18F-FDG PET/CT Unveils Coexistent Myelomatous Hepatosplenic and Thyroid Cartilage Involvement: A Rare Presentation in Multiple Myeloma.

ABSTRACT: Extramedullary myelomatous disease is an aggressive condition where clonal plasma cells proliferate outside the bone marrow, allowing independent survival. This state is generally associated with negative outcomes. A 65-year-old woman presented with progressive bilateral hypochondrial pain, was initially misattributed to an inflammatory etiology, and was consequently managed with corticosteroid therapy. A bone marrow biopsy was offered after further deterioration confirming plasma cell myeloma. Afterward, 18F-FDG PET/CT revealed medullary and extramedullary hepatosplenic and thyroid cartilage involvement, concluding an overall picture of an atypical and extensive extramedullary myelomatous disease.

Classical Hodgkin Lymphoma on the Background of Castleman Disease: A Case Report.

Castleman disease (CD) is a rare lymphoproliferative disorder that is associated with an increased risk for lymphoma. The association between CD and classical Hodgkin lymphoma (HL) is rare. The patient described here is a 44-year-old, HIV-seronegative male who presented with significant weight loss, fever, night sweats, and right axillary swelling. Imaging showed bulky infraclavicular, subpectoral, and axillary lymph nodes. A biopsy revealed classical HL on the background of a human herpesvirus-8 (HHV-8)-negative plasma cell variant of CD. The patient had a complete remission after six cycles of doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) that were followed by consolidative radiotherapy and continued to be disease-free for more than two years.

Breast cancer with scalp metastases: a case report.

BACKGROUND: While breast cancer is the most common cancer in women, cutaneous metastases are rare in breast cancer. Additionally, scalp involvement in breast cancer metastasis is extremely rare. That being said, scalp lesions should always be thoroughly investigated to distinguish metastatic lesions from other neoplasms. CASE PRESENTATION: A 47-year-old female Middle-Eastern patient presented with metastatic breast cancer in the lungs, bone, liver, and brain with no signs of multiple organ failure, in addition to cutaneous metastases, including the scalp. Between 2017 and 2022, she was managed through modified radical mastectomy, radiotherapy, and several lines of chemotherapy. She presented in September of 2022 with enlarging scalp nodules, which started developing 2 months prior to her presentation. Physical examination revealed firm, non-tender, and immobile skin lesions. Magnetic resonance imaging scan of the head showed soft tissue nodules in different sequences. A punch biopsy was taken from the largest scalp lesion and showed metastatic invasive ductal carcinoma. A panel of immunohistochemistry stains was applied, because a single specific marker for differentiating primary cutaneous adnexal tumors or other malignant neoplasms from breast cancer has not yet been identified. The panel showed positive estrogen receptor 95%, progesterone receptor 5%, negative human epidermal growth factor receptor 2, positive GATA binding protein 3, positive cytokeratin-7, negative P63, and negative KIT (CD117). CONCLUSION: Breast cancer metastases to the scalp are extremely uncommon. When a scalp metastasis is present, it might be the only symptomatic sign of disease progression or widespread metastatic lesions. However, such lesions warrant a comprehensive radiologic and pathologic workup to rule out other possibilities of skin pathologies, such as sebaceous skin adenocarcinoma as it effects the management plan.

Interim FDG-PET/CT for therapy monitoring and prognostication in Hodgkin's Lymphoma.

