Prognostic relevance of histologic grading, the cell cycle-associated antigen Ki-S1 and cell cycle regulators in malignant fibrous histiocytomas: a multivariate analysis.

The main aim of this study was to compare the prognostic impact of different histologic grading systems, the expression of the cell cycle-associated antigen DNA-topoisomerase-II-alpha (Ki-S1) and the expression of cell cycle regulators in malignant fibrous histiocytomas (MFH) using multivariate analyses. Paraffin-embedded tissue of 161 cases of MFH were studied immunohistochemically for the expression of the proliferation marker Ki-S1, cell cycle regulators (p53, MDM2, waf-1, pRb, p16) and the oncoprotein EGFR. The percentage of immunolabelled tumor cells (index) was assessed. The histologic grade was determined by the two-level grading systems of Costa, Tsujimoto and Pezzi, by the three-level grading systems of Coindre and Van Unnik and by the grading system presented here. Univariate analyses using the LOG rank test showed that all of the applied grading systems produce highly significant differences in survival between the grades of malignancy. Multivariate analyses with COX regression demonstrated that only the grading system presented here, based on the parameters necroses, mitoses and cellularity, had independent prognostic relevance. Moreover, the inclusion of the proposed grading system, the Ki-S1-index and a prognostic index primarily based on the expression of cell cycle regulators into the COX regression was suited for predicting survival in MFH. The grading system presented shows considerable advantages over the grading systems compared in this study for use in the routine pathology of MFH. The prognostic power of the proposed grading system can be enhanced by the combined study of cell cycle regulators and Ki-S1.

lmmuno Histochemical Profile of Endometrium in Patients With Genital Endometriosis.

The aim of present study was to investigate the occurence of different lymphocyte subsets in the endometrium of endometriosis patients and in healthy women on every day of the menstrual cycle with special emphasis to the proliferative activity of endometrial cells with Ki-S3 antibody. We also conducted immunohistochemical studies of T-lymphocytes, B-lympho-cytes, macrophages, natural-killer-cells and also of antigens class II of the histocompatibility complex (HLA-DR) during the different phases of the menstrual cycle in endometriosis and non-endometriosis patients.Endometrial lymphocyte subsets show equal quantity and distribution in endometriosis patients and in the control group. After a peak in the early preoliferative phase the absolute number of T-lymphocytes decreases while a predominance of T-suppressor/cytotoxic T-lymphocytes (CD8) compared to T-helper/inducer lymphocytes (CD4) occurs towards the end of the menstrual cycle.It can be concluded that endometrium as the potential parent epithelia of endometriotic lesions seems not to be altered in its lymphatic cell content compared to healthy women. Furthermore endometrium is clearly characterised as part of the mucosa associated lymphatic tissue (MALT). T-lymphocytes show specific quantitative changes due to different phases of the menstrual cycle.

Lymphocyte subsets in the endometrium of patients with endometriosis throughout the menstrual cycle.

PROBLEM: Comparison and characterisation of different lymphocyte subsets in the endometrium of endometriosis patients and in healthy women on every day of the menstrual cycle with special emphasis on the CD4:CD8 ratio in the endometrium. METHOD: Immunohistochemical staining of 253 endometrial biopsies of infertile women with and without endometriosis with Anti-Leu4 (CD3), Anti-Leu3a (CD4), Anti-Leu2a (CD8), Anti-Leu7 and Anti-Human-B-cell (CD22) using the immune peroxidase reaction. Identification and counting of positive lymphocyte were performed on cryostat sections. RESULTS: Endometrial lymphocyte subsets show equal quantity and distribution in endometriosis patients and in the control group. After a peak in the early proliferative phase the absolute number of T lymphocytes decreases while a predominance of T-suppressor/cytotoxic T lymphocytes (CD8) compared to T-helper/inducer lymphocytes (CD4) occurs towards the end of the menstrual cycle. CONCLUSION: Endometrium as the potential parent epithelia of endometriosis lesions seems not to be altered in its lymphatic cell content compared to healthy women. Furthermore, endometrium is clearly characterised as part of the mucosa associated lymphatic tissue (MALT). T lymphocytes show specific quantitative changes due to different phases of the menstrual cycle.

