest revealed multiple lung and mediastinal lesions, the largest measuring 9.4 × 5.5 cm lesion in the right perihilar region. Lymph node biopsy revealed abnormal lymphocytes with immunohistochemistry (IHC) positive for cluster of differentiation 30 (CD30), CD20 and Epstein-Barr virus (EBV), consistent with a diagnosis of GZL. The patient received dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, prednisone, and rituximab (DA-EPOCH-R) and attained a complete response. He since completed maintenance rituximab therapy and remains disease-free at 33 months. A 40-year-old female with HIV/AIDS on HAART presented with high-grade fever, dyspnea, and weight loss. CT imaging revealed multiple lung lesions, hepatosplenomegaly and diffuse lymphadenopathy in the chest and abdomen. Lymph node and bone marrow biopsy revealed cells positive for CD20, CD30, and EBV within atypical lymphoid cells. With this, a diagnosis of GZL was made and she was treated with DA-EPOCH-R. She attained a complete response and was on maintenance rituximab therapy. At 9 months she relapsed, she has now received a bone marrow transplant. GZL is a rarely described neoplasm within the HIV population. Here we describe two HIV patients diagnosed with GZL that were successfully treated at our institution. DA-EPOCH-R was able to induce durable remission with limited side effects and it represents a viable strategy for treating patients in this population. Further studies need to be performed to better characterize this lymphoma, especially in HIV patients. Treatment strategies for this select group of patients also need to be better defined.
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Affiliation(s)
- Amith Ahluwalia
- Rutgers New Jersey Medical School, Trinitas Regional Medical Center, Elizabeth, NJ 07202, USA
| | - Leena Bondili
- Rutgers New Jersey Medical School, Trinitas Regional Medical Center, Elizabeth, NJ 07202, USA
| | - Julius Salamera
- Rutgers New Jersey Medical School, Trinitas Regional Medical Center, Elizabeth, NJ 07202, USA
| | - Michelle Cholankeril
- Rutgers New Jersey Medical School, Trinitas Regional Medical Center, Elizabeth, NJ 07202, USA
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Vassilakopoulos TP, Piperidou A, Hadjiharissi E, Panteliadou AK, Panitsas F, Vassilopoulos I, Variamis E, Boutsis D, Michail M, Papageorgiou S, Tsourouflis G, Dimou M, Karakatsanis S, Kalpadakis C, Stavroyianni N, Katodritou E, Kotsopoulou M, Kotsianidis I, Verigou E, Hatzimichael E, Leonidopoulou T, Xanthopoulos V, Panayiotidis P, Konstantopoulos K, Dimopoulos MA, Karmiris T, Batsis I, Papaioannou M, Pangalis GA, Angelopoulou MK. Development of Classic Hodgkin Lymphoma after successful treatment of primary mediastinal large b-cell lymphoma: results from a well-defined database. Leuk Res 2020; 100:106479. [PMID: 33285316 DOI: 10.1016/j.leukres.2020.106479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Hematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece.