The aim of the study was to assess the predictive value of interim FDG-PET/CT (iPET) in patients with Hodgkin's lymphoma (HL) treated with Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. A total of 245 consecutive patients with de novo HL between 12/2013 and 12/2017 were evaluated retrospectively. All patients were treated with upfront ABVD, performed PET/CT scans at baseline, after 2 cycles (interim PET, iPET2) or 4 cycles (iPET4) and at the end of therapy, and followed up for at least 6 months after therapy. The response status on iPET was defined according to the standard five-point Deauville scores (DS) as follows: complete metabolic response (CMR, DS 1-3) and non-complete metabolic response (nCMR) (DS 4 and 5). End-of-treatment (EoT) response was assessed by FDG-PET/CT and if needed biopsy confirmation of PET-positive findings. The association between iPET and EoT response was investigated using logistic regression analysis. Survival analysis was performed using the Cox regression hazard model and Kaplan-Meier methods. Sixty-nine patients underwent iPET-2 and 176 iPET-4. No association was found between the timing of iPET and iPET response status (P-value = 0.71). Two hundred and one patients (82%) had iPET-CMR and 44 (18%) iPET -nCMR. iPET was strongly associated with EoT response status: 194/201 (96 .5%) of iPET-CMR had a complete response at the EoT while only 21/44 (47.7%) of patients with iPET-nCMR presented a complete response at EoT (P-value < 0.0001). The median follow-up was 32 months (range 6-81). Patients with iPET-CMR presented a better outcome with 91% 3 y event-free-survival (EFS) and 95% 3 y overall survival (OS) than those with iPET-nCMR (41 and 86%, respectively, P-value < 0.0001). In multivariable analyses, iPET retained an independent prognostic factor of EFS and OS (P-value < 0.0001 and P-value = 0.002, respectively). iPET is highly predictive of outcome of HL patients treated with ABVD and allows to tailor therapy to the individual patient.

Case Report: Pediatric myeloid/lymphoid neoplasm with eosinophilia and PDGFRA rearrangement: The first case presenting as B-lymphoblastic lymphoma.

According to the latest WHO classification of hematopoietic malignancies, myeloid and lymphoid neoplasms with eosinophilia and gene rearrangements include three specific rare diseases and one provisional entity. Myeloid/lymphoid neoplasms with platelet-derived growth factor receptor alpha (PDGFRA) rearrangements are the most frequent of these disorders and are usually present in adult males with a median age of the late 40s. Patients usually have chronic eosinophilic leukemia but can occasionally manifest as acute myeloid leukemia or extramedullary T- or B-lineage lymphoblastic lymphoma. We report a case of a previously healthy 2-year-old girl who presented with a right supraorbital swelling with no associated lymphadenopathy. Peripheral blood smear evaluation at initial presentation revealed microcytic hypochromic red blood cells and leukocytosis with marked eosinophilia, occasional myelocytes, and occasional blasts. Whole-body CT scans and PET scans revealed hypermetabolic potentially lymphomatous mass in the superior medial aspect of the right orbit in addition to splenomegaly but no evidence of hypermetabolic mediastinal, hilar, abdominal, or pelvic lymph nodes. Bone marrow aspirate and biopsy revealed hypercellular bone marrow with quantitatively decreased erythroid precursors and increased granulocytic precursors with 60% of the cells being eosinophilic cells in different stages of maturation. The diagnosis of myeloid neoplasm with eosinophilia and rearrangement of PDGFRA was made following confirmation by fluorescence in situ hybridization (FISH) test for FIP1L1-PDGFRA gene fusion. An incisional biopsy of the supraorbital mass revealed B-cell lymphoblastic lymphoma (B-LBL). FISH test for FIP1L1-PDGFRA gene fusion was positive in 70% of the cells studied. Thus, the final diagnosis was B-cell lymphoblastic lymphoma arising in the setting of myeloid/lymphoid neoplasm with eosinophilia and PDGFRA rearrangement. The patient was started on imatinib with concomitant therapy for B-LBL per the Children Oncology Group (COG) standard therapy for localized B-LBL and demonstrated a favorable outcome in the 2.5-year follow-up period. To our knowledge, this is the first pediatric case of myeloid/lymphoid neoplasm with PDGFRA rearrangement presenting with synchronous myeloproliferative disease and B-LBL. We present our diagnostic and management approach of this patient and review prior relevant pediatric cases of myeloid/lymphoid neoplasms with PDGFRA rearrangement.

Metastatic non-functional paraganglioma to the lung.