A novel rat mesangial matrix protein, MMP-50/100, involved in mesangial glomerulopathies.

BACKGROUND: Within the glomerular extracellular matrix, the glomerular basement membrane and the mesangial matrix have different compositions, presumably related to their different functions. In this study, a novel mesangial matrix protein is recognized by mAb ED5 and KiM4R, which were originally selected for reactivity with follicular dendritic cells of rat lymphoid organs. EXPERIMENTAL DESIGN: Distribution of this mesangial matrix protein (MMP-50/100) was studied in normal Wistar rat kidneys by indirect immunofluorescence and immunoelectron microscopy. For partial immunobiochemical characterization, ED5-affinity-purified glomerular matrices were subjected to SDS-PAGE analysis. Expression of MMP-50/100 was additionally studied in kidneys of rats depleted for complement and in kidneys of rats depleted for resident macrophages. Functional significance of MMP-50/100 was studied in kidneys of rats with mesangial glomerulopathies. RESULTS: Immunoelectron microscopy showed that MMP-50/100 is located in the extracellular matrix of the rat renal mesangium between mesangial cells and the basement membrane and on the mesangial cell membrane. SDS-PAGE analysis of affinity-purified glomerular matrices indicated that MMP-50/100 is a polypeptide glycoprotein with chains of apparent molecular weights of 50 and 100 kDa. Both in vivo and in vitro results indicate that MMP-50/100 does not appear to be a complement factor, or an Fc or complement receptor. In rats partially depleted for resident macrophages, the expression of MMP-50/100 was similar to that in control rats. In rats with BSA-induced chronic serum sickness nephritis, in rats with anti-Thy-1 nephritis, and in rats with uninephrectomy-induced focal glomerular sclerosis, the mesangial expression of MMP-50/100 was significantly increased. In the first model, double-label immunofluorescence demonstrated identical localization of MMP-50/100 with mesangial immune complex deposits. CONCLUSIONS: We conclude that MMP-50/100 is an intrinsic component of the mesangial matrix, presumably related to the "classic" mesangial cell. Expression of MMP-50/100 is increased in expanded mesangial matrices during development of glomerular disease. Furthermore, MMP-50/100 appears to be involved in the handling of mesangial immune complexes.

Frequent presence of latent Epstein-Barr virus infection in lymphoepithelioid cell lymphoma (Lennert's lymphoma).

This study deals with the investigation of the biological significance of an Epstein-Barr virus (EBV) infection in lymphoepithelioid cell lymphoma. A selection of EBV-detection techniques was applied to 15 cases, including polymerase chain reaction (PCR) for the detection of EBV-DNA, in situ hybridization (ISH) for the cellular localization of EBV-encoded small nuclear (EBER 1 and EBER 2) and immediate-early (BHLF) RNAs, and immunohistology for the detection of EBV-encoded latent membrane protein (LMP) expression. PCR and EBER-ISH produced congruent results in those cases with amplifiable DNA, leading to an EBV presence in 11/15 lymphoepithelioid cell lymphoma cases (73%). EBER-ISH combined with immunohistology localized the virus predominantly in several B immunoblasts and small B lymphocytes in eight of the EBV-positive cases, five of which also contained single infected lymphocytes expressing T-cell characteristic antigens. LMP was detected using immunohistology in only a proportion of immunoblasts in four of these cases. The remaining three EBV-positive lymphoepithelioid cell lymphoma cases contained only single EBER-positive small B lymphocytes without LMP expression. No case contained BHLF-RNA expressing cells. These data imply that, although latently EBV-infected cells are frequently present in lymphoepithelioid cell lymphoma cases, the virus is probably not directly involved in the pathogenesis of this entity.

Rapidly growing Epstein-Barr virus-associated pulmonary lymphoma after heart transplantation.

