Procesos linfoides B cutáneos con patrón nodular / Cutaneous B cell processes with nodular pattern

Cutaneous lymphomas are low grade malignant neoplasms with favourable prognosis. Those related to the germinal centre with nodular pattern may be: follicular lymphomas (LFC) or extranodal marginal zone B-cell lymphomas (LMC). They are difficult to tell apart, and from reactive processes like cutaneous follicular hyperplasia and cutis immunocytomas. The objective of this study was to check the incidence and the value of both histology and immunohistochemistry in differential diagnosis. Fifty six patients with cutaneous lymphomas were selected within the period 1995-2004. The biopsies were studied with hematoxilin eosin and immunohistochemistry. Thirty two out of the fifty six cutaneous lymphoid infiltrates were of T origin (57.1%) and twenty four of B origin (42.8%), ten out of this last figure (17.7%) were lymphoid processes with nodular pattern Four LFC, three LMC and three HLC were diagnosed. Convergent follicles with scarce mantle and germinal centres with monomorph celullarity were observed in the LFC. Among the LMC, follicles with prominent mantle and nests of monocitoid cells in the mantle, interfollicular zone and in the germinal centers observed. In the HLC macrophages with detritus were found in the germinal centers. LFC showed: CD20 (+), CD 10 (+), bcl-2 (+) or (-), and bcl-6 (+) in the follicle and in the interfollicular area. LMC showed: CD 20 (+), bcl-2 (-), CD 10 (+/-), and bcl-6 (+) in the follicle, and bcl-2 (+), CD10 (-/+) and bcl-6 (-) in the interfollicular area. The HLC results were: bcl-2 (-), bcl-6 (+) and CD 10 (-) in the follicle and bcl-2 (+), bcl-6 (-) and CD 10 (-) in the interfollicular zone. We conclude that lymphoid B cell processes with nodular pattern are unusual. Histology and immunohistochemistry proved to be useful in the differential diagnosis of these lymphomas, and for differentiating these from lymphoid hyperplasias or non tumoral hyperplasias.

Procesos linfoides B cutáneos con patrón nodular / Cutaneous B cell processes with nodular pattern

Cutaneous lymphomas are low grade malignant neoplasms with favourable prognosis. Those related to the germinal centre with nodular pattern may be: follicular lymphomas (LFC) or extranodal marginal zone B-cell lymphomas (LMC). They are difficult to tell apart, and from reactive processes like cutaneous follicular hyperplasia and cutis immunocytomas. The objective of this study was to check the incidence and the value of both histology and immunohistochemistry in differential diagnosis. Fifty six patients with cutaneous lymphomas were selected within the period 1995-2004. The biopsies were studied with hematoxilin eosin and immunohistochemistry. Thirty two out of the fifty six cutaneous lymphoid infiltrates were of T origin (57.1%) and twenty four of B origin (42.8%), ten out of this last figure (17.7%) were lymphoid processes with nodular pattern Four LFC, three LMC and three HLC were diagnosed. Convergent follicles with scarce mantle and germinal centres with monomorph celullarity were observed in the LFC. Among the LMC, follicles with prominent mantle and nests of monocitoid cells in the mantle, interfollicular zone and in the germinal centers observed. In the HLC macrophages with detritus were found in the germinal centers. LFC showed: CD20 (+), CD 10 (+), bcl-2 (+) or (-), and bcl-6 (+) in the follicle and in the interfollicular area. LMC showed: CD 20 (+), bcl-2 (-), CD 10 (+/-), and bcl-6 (+) in the follicle, and bcl-2 (+), CD10 (-/+) and bcl-6 (-) in the interfollicular area. The HLC results were: bcl-2 (-), bcl-6 (+) and CD 10 (-) in the follicle and bcl-2 (+), bcl-6 (-) and CD 10 (-) in the interfollicular zone. We conclude that lymphoid B cell processes with nodular pattern are unusual. Histology and immunohistochemistry proved to be useful in the differential diagnosis of these lymphomas, and for differentiating these from lymphoid hyperplasias or non tumoral hyperplasias.(AU)