| | - Alexia Piperidou
- Department of Hematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Evdoxia Hadjiharissi
- Hematology Unit, First Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Fotios Panitsas
- Department of Hematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | - Ioannis Vassilopoulos
- Department of Hematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece; Department of Hematology, Athens Navy Hospital, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Michail Michail
- Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus
| | - Sotirios Papageorgiou
- Second Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Gerassimos Tsourouflis
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, Athens, Greece
| | - Stamatis Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | | | - Niki Stavroyianni
- Department of Hematology, Papanikolaou Hospital, Thessaloniki, Greece
| | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evgenia Verigou
- Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece
| | | | | | | | | | - Kostas Konstantopoulos
- Department of Hematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
| | | | - Themistoklis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Ioannis Batsis
- Department of Hematology, Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Papaioannou
- Hematology Unit, First Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gerassimos A Pangalis
- Department of Hematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece; Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Maria K Angelopoulou
- Department of Hematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens, Greece
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36
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Vitagliano G, Cretella P, Zeppa P, Caputo A. Large-cell lymphoma with features intermediate between Hodgkin's, primary mediastinal B-cell and grey-zone lymphoma: a conundrum on fine needle aspiration cytology. Cytopathology 2020; 31:325-328. [PMID: 32418255 DOI: 10.1111/cyt.12865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Giulio Vitagliano
- Department of Medicine and Surgery, University of Naples "Federico II", Napoli, Italy
| | - Pasquale Cretella
- Department of Medicine and Surgery, University of Naples "Federico II", Napoli, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy
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Sarkozy C, Chong L, Takata K, Chavez EA, Miyata-Takata T, Duns G, Telenius A, Boyle M, Slack GW, Laurent C, Farinha P, Molina TJ, Copie-Bergman C, Damotte D, Salles GA, Mottok A, Savage KJ, Scott DW, Traverse-Glehen A, Steidl C. Gene expression profiling of gray zone lymphoma. Blood Adv 2020; 4:2523-2535. [PMID: 32516416 PMCID: PMC7284085 DOI: 10.1182/bloodadvances.2020001923] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Abstract
Gray zone lymphoma (GZL), a B-cell lymphoma with features intermediate between large B-cell lymphoma (LBCL) and classic Hodgkin lymphoma (cHL), is a rare and poorly defined entity. Alongside GZL, a subset of Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) has been described with polymorphic/GZL-like morphology (polymorphic-EBV-L). To fill the important gap in our understanding of the pathogenic process underlying these entities, we performed a gene expression study of a large international cohort of GZL and polymorphic-EBV-L, combined with cHL and primary mediastinal large B-cell lymphoma (PMBCL) cases. In an unsupervised principal component analysis, GZL cases presented with intermediate scores in a spectrum between cHL and PMBCL, whereas polymorphic-EBV-L clustered distinctly. The main biological pathways underlying the GZL spectrum were related to cell cycle, reflecting tumor cell content, and extracellular matrix signatures related to the cellular tumor microenvironment. Differential expression analysis and phenotypic characterization of the tumor microenvironment highlighted the predominance of regulatory macrophages in GZL compared with cHL and PMBCL. Two distinct subtypes of GZL were distinguishable that were phenotypically reminiscent of PMBCL and DLBCL, and we observed an association of PMBCL-type GZL with clinical presentation in the "thymic" anatomic niche. In summary, gene expression profiling (GEP) enabled us to add precision to the GZL spectrum, describe the biological distinction compared with polymorphic-EBV-L, and distinguish cases with and without thymic involvement as 2 subgroups of GZL, namely PMBCL-like and DLBCL-like GZL.
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Affiliation(s)
- Clémentine Sarkozy
- INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Lauren Chong
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Katsuyoshi Takata
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Elizabeth A Chavez
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | | | - Gerben Duns
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Adèle Telenius
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Camille Laurent
