Lennert ’s Lymphoma
A Clinicopathologic Study With Emphasis on Phenotype
and Its Relationship to Survival
CATHERINE M. SPIER, MD,” SCOTT M. LIPPMAN, MD,t THOMAS P. MILLER, MD,t
AND THOMAS M. GROGAN, MD’
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 IMLEH]) 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 immunoglob-
ulin expression. The B-cell MLEH were morphologically indistinguishable from T-cell MLEH. Clini-
cally, 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 predic-
tor of survival, with B-cell MLEH patients having a longer survival than those of T-cell type.
Cancer 61517-524, 1988.
N 1952, Lennert described a lymphoma characterized
morphologically by an associated increase in epithe-
lioid histiocytes which he initially thought was a variant
of Hodgkin’s disease.’ In 1968, Lennert and Mestdeagh
reported a series of 30 such patients who had a survival
“similar to classic Hodgkin’s disease”.’ This disorder
was subsequently reclassified as a non-Hodgkin’s lym-
phoma in the 1970’s by several investigators, including
Ler~nert.~-~ Clinically, Lennert’s lymphoma is charac-
teristically found in elderly men who have symptomatic.
widespread, reticuloendothelial system (RES) involve-
ment (prominent spleen, liver, and marrow involve-
From the *Department of Pathology, and the ?Section of Hematol-
ogy/Oncology, Department of Internal Medicine, and the Arizona
Cancer Center, University of Arizona, Tucson, Arizona.
Supported in part by Public Health Service Grant No. CA-17094
from the National Cancer Institute, National Institutes of Health,
The authors thank Catherine Rangel and Lynne Richter for techni-
c a l expertise, Nancy Suttle for secretarial assistance, and Dr. Jack M.
Layton for support.
Address for reprints: Catherine M. Spier, MD, Department of Pa-
thology, University of Arizona, College of Medicine, 1501 North
Campbell Avenue, Tucson, AZ 85724.
Accepted for publication August 25, 1987.
ment, with less prominent nodal involvement). The
lymphomas are generally said to be drug-resistant, and
patients have a short survival time, although clinical
heterogeneity is noted, with an occasional patient hav-
ing a distinctly favorable course:.5
Historically, immunologic evaluations of Lennert’s
lymphoma have been limited.7-14 Isolated case reports
have evaluated cytoplasmic immunoglobulins, E-ro-
settes, and a limited range of T-antigens, usually sug-
gesting a T-cell origin of the disea~e.~*~-’~
Lennert’s group” reported more thorough evaluation of
four patients with Lennert’s lymphoma, using both im-
munophenotyping and genotyping techniques. They es-
tablished a T-helper phenotype along with rearrange-
ment of the beta chain of the T-cell receptor in all four
cases,15 thus lending strong support to the T-cell origin
of Lennert’s lymphoma. This suggests a homogeneous
immunologic entity. However, no attempt was made to
correlate this tumor immunotype with clinical parame-
ters, including outcome.
The results of a detailed clinical and immunohisto-
chemical analysis of I 1 consecutive patients with the
specific entity of MLEH, or Lennert’s lymphoma as de-
scribed by Kim er al. and other^,^.^ are reported. The
CANCER February I 1988
Vol. 6 1
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