Procesos linfoides B cutáneos con patrón nodular / Cutaneous B cell processes with nodular pattern

Cutaneous lymphomas are low grade malignant neoplasms with favourable prognosis. Those related to the germinal centre with nodular pattern may be: follicular lymphomas (LFC) or extranodal marginal zone B-cell lymphomas (LMC). They are difficult to tell apart, and from reactive processes like cutaneous follicular hyperplasia and cutis immunocytomas. The objective of this study was to check the incidence and the value of both histology and immunohistochemistry in differential diagnosis. Fifty six patients with cutaneous lymphomas were selected within the period 1995-2004. The biopsies were studied with hematoxilin eosin and immunohistochemistry. Thirty two out of the fifty six cutaneous lymphoid infiltrates were of T origin (57.1%) and twenty four of B origin (42.8%), ten out of this last figure (17.7%) were lymphoid processes with nodular pattern Four LFC, three LMC and three HLC were diagnosed. Convergent follicles with scarce mantle and germinal centres with monomorph celullarity were observed in the LFC. Among the LMC, follicles with prominent mantle and nests of monocitoid cells in the mantle, interfollicular zone and in the germinal centers observed. In the HLC macrophages with detritus were found in the germinal centers. LFC showed: CD20 (+), CD 10 (+), bcl-2 (+) or (-), and bcl-6 (+) in the follicle and in the interfollicular area. LMC showed: CD 20 (+), bcl-2 (-), CD 10 (+/-), and bcl-6 (+) in the follicle, and bcl-2 (+), CD10 (-/+) and bcl-6 (-) in the interfollicular area. The HLC results were: bcl-2 (-), bcl-6 (+) and CD 10 (-) in the follicle and bcl-2 (+), bcl-6 (-) and CD 10 (-) in the interfollicular zone. We conclude that lymphoid B cell processes with nodular pattern are unusual. Histology and immunohistochemistry proved to be useful in the differential diagnosis of these lymphomas, and for differentiating these from lymphoid hyperplasias or non tumoral hyperplasias.(AU)

Linfoma de células en anillo de sello que simula carcinoma mucosecretante / Signet ring cell lymphoma mimicking mucin-producing carcinoma

Signet ring cell lymphoma is a rare neoplasm characterized by large, vacuolated and clear cells mimicking mucin-producing adenocarcinoma. It is localized in nodal and extranodal sites. A case of a 59 years old male, with a diffuse lymphoma signet ring cell type localized on oropharyngeal mucosa is reported. The histopathology study showed signet ring cells and the immunophenotype was: vimentine(+), CD45(+), CD20(+), Ig M(+), Kappa chain(+) and high index proliferative activity of neoplastic cells (Ki 67:70%). After a review of the literature and previous reports, we could not find a similar case in this anatomic site. The patient had a unfavourable clinical course and died two months after the diagnosis without receiving any treatment.

El linfoma de células en anillo de sello es una neoplasia poco frecuente, caracterizada por la presensenciade grandes células de citoplasma vacuolado, claro, similar a los encontrados en adenocarcinomasmucosecretantes. Se ha descripto en ganglios linfáticos y tejidos extralinfáticos. Se presenta el casode un paciente varón de 59 años con linfoma de células en anillo de sello localizado en pared lateral de orofaringe.Esta localización creemos que no ha sido descripta anteriormente. La histología mostró células en anillo de sello y el inmunofenotipo tumoral fue: vimentina, CD45, CD20, Ig M y cadenas kappa positivos, siendo la fracción de crecimiento tumoral alta (Ki 67:70%). El paciente evolucionó desfavorablemente y falleció a los dosmeses del diagnóstico sin recibir tratamiento.