- Institut Universitaire du Cancer-Oncopole de Toulouse, Centre Hospitalier Universitaire Toulouse, INSERM U.1037, Centre de Recherche en Cancerologie de Toulouse-Purpan, Toulouse, France
| | - Pedro Farinha
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Thierry J Molina
- Pathology Department, Necker Enfants Malades Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Christiane Copie-Bergman
- Pathology Department, Henri Mondor-Albert Chennevier Hospital, AP-HP, Paris Est-Créteil (UPEC) University, UMR-S 955, INSERM, Créteil, France
| | - Diane Damotte
- Département de Pathologie, Groupe Hospitalier Cochin, AP-HP, Paris Descartes University-Sorbonne, Paris, France
| | - Gilles A Salles
- INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d'Hématologie, Pierre Bénite Cedex, France
| | - Anja Mottok
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany; and
| | - Kerry J Savage
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
| | - Alexandra Traverse-Glehen
- INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d'Anatomie Pathologique, Pierre Bénite Cedex, France
| | - Christian Steidl
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC, Canada
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38
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Shivarov V, Ivanova M. Clinical outcomes of composite and sequential B-cell lymphomas with features intermediate between DLBCL/PMBCL and classical Hodgkin Lymphoma from the SEER database. Br J Haematol 2020; 190:464-466. [PMID: 32419136 DOI: 10.1111/bjh.16728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Velizar Shivarov
- Department of Clinical Hematology, Sofiamed University Hospital, Sofia, Bulgaria.,Laboratory of Clinical Immunology, Sofiamed University Hospital, Sofia, Bulgaria.,Department of Genetics, Faculty of Biology, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria
| | - Milena Ivanova
- Department of Clinical Immunology, University Hospital Alexandrovska, Medical University Sofia, Sofia, Bulgaria
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39
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Zhang ML, Sohani AR. Lymphomas of the Mediastinum and Their Differential Diagnosis. Semin Diagn Pathol 2020; 37:156-165. [PMID: 32451144 DOI: 10.1053/j.semdp.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/01/2020] [Indexed: 12/24/2022]
Abstract
Lymphoma is the most common malignancy involving the mediastinum but can be challenging to diagnose on small biopsy specimens. This review provides a pattern-based approach to help triage small tissue samples for the diagnosis of mediastinal lymphoid proliferations, with focus on the main primary mediastinal lymphomas. The use of ancillary studies is highlighted, along with considerations to avoid misdiagnosis and scenarios to request additional tissue.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA.
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA
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40
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Sakakibara A, Kohno K, Ishikawa E, Suzuki Y, Shimada S, Eladl AE, Elsayed AA, Daroontum T, Satou A, Takahara T, Ohashi A, Takahashi E, Kato S, Nakamura S, Asano N. Age-related EBV-associated B-cell lymphoproliferative disorders and other EBV + lymphoproliferative diseases: New insights into immune escape and immunodeficiency through staining with anti-PD-L1 antibody clone SP142. Pathol Int 2020; 70:481-492. [PMID: 32367595 DOI: 10.1111/pin.12946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
Epstein-Barr virus (EBV) is prevalent among healthy individuals, and is implicated in numerous reactive and neoplastic processes in the immune system. The authors originally identified a series of senile or age-related EBV-associated B-cell lymphoproliferative disorders (LPD) bearing a resemblance to immunodeficiency-associated ones. These LPDs may be associated with immune senescence and are now incorporated into the revised 4th edition of 2017 WHO lymphoma classification as EBV-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS). These EBV+ B-cells often have a Hodgkin/Reed-Sternberg (HRS)-like appearance and are shared beyond the diagnostic categories of mature B-cell neoplasms, mature T-cell neoplasms, classic Hodgkin lymphoma, and immunodeficiency-associated LPD. In addition, peculiar new diseases, such as EBV+ mucocutaneous ulcer and EBV+ DLBCL affecting the young, were recognized. On the other hand, lymphoma classification is now evolving in accord with deeper understanding of the biology of programmed death ligand 1 (PD-L1). Assessing PD-L1 positivity by staining with the anti-PD-L1 monoclonal antibody SP142 provides new insight by discriminating between immune evasion and senescence or immunodeficiency. The aim of the present review is to briefly summarize the diagnostic use of immunostaining with SP142 in malignant lymphomas and/or LPDs that feature tumor and nonmalignant large B-cells harboring EBV.