INTRODUCTION: Paragangliomas are rare endocrine tumors that arise from the extra-adrenal autonomic paraganglia and sympathetic paragangliomas usually secret catecholamines and are located in the sympathetic paravertebral ganglia of thorax, abdomen, and pelvis. In contrast, most parasympathetic paragangliomas are nonfunctional and located along the glossopharyngeal and vagal nerves in the neck and at the base of the skull. Such neoplasms, although rare, are clinically important because they may recur after surgical resection and 10% of them give rise to metastases causing death with the lymphatic nodes, bones, liver, and lungs being the most common locations. CASE PRESENTATION: We present a case of a 26-year-old male patient that was diagnosed with paraganglioma of the right-frontal lobe infiltrating the falx and frontal bone which was diagnosed after suffering from a headache and abnormal vision. On initial work-up he was found to have right pulmonary nodules that increased in size after follow up and other nodules appeared in the contralateral lung. He underwent subtotal resection of the brain tumor and complete resection of the bilateral pulmonary nodules. CONCLUSION: To our knowledge, paraganglioma is considered to be a rare entity in the central nervous system with very few cases being reported in the supratentorial region and no cases were reported of metastatic such paraganglioma to the lung.

A follow-up study on thyroid aspirates reported as atypia of undetermined significance/follicular lesion of undetermined significance and follicular neoplasm/suspicious for follicular neoplasm: A multicenter study from the Arabian Gulf region.

OBJECTIVE: This is a multicenter study which was conducted to evaluate the follow-up on thyroid aspirate cases with atypia of undetermined significance/follicular cells of undetermined significance (AUS/FLUS) and follicular neoplasm or suspicious for follicular neoplasm (FN/SFN) using the Bethesda system for reporting thyroid cytology (TBSRTC). MATERIALS AND METHODS: The archival materials of all thyroid fine-needle aspirates over a 5-year period were retrieved from 3 institutions in the Arabian Gulf Region. All cytology slides and follow-up material for cases interpreted as AUS/FLUS and FN/SFN were reviewed. The revised diagnoses and follow-up were recorded. Analysis of risk of malignancy was calculated for the 2 entities. RESULTS: A total number of 2592 thyroid fine-needle aspirates were performed, out of which AUS/FLUS was found in 115 (4.4%) while FN/SFN in 39 (1.5%). Follow-up by surgery or repeat FNA was conducted on 42 (27%) and 10 (7%) patients on these 2 categories, respectively. The risk of malignancy was found to be 29% and 45%, respectively. CONCLUSION: The risk of malignancy for AUS/FLUS and FN/SFN are 29% and 45%, respectively. This risk of malignancy in our study is on the higher range of that reported in the literature.

CD10 and CD138 can be expressed in giant cell tumor of bone: An immunohistochemical study.

Giant cell tumor of bone (GCTB) is a primary bone neoplasm which is characterized by the presence of mononuclear cells (MCs) and osteoclast-like multinucleated giant cells (MNGCs). Up to our knowledge, CD10 immunoreactivity in GCTB has not yet been studied, and only one study touched on CD138 immunoreactivity in GCTB. The objective of this study is to investigate the immunoreactivity of CD10 and CD138 in GCTB. We offer a discussion of our findings in the context of the differential diagnosis, particularly in small biopsy material. We retrieved and reviewed 15 well-documented cases of GCTB from January 2008 to December 2014. Well-controlled standard immunohistochemical satins were performed on these cases for CD10 and CD138 and few other selected antibodies. Immunoreactivity for CD10 was membranous and was found in 14 (93%) cases. This immunoreactivity was found only in the MCs, whereas the MNGC were all negative. CD138 showed variable positivity in 11 (73%) while 4 (37%) were completely negative. Similar to CD10, staining for CD138 was only seen in the MC; however, the immunoreactivity was predominantly concentrated in the peri-vascular areas. Most of GCTB cases can show variable immunoreactivity for CD10 and CD138. The aforementioned immune-expression raise the possibility of a role in the pathogenesis of GCTB. Paying attention to this immunoreactivity is recommended when considering the clinical and radiological differential diagnosis, especially in small biopsy specimens.

Identification of breast cancer patients with a high risk of developing brain metastases: a single-institutional retrospective analysis.