Linfoma de células en anillo de sello que simula carcinoma mucosecretante / Signet ring cell lymphoma mimicking mucin-producing carcinoma

Signet ring cell lymphoma is a rare neoplasm characterized by large, vacuolated and clear cells mimicking mucin-producing adenocarcinoma. It is localized in nodal and extranodal sites. A case of a 59 years old male, with a diffuse lymphoma signet ring cell type localized on oropharyngeal mucosa is reported. The histopathology study showed signet ring cells and the immunophenotype was: vimentine(+), CD45(+), CD20(+), Ig M(+), Kappa chain(+) and high index proliferative activity of neoplastic cells (Ki 67:70%). After a review of the literature and previous reports, we could not find a similar case in this anatomic site. The patient had a unfavourable clinical course and died two months after the diagnosis without receiving any treatment.(AU)

El linfoma de células en anillo de sello es una neoplasia poco frecuente, caracterizada por la presensenciade grandes células de citoplasma vacuolado, claro, similar a los encontrados en adenocarcinomasmucosecretantes. Se ha descripto en ganglios linfáticos y tejidos extralinfáticos. Se presenta el casode un paciente varón de 59 años con linfoma de células en anillo de sello localizado en pared lateral de orofaringe.Esta localización creemos que no ha sido descripta anteriormente. La histología mostró células en anillo de sello y el inmunofenotipo tumoral fue: vimentina, CD45, CD20, Ig M y cadenas kappa positivos, siendo la fracción de crecimiento tumoral alta (Ki 67:70%). El paciente evolucionó desfavorablemente y falleció a los dosmeses del diagnóstico sin recibir tratamiento.(AU)

[Incidence and characterization of large-cell anaplastic lymphoma]. / Caracterización e incidencia del linfoma anaplásico de células grandes.

PURPOSE: Large cell anaplastic lymphoma (LCAL) is a new entity among large cell lymphoma. Diagnosis is based upon morphology and on positivity to Ki1 antigen. The objectives of this study were: 1) to determine the incidence of LCAL in the patient population seen at the Instituto Roffo between 1981 and 1993; 2) to study the immunological phenotype; 3) to study the association with Epstein-Barr virus and HIV; 4) To study the expression of oncogen bcl-2 and 5) to evaluate tumoral growth factor. MATERIAL AND METHODS: The study was done on 1030 biopsies of nodal and extranodal lymphoproliferative diseases, with Hodgkin and non-Hodgkin lymphoma. Of the 1030 consecutive cases, 67 were selected. They revealed pleomorphic cells with sinusoidal disposition. Biotin and avidin peroxidase techniques were used to identify the following antigens: CD30(Ki 1), CD45RO (UCHL1), CD20(L26), CD45(CL), Epstein Barr virus (VEB), human immunodeficiency virus (HIV), CD15, CD68, PCNA, bcl-2 oncogen, vimentin, membrane epithelial antigen (EMA). Of these cases, only 10 revealed strong positive reaction to CD 30 (Ki1), thus they were considered to fulfill criteria to be classified as LCAL. RESULTS: 1. Incidence of LCAL in the lymphoma population under study was 1%. 2. Phenotype was B in 3 cases, T in 3, and macrophage in 1.3. There was 1 case of positive EBV and 3 positive HIV. 4. Eight of 10 LCAL cases were positive for bcl-2 protein. 5. Tumoral growth factor was 57%. Also, it was noted that most cases were secondary to Hodgkin lymphoma, and a few secondary to polymorphic immunoblastic lymphoma, with negative reaction to CD15 and EMA and positive for Vimentin. CONCLUSIONS: 1. Incidence of LCAL amongst patients with lymphoma is very low. 2. Immunological phenotype is varied. 3. There was no significant association with EBV or HIV. 4. Oncogen bcl-2 was demonstrated in most cases. 5. There was a high percentage of cells in proliferation.

[Tumor growth fraction and its relationship with morphology of transitional carcinoma of the bladder]. / Estudio de la fracción de crecimiento tumoral y su relación con la morfología en el carcinoma transicional de vejiga.