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Affiliation(s)
- Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Eri Ishikawa
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Ahmed E Eladl
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed A Elsayed
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Teerada Daroontum
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Akiko Ohashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Emiko Takahashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Aichi, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Naoko Asano
- Department of Clinical Laboratory, Nagano Prefectural Suzaka Hospital, Nagano, Japan
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41
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Diagnostic utility of STAT6 YE361 expression in classical Hodgkin lymphoma and related entities. Mod Pathol 2020; 33:834-845. [PMID: 31822802 PMCID: PMC8191386 DOI: 10.1038/s41379-019-0428-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023]
Abstract
Although the distinction of classical Hodgkin lymphoma from nodular lymphocyte predominant Hodgkin lymphoma using morphology and immunostains is straightforward in most instances, occasional cases pose diagnostic challenge. We sought to determine the utility of the novel YE361 STAT6 rabbit monoclonal antibody in Hodgkin lymphoma and diagnostically challenging B- and T-cell non-Hodgkin lymphoma entities with Hodgkin-like features. Cases from seven institutions included: 57 classical Hodgkin lymphomas (31% EBV+), 34 nodular lymphocyte predominant Hodgkin lymphomas, 34 mimicking B- and T-cell non-Hodgkin lymphomas, and 7 reactive lymphoproliferations. After review of histology, STAT6YE361 immunostaining was performed. The intensity and spatial localization of immunopositivity was assessed in neoplastic cells. Additional FISH for programmed death ligand-1 (PD-L1) was performed in one patient in paired treatment-naive and relapse biopsy tissues. Two STAT6YE361 immunopositive cases were examined by whole-exome sequencing after flow sorting to assess mutations in STAT6 pathway genes. Most classical Hodgkin lymphomas showed nuclear staining for STAT6YE361 [46/57 cases (80%)] on Hodgkin cells. Staining was exclusively nuclear in a minority [12/46 (26%)], while dual nuclear and cytoplasmic localization was more common [34/46 (74%)]. In contrast, all nodular lymphocyte predominant Hodgkin lymphomas [0/34 (0%)] were negative for nuclear STAT6YE361 staining on the lymphocyte predominant cells. Within B- and T-cell non-Hodgkin lymphomas, nuclear STAT6YE361 was seen in: B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma, and in primary mediastinal large B-cell lymphoma. Strong PD-L1 gene amplification was noted in the paired cHL and relapse B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma, although STAT6YE361 was negative in both biopsies. Whole-exome sequencing identified mutations in B2M, XPO1, and ITPKB as well CISHP213L (in the STAT pathway) in one classical Hodgkin lymphoma patient positive for nuclear STAT6YE361 although no underlying STAT6 mutations were observed in either sample examined. STAT6YE361 nuclear staining has 100% positive predictive value and 85.7% negative predictive value in confirming or excluding classical Hodgkin lymphoma diagnosis in the distinction from nodular lymphocyte predominant Hodgkin lymphoma and other benign and malignant entities.
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42
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Perwein T, Lackner H, Ebetsberger-Dachs G, Beham-Schmid C, Zach K, Tamesberger M, Simonitsch-Klupp I, Lüftinger R, Dworzak M, Mann G, Benesch M, Attarbaschi A. Management of children and adolescents with gray zone lymphoma: A case series. Pediatr Blood Cancer 2020; 67:e28206. [PMID: 32037692 DOI: 10.1002/pbc.28206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/03/2020] [Accepted: 01/20/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data on management of gray zone lymphoma (GZL) in children and adolescents are scarce. PROCEDURE This retrospective study assessed clinical characteristics and outcome in six Austrian patients with GZL less than 18 years of age (male-to-female ratio: 1:1; median age: 15.8 years). RESULTS Two patients each had a classical Hodgkin lymphoma (cHL)-like and composite GZL subtype, and one patient each had a large B-cell non-Hodgkin lymphoma (LBCL)-like and sequential GZL subtype. All had advanced disease with mediastinal and extranodal involvement. Five patients received an LBCL- and one patient a cHL-directed polychemotherapy ± radiotherapy. Out of the former patients, three survived, including two who relapsed and underwent high-dose chemotherapy with autologous stem cell rescue. The latter patient survived. CONCLUSIONS GZL remains a diagnostic and therapeutic challenge, necessitating the development of novel treatment concepts performed in a prospective setting.