BACKGROUND: The objective of this study was to identify breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention. METHODS: Medical records of 352 breast cancer patients with local or locoregional disease at diagnosis were retrospectively analysed. The brain metastasis-free survival was estimated using the Kaplan-Meier method and patient groups were compared using the log rank test. The simultaneous relationship of multiple prognostic factors was assessed using Cox's proportional hazard regression analysis. The Fisher exact test was used to test the difference of proportions for statistical significance. RESULTS: On univariate analysis, statistically highly significant unfavourable risk factors for the brain metastasis-free survival were negative ER status, negative PR status, and triple negative tumor subtype. Young age at diagnosis (≤35 years) and advanced disease stage were not statistically significant (p = 0.10). On multivariate analysis, the only independent significant factor was the ER status (negative ER status; hazard radio (95% confidence interval), 5.1 (1.8-14.6); p = 0.003). In the subgroup of 168 patients with a minimum follow-up of 24 months, 49 patients developed extracranial metastases as first metastatic event. Of those, 7 of 15 (46.6%) with a negative ER status developed brain metastases compared to 5 of 34 (14.7%) with a positive ER status (Fisher exact test, p = 0.03). The median time interval (minimum-maximum) between the diagnosis of extracranial and brain metastases was 7.5 months (1-30 months). CONCLUSIONS: Breast cancer patients with extracranial metastasis and negative ER status exhibited an almost 50% risk of developing brain metastasis during their course of disease. Future studies are highly desired to evaluate the efficacy of pre-emptive medical intervention such as prophylactic treatment or diagnostic screening for high risk breast cancer patients.

Cytokeratin and epithelial membrane antigen expression in angiosarcomas: an immunohistochemical study of 33 cases.

CONTEXT: Expression of epithelial cell markers can occur in mesenchymal tumors and has been reported in angiosarcomas with variable frequency. In these situations, establishing the diagnosis becomes problematic. OBJECTIVE: To determine the expression of cytokeratin and epithelial membrane antigen in angiosarcoma. DESIGN: To address this issue, 33 well-documented cases of angiosarcomas were retrieved from the archival material of Shands Hospital at the University of Florida, Gainesville, and Jackson Memorial Hospital at the University of Miami, Miami, Florida. These cases were all reviewed and studied using a cytokeratin cocktail (CAM 5.2 and AE1/AE3) and epithelial membrane antigen using standard immunohistochemical techniques. All 33 cases had available material for cytokeratin analysis; however, only 20 cases had enough material for epithelial membrane antigen staining. RESULTS: In the 33 cases studied, the age range of the patients was 2 to 88 years (mean, 63 years). There were 23 (70%) men and 10 (30%) women. One (3%) of 33 was cytokeratin-immunoreactive and 2 (10%) of 20 were epithelial membrane antigen-immunoreactive. CONCLUSION: Cytokeratin and epithelial membrane antigen immunoreactivity in angiosarcomas is infrequent but may be encountered. Interpretation of such expression should be done with caution and in conjunction with the characteristic clinical and morphologic features of the tumor as well as the expression of endothelial cell antigens.

Immunohistochemical evaluation of human epidermal growth factor receptor 2 and estrogen and progesterone receptors in breast carcinoma in Jordan.