There is strong evidence to show an association of Epstein-Barr virus (EBV) infection with the development of post-transplant lymphoproliferative disease. We report the rapid development of a malignant lymphoma in a heart transplant recipient, which occurred within less than eight weeks. The diagnosis of this malignant high grade B-cell lymphoma was established by open lung biopsy, and classified as centroblastic lymphoma of polymorphic subtype. Immunohistochemically, the lymphoma showed reactivity with the B-cell markers L-26 (CD20) and Ki-B5 and with the activation marker Ber-H2 (CD30). Furthermore, an expression of the bcl-2 oncoprotein was detected. Monoclonal JH gene rearrangement was demonstrated by polymerase chain reaction (PCR), indicating monoclonal proliferation of B-blasts. Although serum EBV immunoglobulin M (IgM) antibodies were negative, the association to an EBV infection could be demonstrated by EBV immunostaining pattern which revealed an expression of the latent membrane protein (LMP) of EBV in the atypical blasts. The results give clear evidence of an EBV association of this rapidly growing lymphoma developed after heart transplantation.

Altered expression of the retinoblastoma gene product in human high grade non-Hodgkin's lymphomas.

The retinoblastoma gene (RB) is a growth suppressor gene on the human chromosome 13q14. It encodes a 105 kDa phosphoprotein (p105), with DNA-binding capacity. P105 is thought to be involved in cell cycle control. Inactivation of RB is responsible for the development of retinoblastomas and occurs frequently in osteosarcomas and small cell lung cancer. In this study we looked at the RB-structure and expression in cell lines and primary lymphoma samples from patients with high grade non-Hodgkin's lymphoma (NHL). Forty five primary high grade NHL, the B-lymphoblastoid cell line IM-9 and the NHL cell line WSU-NHL were studied for RB structure by Southern blotting and for RB-expression by Northern blotting, Western blotting and immunocytochemistry. In all experiments freshly cryopreserved material was used. Southern and Northern experiments were performed with the 0.9 kb and 3.8 kb RB-cDNA probe. For the detection of p105 two different anti-p105-monoclonal antibodies were used in immunocytochemistry and Western blotting experiments. No RB mRNA and no p105 could be found in IM-9 cells. Twenty six high grade NHL samples (58%) showed no p105 expression. In the subgroup of centroblastic lymphomas 16 out of 21 and in Burkitt's lymphomas five out of eight showed no p105-expression. P105 expression is absent in 58% of high grade NHL, particularly in centroblastic and Burkitt's lymphomas, suggesting that inactivation of RB may play a crucial role in the pathogenesis of high grade NHL.

[Eosinophilia as the leading symptom of highly malignant enteropathy-associated T-cell lymphoma]. / Eosinophilie als führendes Symptom eines hochmalignen Enteropathie-assoziierten T-Zell-Lymphoms.

A 39 year old man had been suffering from chronic bowel symptoms of changing intensity. At the age of 37 the diagnosis of nontropical sprue was made. After institution of a gluten free diet the patient improved, but soon diarrhea started again. In the examination of peripheral blood smear, bone marrow and small intestinal mucosal biopsies a dominant eosinophilia was found. Since several attacks of abdominal colics and finally an acute abdomen occurred, a laparotomy was indicated. This operative intervention showed a perforation of the intestine and tumors in the bowel wall as well as numerous lymphomas spread over the whole mesentery. The histological examination of both the small intestine resect and the lymphomas proved the diagnosis of a highly malignant Non Hodgkin lymphoma (middle and large cell pleomorphic T-cell lymphoma with transition into a large cell anaplastic lymphoma [ki-1 lymphoma]). The patient received a chemotherapy with COEP but died 4 weeks after the surgery.

Immunohistologic studies of Kikuchi's disease.

An immunohistologic study of lymph nodes from 21 patients with Kikuchi's disease (histiocytic necrotizing lymphadenitis) was performed. The cell components of the affected areas were mainly CD4-positive cells, CD8-positive T cells, alpha/beta T-cell gene receptor-positive T cells, and lysozyme-staining cells. CD3-positive or alpha/beta T-cell gene receptor-positive T cells were composed mainly of CD8-positive and CD11b-negative cytotoxic T cells. Double staining demonstrated that CD4-positive cells usually were positive for Ki-M1p, a marker of plasmacytoid monocytes, but negative for T-cell markers. Although some lysozyme and CD4 double-positive cells were recognized, most CD4-positive cells were negative for lysozyme. The results indicate that CD4-positive cells in the affected foci of Kikuchi's disease were mainly composed of plasmacytoid monocytes.