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Affiliation(s)
- Thomas Perwein
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Herwig Lackner
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Georg Ebetsberger-Dachs
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | | | - Klara Zach
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Tamesberger
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | | | - Roswitha Lüftinger
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Dworzak
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg Mann
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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43
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GATA3 Immunohistochemical Staining in Hodgkin Lymphoma: Diagnostic Utility in Differentiating Classic Hodgkin Lymphoma From Nodular Lymphocyte Predominant Hodgkin Lymphoma and Other Mimicking Entities. Appl Immunohistochem Mol Morphol 2020; 27:180-184. [PMID: 28877074 DOI: 10.1097/pai.0000000000000581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Classic Hodgkin lymphoma (CHL) and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) are clinically distinct entities, with different prognostic and treatment implications. In addition, several large B-cell lymphomas and some T-cell lymphomas can mimic CHL. Differentiating these entities from CHL is crucial for ensuring appropriate therapy. GATA3 is a T-cell transcription factor involved in T-cell maturation and has been previously shown to be overexpressed in CHL cells via gene expression profiling. We investigated the utility of GATA3 immunostain in differentiating CHL from NLPHL and other mimicking entities. MATERIALS AND METHODS We accrued 17 NLPHLs, 49 CHLs [23 nodular sclerosis (NS), 3 syncytial variants, 3 lymphocyte rich and 13 mixed cellularity types], 4 primary mediastinal large B-cell lymphomas (PMBLs), 2 Epstein-Barr virus (EBV) positive diffuse large B-cell lymphomas (DLBCLs) (EBV+LBCLs), 2 T-cell/histiocyte-rich large B-cell lymphomas (TCHRBCLs), 1 gray zone lymphoma, and 2 tissue microarrays consisting of 72 DLBCLs. One slide from each was stained with GATA3 and percent positive tumor cells and intensity of nuclear expression was semiquantitatively graded independently by 2 board certified hematopathologists. RESULTS GATA3 was positive in 80% of CHLs. Both percent positivity and intensity of staining varied greatly. Syncytial variant of NS subtype showed the highest positivity rate (3/3; 100%), followed by NS (20/23; 87%), mixed cellularity (9/13; 70%), and lymphocyte rich (2/3; 67%). GATA3 was negative in all NLPHLs, EBV+LBCLs, TCRBCLs, and DLBCLs stained. The single gray zone lymphoma and 3/4 PMBLs were positive. CONCLUSIONS Nuclear expression of GATA3 can be used to delineate CHL from NLPHL. GATA3 positivity effectively excludes NLPHL with 100% negative predictive value. However, as 20% of CHL can be negative for GATA3, CHL cannot be ruled out with negative GATA3. Additional findings include GATA3 positivity among PMBLs, whereas all 72 DLBCLs were negative for GATA3. This finding further highlights similarities between CHL and PMBL.
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44
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Pittaluga S, Nicolae A, Wright GW, Melani C, Roschewski M, Steinberg S, Huang D, Staudt LM, Jaffe ES, Wilson WH. Gene Expression Profiling of Mediastinal Gray Zone Lymphoma and Its Relationship to Primary Mediastinal B-cell Lymphoma and Classical Hodgkin Lymphoma. Blood Cancer Discov 2020; 1:155-161. [PMID: 32914098 DOI: 10.1158/2643-3230.bcd-20-0009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mediastinal gray zone lymphoma (MGZL) has immunopathologic features between classical Hodgkin lymphoma (cHL) and primary mediastinal thymic B-cell lymphoma (PMBL), leading to uncertainty regarding its biological relationship to these entities. We performed gene expression profiling from patients with MGZL (20), cHL (18), and PMBL (17) and show MGZL clusters between cHL and PMBL. Expression signatures reveal germinal B-cell and IFN regulatory factor 4 (IRF4) signatures were relatively low in MGZL and cHL compared with PMBL, indicating downregulation of the B-cell program in MGZL, a hallmark of cHL. T-cell and macrophage signatures were higher in MGZL and cHL compared with PMBL, consistent with infiltrating immune cells, which are found in cHL. The NFκB signature was higher in MGZL than PMBL, and like cHL, MGZL and PMBL express NFκB inducing kinase (NIK), indicating noncanonical signaling. These findings indicate that while MGZL has distinctive clustering, it is biologically closer to cHL.
