Lennert's lymphoma: A clinicopathologic study with emphasis on phenotype and its relationship to survival

Department of Pathology, University of Arizona, College of Medicine, Tucson 85724.
Cancer (Impact Factor: 4.89). 03/1988; 61(3):517-24. DOI: 10.1002/1097-0142(19880201)61:33.0.CO;2-1
Source: PubMed


In this report we describe the results of a clinical and immunohistochemical analysis of 11 consecutive patients with the specific clinicopathologic entity of Lennert's lymphoma (non-Hodgkin's malignant lymphoma with a multifocal epithelioid histiocytic reaction [MLEH]) evaluated at the Arizona Cancer Center. Detailed immunophenotyping of ten patients showed that seven patients (73%) had an activated "novel" T-cell phenotype, indicative of peripheral T cell lymphoma (PTL). Additionally, six of these seven PTL patients had T-helper (Leu-3) antigen expression to the exclusion of T-suppressor (Leu-2) expression. Three patients, in complete contrast, had a B-cell lymphoma with monoclonal immunoglobulin expression. The B-cell MLEH were morphologically indistinguishable from T-cell MLEH. Clinically, the initial diagnosis proved difficult; ten of the 11 patients were initially misdiagnosed, most often as another lymphoid disorder or as granulomatous disease (mean delay of 10 months in diagnosis from onset of symptoms). The median survival of all patients was 20 months (1 to 45+ months) with two apparent subgroups: those who had rapid progression of disease with a median survival of 5 months, all of T-cell phenotype; and a small group whose median survival has not yet been reached, all of B-cell phenotype. Our results suggest that the immunophenotype, B-cell versus T-cell, may be a major predictor of survival, with B-cell MLEH patients having a longer survival than those of T-cell type.

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    ABSTRACT: Lymphoepithelioid cell lymphoma (LCL) is a rare morphologic variant of peripheral T-cell lymphoma. Although their histopathologic and immunohistochemical findings are well known, the cytopathologic features have not been well documented. This report describes the fine needle aspiration cytology (FNAC) findings of a case of LCL. A 75-year-old woman presented with cervical, supraclavicular, axillary and mediastinal lymphadenopathy. FNAC of a cervical lymph node was performed. The smears contained a polymorphous infiltrate formed by abundant histiocytes disposed singly or in clusters, small and medium-sized to large atypical lymphoid cells and reactive cells, including eosinophils and plasma cells. Isolated capillary-sized vessels also were observed. Histopathologic and immunohistochemical examination confirmed the diagnosis of Lennert's lymphoma. Although histopathologic and immunohistochemical studies were required for a definitive diagnosis, the findings of FNAC in this case appeared distinctive and suggested the possibility of LCL.
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    ABSTRACT: Three cases with the typical light microscopic picture of lymphoepithelioid cell lymphoma (so-called Lennert's lymphoma) were investigated by electron microscopy. Surprisingly, Lennert's lymphoma could be excluded in two cases. These two cases exhibited, in addition to pleomorphic lymphocytes and epithelioid cells, macrophages with accumulations of bacteria, indicating that a bacterial infection was the cause of the disease. By comparing the typical case of Lennert's lymphoma with the other cases, we found several criteria for distinguishing between Lennert's lymphoma and bacterial lymphadenitis. In bacterial lymphadenitis: (1) small and medium-sized lymphocytes exhibited a wide cytological spectrum whereas the lymphocytes in Lennert's lymphoma were relatively uniform; the lymphocytes with prominent lysosome-like granules found in Lennert's lymphoma were not seen; (2) cytology and distribution of epithelioid cells were similar to those in Lennert's lymphoma; (3) epithelioid venules contained recirculating lymphocytes, which were rarely found in Lennert's lymphoma; (4) numerous interdigitating reticulum cells, fibroblasts and myofibroblasts were seen, but not in Lennert's lymphoma; (5) focal increase in reticulin fibres was the main difference in light microscopy; (6) rod-shaped bacteria were accumulated in the cytoplasm of a few macrophages. The presence of bacteria could not be demonstrated unequivocally by light microscopy. In both cases the large number of intracytoplasmic bacteria suggests that this unusual and until now unknown lymphadenitis is the result of an infection caused by facultative intracellular parasitic bacteria. The outcome of bacterial lymphadenitis that gives the false impression of Lennert's lymphoma is uncertain. Cure was achieved in one of our cases. The other patient died before therapy was commenced.
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