INTRODUCTION: Although breast carcinoma (BC) is the most common malignancy affecting Jordanian females and the affected population in Jordan is younger than that in the West, no information is available on its biological characteristics. Our aims in this study are to evaluate the expression of estrogen receptor (ER) and progesterone receptor (PR) and Her-2/neu overexpression in BC in Jordan, and to compare the expression of these with other prognostic parameters for BC such as histological type, histological grade, tumor size, patients' age, and number of lymph node metastases. METHOD: This is a retrospective study conducted in the Department of Pathology at Jordan University of Science and Technology. A confirmed 91 cases of BC diagnosed in the period 1995 to 1998 were reviewed and graded. We used immunohistochemistry to evaluate the expression of ER, PR, and Her-2. Immunohistochemical findings were correlated with age, tumor size, grade and axillary lymph node status. RESULTS: Her-2 was overexpressed in 24% of the cases. The mean age of Her-2 positive cases was 42 years as opposed to 53 years among Her-2 negative cases (p = 0.0001). Her-2 expression was inversely related to ER and PR expression. Her-2 positive tumors tended to be larger than Her-2 negative tumors with 35% overexpression among T3 tumors as opposed to 22% among T2 tumors (p = 0.13). Her-2 positive cases tended to have higher rates of axillary metastases, but this did not reach statistical significance. ER and PR positive cases were seen in older patients with smaller tumor sizes. CONCLUSION: Her-2 overexpression was seen in 24% of BC affecting Jordanian females. Her-2 overexpression was associated with young age at presentation, larger tumor size, and was inversely related to ER and PR expression. One-fifth of the carcinomas were Her-2 positive and ER negative. This group appears to represent an aggressive form of BC presenting at a young age with large primary tumors and a high rate of four or more axillary lymph node metastases.

Combined evaluation of expressions of cyclin E and p53 proteins as prognostic factors for patients with gastric cancer.

BACKGROUND: There is a lack of consistency regarding the prognostic value of cyclin E overexpression in gastric cancer (gastric cancer). Our aim was to report on this overexpression and to analyze its correlations with the clinicopathologic variables. Another aim was to examine if aberrant expression of both cyclin E and p53 might increase the malignant potential of gastric cancer. METHODS: Specimens from 89 patients with gastric cancer treated with "curative" intent were evaluated for cyclin E and p53 expressions using immunohistochemical method. The correlations between cyclin E overexpression alone or in combination with p53 expression and the patient's clinicopathologic variables were analyzed. RESULTS: Cyclin E overexpression and p53 expression were shown in 35 (39.3%) and 46 (51.7%) tumors, respectively. The incidence of cyclin E overexpression was significantly higher in deeply invasive cancers (P < 0.0001), in cancers with lymph node metastasis (P = 0.003), and in cancers with advanced stages (P < 0.0001). There were no significant correlations with other clinicopathologic variables. Patients in whom their tumors showed cyclin E overexpression alone or in combination with p53 survived less than patients with negative cyclin E tumors. Multivariate analysis revealed that combined cyclin E overexpression and p53 expression was significantly associated with poor survival after adjusting for other variables (hazard ratio, 3.12; P = 0.009). CONCLUSIONS: Cyclin E overexpression is a common event in gastric cancer. Gastric cancer with cyclin E overexpression exhibit increased aggressiveness in the presence of aberrant p53. The combination of cyclin E overexpression with the p53 expression in gastric cancer further distinguished a subgroup of patients with poor prognosis.

Bcl-2 gene rearrangement in Jordanian follicular and diffuse large B-cell lymphomas.

OBJECTIVE: Follicular lymphoma (FL), a common subtype of non-Hodgkin's lymphoma (NHL) in the West, represents a rare subtype in Jordan. Bcl-2 gene rearrangement plays a crucial role in the biology of the vast majority of FL and a substantial number of diffuse large B-cell lymphoma (DLBCL) in the West; but its presence has not been studied in Jordan. Our aims are to document if bcl-2 gene rearrangement exists in Jordanian FL and DLBCL, and if present to determine whether its frequency among these lymphomas is different from the West and therefore may be responsible for some of the epidemiological differences seen between Jordan and the West. METHODS: The study was conducted in the year 2001 using polymerase chain reaction (PCR), to detect bcl-2 gene rearrangement in paraffin sections in 5 FL and 23 DLBCL cases diagnosed at the Department of Pathology at Jordan University of Science and Technology, Irbid, Jordan. Two sets of primers including the major breakpoint region (MBR) and the minor cluster region (MCR) were used. RESULTS: Amplifiable DNA was extracted from all cases. Bcl-2 gene rearrangement was seen among 4 (80%) of 5 FL cases, and 8 (35%) of 23 DLBCL cases. The majority of the rearrangements involved the MBR; however, one fourth of cases (one of 4 FL; 2 of 8 DLBCL) with bcl-2 rearrangement involved the MCR. CONCLUSION: Bcl-2 gene rearrangement was seen in the vast majority of Jordanian FL cases and approximately one third of all DLBCL cases. These figures are similar to those reported in the West, and therefore bcl-2 gene rearrangement does not help in explaining the epidemiological differences of NHL between Jordan and the West. The presence of bcl-2 gene rearrangement in DLBCL may define a subset of lymphomas that may be biologically and clinically unique and different from the rest of DLBCL.