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Affiliation(s)
| | | | | | | | | | | | - DaWei Huang
- Lymphoid Malignancies Branch, NCI, Bethesda, Maryland
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Aussedat G, Traverse-Glehen A, Stamatoullas A, Molina T, Safar V, Laurent C, Michot JM, Hirsch P, Nicolas-Virelizier E, Lamure S, Regny C, Picquenot JM, Ledoux-Pilon A, Tas P, Chassagne-Clément C, Manson G, Lemal R, Fontaine J, Le Cann M, Salles G, Ghesquières H, Copie-Bergman C, Sarkozy C. Composite and sequential lymphoma between classical Hodgkin lymphoma and primary mediastinal lymphoma/diffuse large B-cell lymphoma, a clinico-pathological series of 25 cases. Br J Haematol 2020; 189:244-256. [PMID: 32030731 DOI: 10.1111/bjh.16331] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/30/2019] [Indexed: 01/12/2023]
Abstract
Composite and sequential lymphomas involving both classical Hodgkin lymphoma (CHL) and primary mediastinal B-cell lymphoma (PMBCL) are rare phenomena. Beyond the relevant biological interest raised by these cases, treatments and outcome data are poorly covered in the recent literature. This retrospective analysis describes the pathological and clinical characteristics of 10 composite and 15 sequential cases included after a central pathological review. At diagnosis, 70% of the composite lymphomas presented a disseminated and extranodal disease. Among the 15 sequential lymphomas, 12 were CHL at first occurrence and three were PMBCL. Based on their clinical evolution, these sequential lymphomas could be divided into early (i.e., diagnosis of second lymphoma within a year) and late [(i.e., a second lymphoma occurrence occurring after a long period of complete remission]). All composite cases were alive in complete remission after a median follow-up of 34 months. If the early sequential lymphoma presented a particularly poor outcome with a median overall survival shorter than one year, the late cases were efficiently salvaged. Further molecular studies are needed to describe the underlying biology of these rare diseases, possibly representing the extreme of tumour cell plasticity found in grey-zone lymphoma.
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Affiliation(s)
- Guillaume Aussedat
- Department of Haematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite cedex, France.,INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France-Equipe Labellisée Ligue Contre le Cancer - Université Claude Bernard Lyon 1, Pierre Bénite cedex, France
| | - Alexandra Traverse-Glehen
- INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France-Equipe Labellisée Ligue Contre le Cancer - Université Claude Bernard Lyon 1, Pierre Bénite cedex, France.,Pathology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite cedex, France
| | | | - Thierry Molina
- Pathology Department, Necker Enfants Malades Hospital, Université Paris Descartes, APHP, Paris, France
| | - Violaine Safar
- Department of Haematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite cedex, France
| | - Camille Laurent
- Pathology Department, Centre de Recherche en Cancerologie de Toulouse-Purpan, Institut Universitaire du Cancer-Oncopole de Toulouse, CHU Toulouse, INSERM U.1037, Toulouse, France
| | - Jean-Marie Michot
- Department of Haematology, Gustave Roussy, Université Paris-Saclay, INSERM U1170, Villejuif, France
| | - Pierre Hirsch
- Department of Haematology, Centre de Recherche Saint-Antoine CRSA, Sorbonne Université, Inserm, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | - Sylvain Lamure