Frequent latent Epstein-Barr virus infection of neoplastic T cells and bystander B cells in human immunodeficiency virus-negative European peripheral pleomorphic T-cell lymphomas.

We investigated 81 cases of peripheral pleomorphic T-cell lymphoma (PMTCL) occurring in human immunodeficiency virus-negative Europeans for the presence of Epstein-Barr virus (EBV)-DNA through polymerase chain reaction (PCR) for the presence of EBV-encoded small nuclear RNAs (EBER) and immediate early mRNAs (Bam H-fragment, lower strand frame [BHLF]) by in situ hybridization (ISH) and for EBV-encoded latent membrane protein (LMP) and nuclear antigen 2 (EBNA2) by immunohistology (IH). EBER-ISH, which could be applied on all cases, showed an overall incidence of EBV-infected cells in 38 of 81 cases (47%) of PMTCL. These data could be confirmed by PCR, which produced congruent results in the cases with amplifiable DNA. By EBER-ISH, the virus was located in the tumor cells in 30 of the 38 EBV-positive cases, with the proportion of the infected cells ranging from 1% to 100%. In 18 of these cases and in the 8 cases without EBV-infected tumor cells, the virus was, respectively, either additionally or exclusively detectable in occasional nonmalignant lymphoid bystander cells. An LMP expression was observed in several of the EBER-expressing tumor cells in 18 cases, whereas EBNA2 was detectable only in one case, which also displayed signs of viral replication. Some nonmalignant EBV-infected B immunoblasts also expressed LMP in several cases. Primary cutaneous and enteropathy-associated PMTCL displayed less frequent EBV infection when compared with other extranodal or nodal manifestations.

Ki-S1, a novel proliferative marker: flow cytometric assessment of staining in human breast carcinoma cells.

There is considerable interest in immunohistochemical markers of proliferation which are suitable for use on routinely fixed clinical material. The novel proliferation-associated antibody Ki-S1 shows promise in this respect. In this study we have: (i) defined the pattern of Ki-S1 labelling relative to the cell cycle phase; (ii) investigated the labelling pattern with Ki-S1 on a human breast cell line (ZR75) under varying proliferative conditions induced by serum deprivation and refeeding; (iii) examined in a flow cytometric study Ki-S1 staining in archival, clinical breast carcinoma samples. In exponentially growing cells Ki-S1 showed a marked cell cycle phase-specific variation in staining intensity which increased linearly through the S-phase, was high in G2 and reached its peak in mitosis. Ki-S1 staining intensity mirrored the changes in proliferative activity of ZR75 cells during serum deprivation and refeeding. In a small series of human breast carcinoma, Ki-S1 staining intensity correlated with S-phase fraction (SPF) derived from DNA profiles. The antigen labelled by Ki-S1 is extremely robust, resisting degradation by fixation and by an aggressive enzymic tissue disaggregation method. Ki-S1 warrants further investigation as a proliferation-related marker, particularly for routine clinical application.

[Determination of proliferation activity of prostate cancers by means of nuclear proliferation-associated formalin resistant Ki-S5 antigens]. / Bestimmung der Proliferationsaktivität von Prostatakarzinomen anhand des nukleären Proliferations-assoziierten formalinresistenten Ki-S5 Antigens.

In order to evaluate the growth fraction in normal, hyperplastic and neoplastic prostatic tissue, we examined paraffin sections of 55 cases of prostatic cancer containing areas of benign (BPH) and atypical hyperplasia (AH). Cellular proliferation was assessed by nuclear staining with the monoclonal antibody Ki-S5 directed against a formalin-resistant epitope of the Ki67 antigen. The proliferation rate was minimal in normal glands and BPH (mean 0.35%), rather low in AH and grade I carcinoma (0.5 to 15% compared to grade II carcinoma (1 to 40%) and peaking to near 80% labeled cells in grade III carcinoma. In the majority of the tumors, foci of increased cell growth could be detected by this method. Ki-S5 labeling indices correlated significantly with the histopathologic grading established by Dhom. Correlation with the clinical outcome will be the subject of subsequent retrospective studies.

Clonal analysis of agnogenic myeloid metaplasia.

