Clinicopathological and immunophenotypic studies on 12 cases with B cell chronic lymphocytic leukemia

To clarify the histogenesis of B cell chronic lymphocytic leukemia (BCLL), clinicopathological and immunophenotypic studies were performed using a large panel of monoclonal antibodies on 12 cases with BCLL including three cases with prolymphocytic/chronic lymphocytic leukemia (CLL/PL). Immunophenotypically, CD19 and CD20 were positive for all cases of this series and CD5, CD21, CD22, CD23, CD25, CD38, Leu-8, KB-61, and bcl-2 protein were expressed in variable proportion from case to case. CD10, however, did not react. No alkaline phosphatase (ALP) positive cases were found. The phenotype of BCLL was similar to that of B cells of the mantle zone (MZ) of secondary follicle in the lymph node. It is therefore postulated that the neoplastic cells of BCLL in these cases might be derived from B cells of the MZ. Moreover, the cells possibly originated from the lymphocytes located in the inner layer of the MZ, since ALP+ B cells are usually observed in the outer layer of the MZ. The pseudofollicular (PF) pattern was observed in four biopsied lymph nodes among five cases tested, but no such a pattern in an aspiration clot of bone marrow. These four cases consisted of three cases with CLL and a case with CLL/PL. The immunohistochemical study showed that there were many proliferating cells showing Ki-67+ in the PF area of the lymph nodes. In these cases, leukemic cells might have developed from the PF area of the lymph node.

[Surgical results in Crohn's disease--an analysis in view of cumulative risk or recurrence and reoperation]

Forty nine cases with Crohn's disease operated at our department were analyzed in view of cumulative risk of reoperation and recurrence. Cumulative risk of reoperation was 22% at five years and 40% at ten years. Cumulative risk of recurrence after "curative" resection in thirty four cases was 53% at five years and 73% at ten years. Both risks were the highest in ileal type and the lowest in colonic type. Cumulative risk of relapse in ileocolic type after non-"curative" resection was 67% at five and ten years, which showed no significant difference with cumulative risk of recurrence after "curative" resection. Cumulative risk of recurrence after "curative" resection with proximal resection margin longer than 10 cm had no significant difference from the group with shorter margin. Cumulative risk of recurrence and reoperation after reoperation was a little higher than after initial operation, but they showed no statistical difference. In conclusion, there is no need to stick to "curative" resection, and it is enough to have the resection margin no longer than 10 cm. It is essential not to spoil the quality of life by excessive resection.

Peripheral T-cell lymphoma with helper T-cell phenotype (Leu 3a+ Leu 8-)

Eleven cases of Leu 3a+ Leu 8- peripheral T-cell lymphoma (PTCL), excluding adult T-cell leukemia/lymphoma, were studied by immunostaining with monoclonal antibodies and enzyme histochemistry in order to clarify the histogenesis of PTCL. Seven of the eleven cases had varying degrees of polyclonal hypergammaglobulinemia. All cases were histologically characterized by neoplastic proliferation of clear cells and some cases showed a histologic background similar to IBL or AILD lesions with proliferation of immunoblasts or plasmacytoid cells and vascular proliferation. Immunohistologic analysis of PLP-fixed frozen tissues revealed that neoplastic clear cells expressed a Leu 3a+ Leu 8- phenotype (helper T-cell subset). The distribution of Leu 3a+ Leu 8- neoplastic cells corresponded closely to that of DRC-1+ cells, which are localized in the lymphatic follicles, but hardly at all with that of beta-glucuronidase+ vessels, termed PCV or HEV, which are usually present in T-cell areas. One case only progressed from Leu 3a+ Leu 8- IBL-like T-cell lymphoma (IBL-T), with proliferation of immunoblasts or plasmacytoid cells and vascular proliferation, to diffuse lymphoma of the large cell type showing none of these lesions. From these observations it is suggested that IBL-T might progress to T-cell-type monomorphous diffuse lymphoma.

Necrotizing lymphadenitis. Electron microscopical and immunohistochemical study

Seven cases of necrotizing lymphadenitis (NEL) including a pair of male siblings, a female suffering from non-bacterial meningitis, and two cases with the proliferation of monocytes and/or macrophages in the bone marrow are reported. This disease is clinically documented by the occurrence in young adults usually accompanied by painful cervical lymphadenopathy with fever and leukopenia (below 4,000/mm3). Morphological features were characterized by nuclear debris from degenerated lymphocytes and the appearance of blastoid cells and/or immunoblasts and macrophages. Ultrastructurally, tubular inclusions with a close relation to the endoplasmic reticulum were observed in various kinds of cells in the lesion. Immunohistochemical studies revealed that the ratio of helper/suppressor T-lymphocytes became low at the active stage and returned to normal range at the recovery stage. By immuno-histochemical study it was confirmed that suppressor cells mainly corresponded to large transformed lymphocytes and/or immunoblasts and helper cells were degenerated by an unknown agent. Though the pathogenesis of NEL is still uncertain, it is suggested that T-lymphocytes are mainly involved during the course of the disease and lymphocytes show cellular debris or blastoid transformation.