- Department of Haematology, CHU Montpellier, Montpellier, France
| | - Caroline Regny
- Department of Haematology, CHU Grenoble, Grenoble, France
| | | | | | - Patrick Tas
- Pathology Department, CHU Rennes, Rennes, France
| | | | | | - Richard Lemal
- Histocompatibility Unit, CHU, Université Clermont Auvergne, EA7453 CHELTER, CIC1405, Clermont Ferrand, France
| | - Juliette Fontaine
- Pathology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite cedex, France
| | - Marie Le Cann
- Department of Hematology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Gilles Salles
- Department of Haematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite cedex, France.,INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France-Equipe Labellisée Ligue Contre le Cancer - Université Claude Bernard Lyon 1, Pierre Bénite cedex, France
| | - Hervé Ghesquières
- Department of Haematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite cedex, France.,INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France-Equipe Labellisée Ligue Contre le Cancer - Université Claude Bernard Lyon 1, Pierre Bénite cedex, France
| | - Christiane Copie-Bergman
- Pathology Department, CHU Henri Mondor, APHP, INSERM U955, Université Paris-Est, Créteil, France
| | - Clémentine Sarkozy
- Department of Haematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite cedex, France.,INSERM Unité Mixte de Recherche (UMR)-S1052, Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France-Equipe Labellisée Ligue Contre le Cancer - Université Claude Bernard Lyon 1, Pierre Bénite cedex, France
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Sakakibara A, Kohno K, Iwakoshi A, Moritani S, Fujishiro A, Kito K, Suzuki Y, Shimada S, Nakaguro M, Shimoyama Y, Takahara T, Takahashi E, Ohashi A, Satou A, Kato S, Asano N, Nakamura S. Diagnostic utility of programmed cell death ligand 1 (clone SP142) in mediastinal composite lymphoma: A report of two cases. Pathol Int 2020; 70:116-122. [PMID: 31894883 DOI: 10.1111/pin.12891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
Abstract
Composite lymphoma is a well-known diagnostic entity exhibiting the synchronous occurrence of two or more distinct types of lymphomas in the same specimen. Here we report two patients, a 14-year-old female (Case 1) and a 45-year-old male (Case 2), with mediastinal composite lymphoma, comprising nodular sclerosis classic Hodgkin lymphoma (NSCHL) and primary mediastinal large B-cell lymphoma (PMBL). Both patients had a mediastinal mass, and manifested two different histologic components in the same biopsy, one characteristic of NSCHL and the other PMBL. The NSCHL areas included Hodgkin and Reed-Sternberg (HRS) cells with typical immunophenotypic features (CD30-positive and CD20-negative), whereas the sheets of large tumor cells characteristic of PMBL were strongly and uniformly CD20-positive. Interestingly, although both cases showed neoplastic PD-L1 (nPD-L1) positivity on the HRS cells of NSCHL, they differed regarding nPD-L1 expression on the PMBL tumor cells. In Case 1, the nPD-L1-negative PMBL component was anatomically situated outside the NSCHL lesion. On the other hand, in Case 2, the nPD-L1-positive PMBL component was characterized by transitional or continuous areas with the NSCHL component. These findings suggested that nPD-L1 expression may define two subtypes of PMBL that are more similar to or distinct from classic Hodgkin lymphoma.