Papillary transitional cell carcinoma of the bladder (PTCCB) is characterized by a high recurrence rate with infiltration of bladder wall and surrounding tissues. The outcome is poor in 10-20% of the cases and these cannot be detected by conventional methods. Different methods have been utilized to identify this high risk patient group, such as the tumor growth factor (TGF). This is obtained with the KI-67 antibody, which identifies a nuclear protein in the cells in the active cellular cycle (G1, G2, S and mitosis). TGF represents the percentage of KI-67 positive tumor cells. The aims of the present study were: 1) to determine the correlation of the histological features and TGF in PTCCB; 2) to determine the percentage, if any, of superficial low grade lesions with a high TGF. Thirty-one transurethral biopsies of patients with PTCCB were analyzed to determine the histological grade (following the criteria described by Ash), wall infiltration (according to the IUAC criteria) and TGF (using the PAP technique). The study revealed 16 (52%) were low grade and 15 (48%) were high grade tumors, 20 (64.5%) were superficial (PTa-PT1), 9 (29%) were deep (PT1-PT4) and the degree of wall infiltration could not be determined in two cases. Of the 20 superficial tumors, 15 (75%) had a low (0-15%) and 5 (25%) had a high (> or = 16%) TGF. The 9 cases with deep infiltration of the bladder wall (PT2-PT4) had a high TGF.(ABSTRACT TRUNCATED AT 250 WORDS)

[Specific prostatic antigen in prostatic carcinoma: its relationship with tumor differentiation and clinical course]. / Antígeno prostático específico en el carcinoma de próstata: su relación con la diferenciación tumoral y la evolución clínica.

Carcinoma of the prostate is a tumor with a variable clinical course and a high incidence of local progression and/or metastasis. This study was undertaken to evaluate tissue prostate specific antigen (PSA) in patients with carcinoma of the prostate, its correlation with Gleason's grading and its value in predicting the clinical course of these patients. We studied 28 transurethral biopsies of patients with prostatic carcinoma utilizing HE and peroxidase-antiperoxidase staining techniques. These were given a score of 2 to 10 using Gleason's grading. PSA was determined according to percent positivity. The clinical course was considered favourable (F) when the lesion remained stable and unfavourable (U) when peri-prostatic spread was evidenced, metastasis and/or death from the disease. Statistical analysis was performed with the linear discriminatory test. PSA percentages ranged from 0 to 95 and the Gleason score from 3 to 11. There was an indirect correlation between these methods (r = 0.74): high Gleason scores corresponded to low PSA values and viceversa. PSA was highly positive in patients with F and U clinical courses whereas low positive values (less than 40%) were observed only in patients with U clinical course. High Gleason (8 to 10) and low (less than 5) scores were observed only in patients with a clinical course of U or F, respectively, while intermediate values (5 to 8) were not predictive of the clinical course. Discriminatory analysis gave Z values of -2.446 (P = 0.014) for PSA, -2.90 (P = 0.004) for the Gleason score in predicting prognosis, conferring a greater value overall to the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

[Membranoproliferative glomerulonephritis with semilunar forms and massive deposits of IgA associated with HBsAg]. / Glomerulonefritis membranoproliferativa con semilunas y depósitos masivos de IgA asociada a HBsAg.

