[Histoenzymologic methods in differential diagnosis of benign and malignant tumors in human].
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Publications and source records attributed to N A Probatova.
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Using histochemical methods, we studied distribution of dipeptidylaminopeptidase-IV (DPP-IV) in tumor cells of 16 patients with non-Hodgkin's malignant lymphomas (NHL) including B-cell NHL (10 cases), pleomorphic T-cell lymphoma (1 case), CD30+ anaplastic large cell lymphoma (ALCL) of T-cell (1 case) and ALCL of null-cell type (4 cases) and of 13 patients with Hodgkin's disease (HD). The results indicate that tumour cells of pleomorphic T-cell NHL and ALCL of T- and null-cell type showed DPP-IV activity. In contrast, no DPP-IV activity was seen in the tumor cells of B-cell NHL (lymphocytic, centroblastic/centrocytic, centroblastic, immunoblastic), in Berezovsky-Reed-Sternberg and Hodgkin's cells of different HD variants. These results demonstrate that difference in DPP-IV activity between tumor cells of ALCL and HD may be diagnostically important for separation of ALCL from HD and moreover may be used in verification of the borderline between HD-like ALCL and ALCL-like HD. It is possible that DPP-IV activity contributes to pathogenesis of ALCL and may determine clinical behaviour of this NHL being involved in autocrine and paracrine regulation of tumor cell growth of ALCL.
Basing on the analysis of the cytological evidence, the authors suggest criteria for differential diagnosis of peripheral small-cell B-cell lymphomas including position of the tumor cells in cytological preparations and cell composition of the tumor. A high level of p53mut and bcl-2 expression in centrofollicular lymphomas and lymphomas originating from small lymphocytes may serve an additional criterion in differential diagnosis with reactive changes in the lymph nodes.
Classic morphological and lymphohistiocytic variant were found in 46 and 2 cases, respectively, of 49 LCAL cases studied pathohistologically. One patient had a variant with a predominance of small tumor cells. Ultrastructurally, cells with feature of histiocytic and lymphoid differentiation and undifferentiated cells in various proportions were observed.
The results are available of clinical, morphological, cytological and immunological investigations of orbital lymphomas and lymphomas of appendages of the eye. Malignant lymphoma was detected in 17 patients and reactive lymphoid hyperplasia in 3 patients. All the malignant lymphomas had B-cell phenotype. By cell composition, MALT-lymphoma is more polymorphic than lymphoma from mantle zone cells and lymphoma from small lymphocytes and centro follicular lymphoma. The conjunctive is affected primarily with lymphoma from marginal zone cells or mantle zone cells. As a rule, this is a primary local lesion. Other variants of orbital lymphoma and lymphoma of the eye appendages develop more often as secondary lesions in systemic disease and are characterized by more aggressive course. The key in differential diagnosis of reactive lymphoid hyperplasia and small cells lymphomas is immunophenotyping, especially at initial stages of the tumor process.
Two morphological variants of mantle cell lymphoma are described: classic and blastoid. The former consists of small and medium-size cells, the latter is represented by cells with lympho- and centroblast morphology. An immunohistochemical examination has established a high degree of cyclic D1 expression by these lymphomas.
31 cases of chronic lymphoid leukemia (CLL)/lymphoma from small lymphocytes (LSL) was studied immunomorphologically. All cases had B-phenotype and positive expression of markers CD 5, CD 23. Most characteristic for CLL/LSL was pseudofollicular character of tumour growth. Two morphological variants of CLL/LSL having similar phenotype were distinguished: typical variant with roundish conturs of tumour cells and atypical with centrocytoid morphology of tumour cell nuclei.
A topical problem of differential diagnosis of nodular lymphoid predominance of Hodgkin's lymphoma and classical variant rich in lymphocytes is discussed. Main morphological diagnostic criteria are considered on the basis of the authors' observations and literature data. Immunological characteristics of two variants of Hodgkin's lymphoma with lymphoid predominance are reviewed.