Agnogenic myeloid metaplasia (AMM) is a chronic myeloproliferative disorder that leads to a sustained proliferation of megakaryocytes and an increase of reticulin fibers within the bone marrow. Blood and bone marrow samples from patients with advanced AMM with fully developed myelofibrosis as well as cases in the cellular phase of the disease were investigated for clonality. Clonality was studied by X-linked restriction length polymorphism in conjunction with DNA methylation patterns. Granulocytes and total bone marrow cells proved to be monoclonal in origin whereas at least a minor portion of the peripheral lymphocytes were not clonally derived. Our findings indicate that the cellular phase of AMM as well as the fully developed disease progressed to myelofibrosis represent a monoclonal proliferation of pluripotent hematopoietic stem cells.

Lymph node findings in generalized mastocytosis.

Lymph nodes from 21 cases of generalized mastocytosis were studied histologically to confirm or exclude mast cell infiltration, and to investigate their micro-architecture. Mast cell infiltrates were detected in 17 (80%) of the lymph nodes and were found mainly in the medullary cords and sinuses. Diffuse infiltration was seen in 14 cases and focal infiltration in three cases. The following pathological findings were frequently observed: germinal centre hyperplasia (n = 14), which is probably a nonspecific finding; and hyperplasia of small blood vessels, which sometimes resembled high endothelial venules (14), eosinophilia (8), plasmacytosis (7) and collagen fibrosis (6), all of which may well be related to the effects of mediators released by mast cells. Infiltrates of acute or chronic myeloid leukaemia were seen in six lymph nodes. Division of the cases into two prognostically different groups, i.e. systemic mastocytosis, in which the skin lesions of urticaria pigmentosa are present and the prognosis is favourable, and malignant mastocytosis, in which there is no cutaneous involvement and the prognosis is poor, revealed that all six lymph nodes exhibiting leukaemic infiltrates came from the malignant mastocytosis group; eosinophilia, plasmacytosis and fibrosis were seen significantly more often in malignant than in systemic mastocytosis, but blood vessel hyperplasia and germinal centre hyperplasia were encountered with the same high frequency in both groups; and mast cell atypia tended to be more pronounced in malignant mastocytosis; this diagnosis could therefore easily be missed without naphthol AS-D chloroacetate esterase staining.(ABSTRACT TRUNCATED AT 250 WORDS)

Heterogeneous Epstein-Barr virus infection patterns in peripheral T-cell lymphoma of angioimmunoblastic lymphadenopathy type.

In this study, 32 cases of T-cell lymphoma of angioimmunoblastic lymphadenopathy type (AILD-TCL) were investigated for their association with Epstein-Barr virus (EBV). For this purpose, three different approaches were applied: polymerase chain reaction (PCR) for the presence of EBV-DNA, in situ hybridization (ISH) for EBV-encoded small nuclear RNAs (EBER), and immunohistology for EBV-encoded latent membrane protein (LMP). PCR and EBER-ISH produced almost identical results, showing that all but one case of AILD-TCL contained EBV genomes. Three distinctive patterns of EBV infection were observed after immunophenotypical characterization of EBER-positive cells: (1) in 26% of the cases, B and T cells were infected, the majority of which were B cells of immunoblastic morphology located in the remnants of lymphoid follicles; (2) in 42% of the cases, the vast majority of infected cells were neoplastic T cells diffusely distributed in the lymph nodes, but infected B cells were also present; and (3) in 32% of the cases, there were only a few infected small lymphoid cells. Detectable LMP was frequent in cases exhibiting patterns 1 and 2. These findings suggest that in AILD-TCL patients, B cells and especially T cells are highly susceptible to a persistent EBV infection, which often leads to a growth advantage of the infected cells. Thus EBV, in conjunction with genetic abnormalities and selective defects of the immune system, might be involved in the pathogenesis of AILD-TCL.

Immunohistochemical monitoring of plasmacytoid cells in lymph node sections of Kikuchi-Fujimoto disease by a new pan-macrophage antibody Ki-M1P.