The association of HBV infection and glomerular damage was first reported by Combes et al in 1971, in a patient with nephrotic syndrome due to membranous glomerulopathy and chronic hepatitis B. Since, then, other glomerular diseases have been reported such as a) minimal changes nephropathy, b) IgA nephropathy, c) membranous-proliferative glomerulonephritis (MPGN), d) membranous, e) mesangial proliferative and f) lupus nephritis. All of them are associated with chronic hepatic disease and some of the following antigens: 1) HBsAg; 2) HBeAg; 3) HBcAg. These disorders are very frequent in Southeast Asia. Vertical transmission from mothers to fetuses may be important in maintaining the high carrier rate, and possibly plays a role in the development of glomerular damage. On the other hand, MPGN associated with HBsAg has rarely been reported and always with a favorable benign course. The present report describes interesting findings in a renal biopsy from a HBsAg and HBeAg carrier, who developed renal failure requiring hemodialysis. A 21 year old Korean man was admitted to the Hospital for nephrotic syndrome, microhematuria hypertension and renal failure. He had no previous history of blood transfusion, intravenous drug addiction, jaundice or liver disease. His father was HBsAg carrier with hepatic cirrhosis. An ultrasound examination showed normal renal size. Renal biopsy was performed and the patient received hemodialysis treatment. The specimen was processed for light microscopy, immunofluorescent studies and peroxidase-antiperoxidase technique. Frozen sections were studied by direct immunofluorescence for the identification of IgG, IgA, C1q, C3, fibrinogen and albumin. Paraffin sections stained by immunoperoxidase technique for HBsAg, using polyclonal monospecific rabbit anti-Human antisera (Dakopatts, Copenhagen).(ABSTRACT TRUNCATED AT 250 WORDS)

Glomerulonefritis membranoproliferativa con semilunas y depósitos masivos de IgA asociada a HBsAg. / [Membranoproliferative glomerulonephritis with semilunar forms and massive deposits of IgA associated with HBsAg]

The association of HBV infection and glomerular damage was first reported by Combes et al in 1971, in a patient with nephrotic syndrome due to membranous glomerulopathy and chronic hepatitis B. Since, then, other glomerular diseases have been reported such as a) minimal changes nephropathy, b) IgA nephropathy, c) membranous-proliferative glomerulonephritis (MPGN), d) membranous, e) mesangial proliferative and f) lupus nephritis. All of them are associated with chronic hepatic disease and some of the following antigens: 1) HBsAg; 2) HBeAg; 3) HBcAg. These disorders are very frequent in Southeast Asia. Vertical transmission from mothers to fetuses may be important in maintaining the high carrier rate, and possibly plays a role in the development of glomerular damage. On the other hand, MPGN associated with HBsAg has rarely been reported and always with a favorable benign course. The present report describes interesting findings in a renal biopsy from a HBsAg and HBeAg carrier, who developed renal failure requiring hemodialysis. A 21 year old Korean man was admitted to the Hospital for nephrotic syndrome, microhematuria hypertension and renal failure. He had no previous history of blood transfusion, intravenous drug addiction, jaundice or liver disease. His father was HBsAg carrier with hepatic cirrhosis. An ultrasound examination showed normal renal size. Renal biopsy was performed and the patient received hemodialysis treatment. The specimen was processed for light microscopy, immunofluorescent studies and peroxidase-antiperoxidase technique. Frozen sections were studied by direct immunofluorescence for the identification of IgG, IgA, C1q, C3, fibrinogen and albumin. Paraffin sections stained by immunoperoxidase technique for HBsAg, using polyclonal monospecific rabbit anti-Human antisera (Dakopatts, Copenhagen).(ABSTRACT TRUNCATED AT 250 WORDS)

[Intratubular neoplasm adjacent to germ cell tumor of the testis]. / Neoplasia intratubular adyacente a tumor germinal de testículo.