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Affiliation(s)
- Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Akari Iwakoshi
- Department of Pathology, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - Suzuko Moritani
- Department of Pathology, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Aya Fujishiro
- Division of Hematology, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Kito
- Division of Hematology, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Yoshie Shimoyama
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Emiko Takahashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Akiko Ohashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Aichi, Japan
| | - Naoko Asano
- Department of Clinical Laboratory, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan
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47
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Egan C, Pittaluga S. Into the gray-zone: update on the diagnosis and classification of a rare lymphoma. Expert Rev Hematol 2019; 13:1-3. [DOI: 10.1080/17474086.2020.1696186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Caoimhe Egan
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
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Primary Mediastinal Nodal and Extranodal Non-Hodgkin Lymphomas: Current Concepts, Historical Evolution, and Useful Diagnostic Approach: Part 1. Adv Anat Pathol 2019; 26:346-370. [PMID: 31567132 DOI: 10.1097/pap.0000000000000249] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary mediastinal non-Hodgkin lymphomas (PM-NHLs) represent ~5% of all NHLs and comprise lymphomas of B-cell and T-cell origin. PM-NHLs are defined as involvement of mediastinal lymph nodes, thymus, and/or mediastinal organs (heart, lung, pleura, pericardium) by NHL without evidence of systemic disease at presentation. The clinical scenario is variable and depends on the lymphoma subtype. The radiologic presentation is also variable ranging from a mediastinal mass with or without superior vena cava syndrome, a pleural or a cardiac mass associated with an effusion, or as an effusion only. The diagnosis of PM-NHLs can only be established by microscopic evaluation, and therefore, general pathologists should be aware of these tumors and familiar with their diagnostic approach. The most common anterior mediastinal NHLs (90% to 95%) are primary mediastinal large B-cell lymphoma and T lymphoblastic lymphoma. Thymic marginal zone lymphoma and mediastinal gray zone lymphoma are very rare. The remainder PM-NHLs involving middle or posterior mediastinum include diffuse large B-cell lymphoma (DLBCL) and rare cases of T-cell lymphoma, including anaplastic large cell lymphoma and breast implant-associated anaplastic large cell lymphoma extending to the anterior mediastinum. Primary pleural and cardiac NHLs are mostly DLBCLs. Other rare subtypes of PM-NHLs include DLBCL associated with chronic inflammation/pyothorax-associated lymphoma, fibrin-associated DLBCL (both EBV), and pleural and/or pericardial primary effusion lymphoma (HHV-8/EBV). We review the historical aspects, epidemiology, clinico-radiologic features, histopathology, immunohistochemistry, differential diagnosis, and relevant cytogenetic and molecular features of PM (thymic) LBCL, PM "nonthymic" DLBCL, BCL, unclassifiable, with features intermediate between DLBCL and classic Hodgkin lymphoma (mediastinal gray zone lymphoma), DLBCL associated with chronic inflammation (pyothorax-associated lymphoma), fibrin-associated DLBCL, and primary effusion lymphoma. This review represents the first part of 2 manuscripts covering PM-NHLs.
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Abstract
The diagnosis of B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma, also called gray zone lymphoma (GZL), is frequently challenging. Incorrect diagnosis as either classic Hodgkin lymphoma or diffuse large B-cell lymphoma has significant implications for choice of upfront therapy based on recent large multi-institutional series from the United States and Europe. These studies have clarified some diagnostic challenges and provided guidance on the spectrum of morphologic features in this entity. This article clarifies some of the diagnostic conundrum surrounding GZL and provides an evidence-based approach to GZL diagnosis using morphology and immunohistochemistry.
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Affiliation(s)
- Kyle Parker
- Department of Pathology, Section of Hematopathology, University of Chicago Medical Center, Chicago, IL, USA
| | - Girish Venkataraman
- Clinical Immunohistochemistry Lab, Department of Pathology, Section of Hematopathology, The University of Chicago Medical Center, 5841 South Maryland Avenue, TW055B, MC0008, Chicago, IL 60637, USA.
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Ebisawa K, Masamoto Y, Koya J, Shimura A, Shinozaki-Ushiku A, Toyama K, Nakazaki K, Kurokawa M. Long-term Remission by Brentuximab Vedotin for Non-mediastinal Gray Zone Lymphoma Refractory to Autologous Stem Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e602-e604. [PMID: 31551171 DOI: 10.1016/j.clml.2019.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Kazutoshi Ebisawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yosuke Masamoto
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Junji Koya
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Arika Shimura
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Aya Shinozaki-Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiro Toyama
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kumi Nakazaki
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
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