The new monoclonal antibody Ki-M1P, which detects a formalin-resistant epitope on conventional paraffin sections, was applied in 20 cases of different stages of Kikuchi-Fujimoto disease. This new pan-macrophage immunoreagent detects plasmacytoid T cells, referred to as plasmacytoid cells, and renders a reliable delineation of these cells against other similar cell types, such as blasts of high-grade B- and T-cell lymphoma. Histiocytes as well as macrophages were strongly positive, and plasmacytoid cells showed a somewhat weaker and primarily granular, intracytoplasmic immunoreactivity. Plasmacytoid cells, being a diagnostic feature of the Kikuchi-Fujimoto disease, facilitate a clear distinction of this disease entity from large cell or high-grade lymphomas. These results may represent an additional argument favoring the histiocytic origin of plasmacytoid cells. Additionally, they may point to an immunohistochemical tool that facilitates the differential diagnosis between Kikuchi-Fujimoto disease, especially in early stages of the disease, and malignant lymphoma.

Lineage-specific methylation of the c-fms gene in blood cells and macrophages.

DNA methylation belongs to the multilevel genetic control system regulating differentiation processes and gene expression. The extent to which DNA methylation contributes to the differentiation of hematopoietic cells is elusive. In the present study we investigated the methylation state of the c-fms/M-CSF receptor gene in normal human blood cells and tissue macrophages. The methylation pattern of the c-fms gene as detected by isoschizomeric restriction analysis with MspI/HpaII showed only slight interindividual variations in normal donors, whereas constant differences were found between granulocytes and monocytes from the same donor. The second intron of the c-fms gene contains several CpG loci which were found to be hypomethylated on both alleles in monocytes and tissue macrophages. By contrast, these positions were methylated in granulocytes and lymphocytes that did not express the c-fms gene. In comparison to monocytes alveolar and peritoneal macrophages revealed an enhanced demethylation. There were constant differences in c-fms gene methylation between alveolar and peritoneal macrophages with a higher degree of demethylation in alveolar macrophages. We conclude that c-fms gene demethylation is involved in the differentiation of monocytes and macrophages from immature precursors and that the demethylation of lineage-specific growth factor receptor genes might provide an important step in lineage commitment of hematopoietic cells.

Isolation of monocytic serine esterase and evaluation of its proteolytic activity.

Monocytes are characterized by high activity of alpha-naphthyl acetate esterase (ANAE), distinguishing them from all other blood cells. The physiological function of this monocyte marker enzyme has not yet been elucidated. In this study ANAE's potential proteolytic activity was analyzed because serine esterases/proteases can function as effector molecules in cell-mediated cytotoxicity and because monocytes-macrophages are known to exert cytotoxic effects on tumor cells. This enzyme was purified from the monocytic cell line U-937 by preparative isoelectric focusing and a three-step high-performance liquid chromatography that conserved its catalytic activity. It has a molecular mass of 60 kd, and partial amino acid sequence revealed that the enzyme is not identical to known serine esterases/proteases. The purified enzyme failed to digest a couple of peptides, indicating lack of protease activity. In addition, the esterolytic activity of ANAE was not inhibited by protease inhibitors. The isolation and purification of ANAE enable further studies concerning its function in monocytes-macrophages and its relation to monocytic cytotoxicity.

Demonstration of clonal disease in early mycosis fungoides.

Cutaneous T-cell lymphomas (CTCLs) are known to show monoclonal T-cell infiltrates late in the course of the disease. However, detection of monoclonal T-cell proliferation in early stages is difficult. To investigate the possibility that clones might appear only as minor subpopulations, we analyzed the proliferative activity of T cells expression certain variable (V) regions of the T-cell receptor (TCR). In biopsy specimens from 27 patients with CTCLs, all T cells expressing the V regions V alpha 2, V beta 5a, V beta 5b, V beta 6, V beta 8 and V beta 12 accounted for less than 5% of the total infiltrate. In the vast majority of the cases, less than 3% of the cells expression one TCR V region proliferated. In one case of mycosis fungoides, however, an epidermotropic clone expressing V beta 8 was detected. This clone was present in two distinct lesions from different anatomic sites and was found in an early relapse 1 year after complete remission following PUVA therapy. The case described here documents the possibility of clonal disease early in the course of mycosis fungoides.