MALT gastric lymphoma presents difficulties for morphological diagnosis as it is represented by neoplastic elements having morphology of mature cells. 75 MALT-lymphomas of the stomach with polymorphous tumour infiltrate are reported. The infiltrate was analyzed by cell composition, cell atypia, the presence of lymphoepithelial lesions (LEL) and lymphoid follicles, blast cells and "blast" LEL. Immunohistochemistry may be necessary for diagnosis when clear-cut morphological characteristics are lacking.
Expression of APNOR was studied in 26 benign and malignant tumors of adrenal cortex and medulla. The histochemical method with silver nitrate was used. Expression of APNOR argyrophilic proteins in adrenocortical carcinomas was 4.59 times higher than in adrenocortical adenomas and 2.63 times higher in pheochromoblastomas than in pheochromocytomas. This index may be recommended as an additional method for differential diagnosis of benign and malignant adrenal tumors, particularly in difficult border line cases as well as determination of prognosis and metastatic potential of these tumors. Cytospecificity of APNOR expression in different types of adrenal cells was established.
Expression of argyrophilic proteins of nucleolar organizers regions (Ag-NOR-proteins) was studied in tumor cells from 17 patients with a classic variant of anaplastic large-cell lymphoma (ALCL) and 22 patients with Hodgkin's lymphoma (HL). Eight cases of p80+ and nine cases of p80-ALCL were studied. HL was represented by 13 cases with lymphoid depletion by a reticular type and 9 cases with nodular sclerosis with a syncytial growth. Ag-NOR-proteins were identified using histochemical method with silver nitrate. The expression of Ag-NOR-proteins in tumor cells of ALCL and HL appeared intensive, being highest in ALCL cells, in p80+ cells of ALCL there was superexpression. The differences in expression of Ag-NOR-proteins point to different proliferative activity and growth of the above variants of ALCL and HL. The test for Ag-NOR-proteins expression can be recommended as an additional tool in differential diagnosis, determination of malignancy grade, assesssment of prognosis and sensitivity to chemotherapy.
Stomach MALT-lymphomas have a specific feature of clinical behaviour and prognosis, this being reason to differentiate it from others gastric lymphoma's variants. 75 cases of gastric MALT-lymphomas having "classical" morphological features with polymorphic tumour infiltration. We described the only case of MALToma in our series characterised by a strong marker tendency of monoclonal plasmocytic differentiation (including plasmoblasts) with 'signet-ring' cells, Dutcher and Russel bodies using morphological, histochemical and immunohistochemical methods. We suppose this case to be MALT lymphoma with Mot's cell differentiation.
Morphological and immunophenotypical features of Hodgkin's lymphoma with lymphoid predominance are described: a variant with nodular lymphoid predominance (NLPHL) and variants of large-cell lymphoma including mediastinal large B-cell lymphoma, diffuse large B-cell lymphoma rich with T-cells and/or histiocytes. In view of the fact that these lymphomas enter so-called "gray zone" criteria for immunohistochemical differential diagnosis are suggested.
Principles of morphological diagnosis of anaplastic large-cell lymphoma (ALCL) are considered, several its variants are distinguished: classic (32 cases), small-cell (4 cases), rich in granulocytes (2 cases) and lymphohistiocytic (1 case). ALK expression was variable: 93% at the age up to 20, 60% at the age from 20 to 40 years, none at the age 40 years and older. Morphological similarities between ALCL, classic variants of Hodgkin's lymphoma, variants of diffuse large B-cell lymphoma may require immunohistochemical investigation the criteria of which are suggested.
The paper considers the stages of B-cell differentiation at the level of central (bone marrow) and peripheral (lymph node) organs of the immune system. The immunophenotype of B-cell lymphoid tumors and their "normal" cell analogues was compared, by taking into account 4 stages of B-cell differentiation: bone marrow B-cell precursors, mature B-cell, B-cell with follicular differentiation, postfollicular B-cell. Algorithms of immunohistochemical differential diagnosis of B-cell lymphomas are proposed when their morphological patterns are similar.