Epstein-Barr virus expression in Hodgkin's disease in Jordan.

OBJECTIVE: Epstein-Barr virus (EBV) has been associated with many hematopoietic malignancies including Hodgkin's disease (HD). The association of HD correlates with the histologic subtype, age of presentation and geographic location. Our aims were to find out if EBV is associated with Jordanian HD; and if EBV association exists, to determine its relationship to certain age groups or specific histologic subtypes of HD; and finally to establish whether such association follows patterns seen in developing or developed countries. METHODS: We have examined 64 cases of HD diagnosed in 2 major medical centers in Jordan for evidence of EBV association. We used immunohistochemistry and in-situ hybridization techniques to detect latent membrane protein (LMP-1) and Epstein-Barr virus encoded RNA (EBER) in the Reed-Sternberg cells. The study was conducted at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan in the years 2000 and 2001. RESULTS: Epstein Barr virus was seen in 47% of our cases: 22 (65%) of the 34 mixed cellularity and 8 (29%) of 28 nodular sclerosis HD. None of our 2 lymphocyte predominant HD cases showed evidence of EBV. Epstein-Barr virus was seen in 73% of HD cases in children below 15 years of age as opposed to 34% of the young adult group. CONCLUSION: Our results confirm the presence of EBV in Jordanian HD in approximately half of the cases, a figure close to those reported in the West. Epstein-Barr virus association with HD in Jordan is seen mostly in the mixed cellularity subtype and childhood HD.

Non-Hodgkin lymphoma in Jordan. Types and patterns of 111 cases classified according to the WHO classification of hematological malignancies.

OBJECTIVE: Non-Hodgkin lymphoma (NHL) is one of the most frequent malignancies in Jordan. The aims of this study are: 1. To classify NHL cases in Jordan, using the new World Health Organization (WHO) classification system, 2. To identify the most common types of NHL in Jordan, and 3. To compare lymphoma types and patterns in Jordan with those in surrounding countries and the West. METHODS: We studied all NHL cases, diagnosed during 1996 through to 1999 inclusive, at 2 major medical centers in Jordan, in order to identify their main types and patterns. One hundred and eleven cases of confirmed NHLs were reexamined and immunophenotyped in the year 2000, at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan, using an immunohistochemical panel of antibodies, including CD3, CD15, CD20, CD30, CD43, CD45 and CD45RO. Confirmed NHL cases were reclassified according to the recently proposed WHO system of Hematological Malignancies. RESULTS: The median age of NHL cases was 44-years (range 2-85). The vast majority of cases were of B-cell phenotype; only 14% of the cases were T-cell lymphomas. Most of the cases were of the aggressive intermediate to high-grade large cell type. Diffuse large B-cell lymphoma (DLBCL) comprised 53% of NHLs and 62% of B-cell NHLs. Indolent lymphomas were uncommon, comprising 14% of all NHL cases. Twenty-nine cases were seen among patients less than 20-years. Burkitt lymphoma represented the largest group (55%) of the childhood NHLs followed by diffuse large cell and lymphoblastic types. CONCLUSION: Indolent lymphomas are rare in Jordan and account for less than 15% of all NHLs. Aggressive lymphomas; on the other hand, account for the majority of NHLs in Jordan. Burkitt lymphoma affected children less than 10-years of age with a median of 4.5-years. These observations indicate that NHLs in Jordan have different type distribution and patterns from those seen in the West.

Association between Epstein-Barr virus and classic Hodgkin lymphoma in Jordan: a comparative study with Epstein-Barr virus-associated Hodgkin lymphoma in North America.