Because intratubular germ cell neoplasia (IGCN) is considered to be a precursor of testicular cancer, precise identification of this tumor type is important. The present study was undertaken to determine the cytological features of IGCN, its histological classification, and its incidence relative to other invasive germ cell tumors. We studied the biopsy specimens from a similar number of patients. The biopsy material was fixed in formol and embedded in paraffin. Sections were processed and analyzed with the hematoxylin-eosin and PAS stainings methods with and without diastase. IGCN classification was performed following the criteria recommended at the International Symposium on Testicular Cancer (Minneapolis, 1980). IGCN was recognized in 22 (26%) of the 85 biopsies and presented the following characteristic features; large cells with hyperchromatic nuclei, one or more nucleoli and abundant cytoplasm. Glycogen was present in most of the lesions but not in controls. In 12 patients (54.5%), the cytological anomaly was observed in the periphery of the tubules without the characteristic features of germ cell tumors. This lesion type was termed "unclassified". In 5 cases (22.7%), the tubule lumen was filled with atypical cells with round nucleus, scant chromatin, prominent nucleolus and scant cytoplasm. This variety was termed "intratubular seminoma". In 2 cases (9%) the intratubular lesion revealed large cells with pleomorphic nucleus and central necrosis. This variety was called "intratubular embryonal carcinoma".(ABSTRACT TRUNCATED AT 250 WORDS)

Manifestaciones cutaneas de la amiloidosis sistemica. / Skin manifestaions of systemic amyloidosis

A proposito de una observacion de amiloidosis sistemica adquirida, se hace referencia a las caracteristicas que identifican a la sustancia amiloide, se passa revista a las manifestaciones clinicas de la amiloidosis sistemica, especialmente las manifestaciones cutaneomucosas, para referirse finalmente al tratamiento

Manifestaciones cutaneas de la amiloidosis sistemica. / Skin manifestaions of systemic amyloidosis

A proposito de una observacion de amiloidosis sistemica adquirida, se hace referencia a las caracteristicas que identifican a la sustancia amiloide, se passa revista a las manifestaciones clinicas de la amiloidosis sistemica, especialmente las manifestaciones cutaneomucosas, para referirse finalmente al tratamiento

Primary T-cell lymphoma of oral cavity.

Immunopathologic studies classify lymphoma under the T-cell or B-cell groups. Such a classification gives a better indication for prognosis and treatment of lymphomas, with the T-cell group having the worse prognosis. A patient with a T-cell lymphoma of the oral cavity is presented. The diagnostic features and management are discussed.

Granulomatosis linfomatoidea con localizacion intestinal. / Lymphomatoid granulomatosis with intestinal localization

Desde un punto de vista clinico-quirurgico frente a un paciente que presenta uno o varios nodulos pulmonares que se acompanan de lesiones cutaneas o viscerales, con o sin alteraciones inmunologicas demostrables, se debe pensar en una granulomatosis linfamotoidea. Ante la sospecha clinica,la confirmacion del diagnostico se establece unicamente por el estudio histomorfologico La naturaleza y comportamiento de esta enfermedad se deben investigar con tecnicas inmunologicas e histoquimicas las que proveen una orientacion terapeutica. Se presenta un enfermo de 39 anos de edad, con una granulomatosis linfomatoidea de localizacion pulmonar, muscular, ganglios mesentericos e intestino delgado. Esta ultima no ha sido descripta en la literatura a nuestro alcance. Se efectuo estudio inmunohistoquimico, estableciendose como caracteristicas del infiltrado, ser linfoideo B policlonal

Granulomatosis linfomatoidea con localizacion intestinal. / Lymphomatoid granulomatosis with intestinal localization

Desde un punto de vista clinico-quirurgico frente a un paciente que presenta uno o varios nodulos pulmonares que se acompanan de lesiones cutaneas o viscerales, con o sin alteraciones inmunologicas demostrables, se debe pensar en una granulomatosis linfamotoidea. Ante la sospecha clinica,la confirmacion del diagnostico se establece unicamente por el estudio histomorfologico La naturaleza y comportamiento de esta enfermedad se deben investigar con tecnicas inmunologicas e histoquimicas las que proveen una orientacion terapeutica. Se presenta un enfermo de 39 anos de edad, con una granulomatosis linfomatoidea de localizacion pulmonar, muscular, ganglios mesentericos e intestino delgado. Esta ultima no ha sido descripta en la literatura a nuestro alcance. Se efectuo estudio inmunohistoquimico, estableciendose como caracteristicas del infiltrado, ser linfoideo B policlonal