Lennert's lymphoma. A clinicopathologic study with emphasis on phenotype and its relationship to survival.
ABSTRACT 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: The electronic database of the institute of pathology, Medical University of Innsbruck, was reviewed and patient histories studied to analyse systematically the coincidence of granulomatous reactions and lymphomas in a large patient collective, and to find distinct clinicopathological correlations. Five cases of small lymphocytic lymphoma/chronic lymphocytic leukaemia (CLL) associated with granulomatous reactions in lymph nodes and bone marrow were identified, all clinically associated with signs of progressive disease. Cases were acquired by reviewing an electronic database comprising approximately 715,000 patients diagnosed between 1993 and 2003. Histochemical, immunohistochemical, and molecular techniques were used to verify diagnosis and associated infectious diseases. Clinical data were obtained from reviewing the charts. Of 2044 bone marrow and 411 lymph node non-Hodgkin lymphoma biopsy samples, CLL was most frequently associated with bone marrow (two cases) and lymph node granulomas (three cases). These granulomas were mostly composed of epithelioid cells, with or without giant cells, and in all but one case did not show necrosis. All patients with CLL had clinical symptoms primarily caused by the granulomatous disease: two suffered from acid fast bacilli infections (Mycobacterium tuberculosis and mycobacteria other than tuberculosis) and three presented with clinical manifestations of sarcoidosis (the reason a diagnostic biopsy was performed). Granulomatous reactions in patients with CLL might obscure diagnosis and imitate disease progression and Richter's transformation. Careful histological examination, exclusion of infectious agents, and a detailed clinical history are essential for correct diagnosis.Journal of Clinical Pathology 09/2005; 58(8):815-9. · 2.44 Impact Factor
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ABSTRACT: Nontuberculous mycobacteria are opportunistic pathogens which predominantly infect the immunocompromised host. The clinical and pathologic diagnosis of mycobacterial infection is generally not difficult. However, it may mimic malignancy on account of the clinical manifestations or the morphology of atypical lymphocytes with epithelioid histiocytes. The latter can be found in some types of lymphomas, especially T-cell lymphoma. This report describes two immunocompetent patients with systemic Mycobacterium kansasii infection presenting with fever, systemic lymphadenopathy, and osteolytic bone lesions. The microscopic features of these two cases were similar and were characterized by effacement of the nodal architecture by lymphocytic infiltrates and small aggregates of epithelioid histiocytes throughout. These lymphocytes showed mild atypia and expressed predominantly CD3. Bone marrow was also involved in the same process in one case and T-cell lymphoma with lymphoepithelioid features was the initial impression. However, further studies reported germline arrangements of T-cell receptor genes, presence of acid-fast bacilli, and recovery of M. kansasii in culture. At follow-up, the lymphadenopathy was seen to have disappeared during antimycobacterial treatment. This report describes two infectious cases with small aggregates of epithelioid histiocytes and atypical lymphocytes mimicking peripheral T-cell lymphoma; and such cases may become more common as the number of immunosuppressed hosts is increasing worldwide. We have reviewed the literature and summarized useful morphologic criteria for differentiation.Apmis 10/2008; 116(9):850-8. · 2.07 Impact Factor
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ABSTRACT: Both malignancy and granulomatous diseases may be diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Sarcoidal reactions may be seen in the presence of non-small cell lung cancer (NSCLC). Demonstration of granulomas by lymph node EBUS-TBNA in the staging of NSCLC is of uncertain significance. To determine the frequency of sarcoidal reactions in lymph nodes of patients with NSCLC. To report the frequency of co-involvement of sarcoidal reactions with metastatic NSCLC in regional lymph nodes. We prospectively examined 50 consecutive patients undergoing EBUS-TBNA for staging of suspected or confirmed NSCLC. We also performed a retrospective chart review of 187 patients undergoing lobectomy or mediastinoscopy for NSCLC. EBUS-TBNA revealed non-necrotising granulomas in one patient, and in 45 patients it revealed metastatic primary lung malignancy. Surgical lymph node sampling was performed in 187 patients undergoing treatment for, or staging of, NSCLC. Sarcoidal reactions were seen in regional lymph nodes of eight (4.3%) of patients, with all lymph nodes free of metastatic NSCLC (pathologic Stage I) (p=0.02). Four of these patients were pre-operatively assessed as Stage III (cN2/3). None had a prior history of sarcoidosis or other granulomatous diseases. All eight patients remain alive and recurrence-free. Sarcoidal reactions are seen in 4.3% of all patients with NSCLC. Metastatic involvement by NSCLC is not seen in lymph nodes exhibiting sarcoidal granulomatous reactions. Non-necrotising granulomas revealed by EBUS-TBNA of lymph nodes during staging of NSCLC should serve to indicate the absence of lymph node metastases.Lung cancer (Amsterdam, Netherlands) 04/2009; 66(3):305-8. · 3.14 Impact Factor