An association between Epstein-Barr virus and Hodgkin lymphoma has been shown in several parts of the world. The reported incidence of Epstein-Barr virus in Hodgkin lymphoma varies significantly from one country to another and ranges from <30% in Swedish patients to 100% in patients from Kenya. Using in situ hybridization for detection of Epstein-Barr virus-encoded RNA and immunohistochemistry for detection of Epstein-Barr virus latent membrane protein, we analyzed 28 cases of Hodgkin lymphoma from Jordan and 30 cases from the United States. Eight of 28 Jordanian cases and 9 of 30 North American cases were Epstein-Barr virus positive. Our studies show that the incidence of Epstein-Barr virus among Jordanian patients with Hodgkin lymphoma is similar to the rate in patients from the United States. This rate appears to be low to intermediate compared with rates in other parts of the world.

Hodgkins lymphoma in North Jordan. Does it have a different pattern?

OBJECTIVE: To study the pattern of Hodgkin's lymphoma (HL) in North Jordan, identify the epidemiological features of this disease, and to see if these patterns are unique or follow the patterns seen in developed or developing countries. METHODS: All of the cases of HL diagnosed at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan between January 1996 and September 2002 were retrieved and reviewed histologically. Seventy-five confirmed HL cases were classified according to the WHO classification of hematological malignancies. Data on the age and gender of the patients were correlated with those of the histopathologic types of the disease. RESULTS: Patients range in age from 3-72 years with a median of 20 years. The young adult population (15-34 years) was the largest group in this study accounting for 45.9% of all cases followed by the childhood group (0-14 years), which accounted for 25.6% of the cases. The age distribution displayed only one peak between 11 and 20 years. Classic HL accounted for 91% of the cases, half of these cases belong to the mixed cellularity (MC) type and 46% belong to the nodular sclerosis (NS) type. The overall male to female ratio was 1.7:1; but the ratio was the highest (3.75:1) among children, and reversed among patients with NS type in the young adult group (0.78:1). CONCLUSION: The MC and NS types of HL accounted for the vast majority of HL in North Jordan. Similar to other developing countries the MC type of HL was the most common type followed by the NS type. The age distribution displayed a unimodal pattern with a peak between 11 and 20 years of age, which is a decade earlier than the first peak seen in the West. This pattern is also different from developing countries, where HL peaks in children less than 10 years of age. Hodgkin's lymphoma in Jordan appears to have an intermediate pattern between developing countries and the West.

IgH PCR of zinc formalin-fixed, paraffin-embedded non-lymphomatous gastric samples produces artifactual "clonal" bands not observed in paired tissues unexposed to zinc formalin.

Helicobacter pylori (HP) causes dense gastritis that can be difficult to distinguish morphologically from MALT-type lymphoma (ML). Immunoglobulin heavy chain (IgH) gene analysis by polymerase chain reaction (PCR) is often used to resolve diagnosis. However, monoclonal bands have been reported in nonmalignant cases of gastritis. Retrospectively, 16 gastric ML with both formalin-fixed, paraffin-embedded (FF-PE) and ethanol-fixed samples (EF), and 9 cases of FF-PE HP-gastritis were analyzed by IgH PCR to document the presence of non-reproducible bands in HP-gastritis, but not ML samples. In duplicate analyses, 12 of 16 ML yielded identical monoclonal bands in FF-PE and EF samples whereas 3 of 9 FF-PE gastritis cases yielded different-sized (ie, non-reproducible) "clonal" bands. Sequencing of two PCR products from a gastritis case confirmed IgH gene sequences. To investigate whether FF-PE had a direct effect on producing these non-reproducible bands, 7 gastrectomy samples were prospectively divided into EF and FF-PE halves for IgH PCR. All 7 samples demonstrated polyclonal smears in EF portions while 4 of 7 FF-PE portions yielded either multiple distinct bands or non-reproducible bands. In conclusion, IgH PCR of FF-PE tissue can create artifactual "clonal" bands, which are the appropriate product size, contain IgH sequences, and, if not performed in duplicate, may confuse interpretation of B-cell clonality.