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N L Harris

Publications and source records attributed to N L Harris.

At least 145 records · Page 8Linked to original sources
PubMed1991

Plasmacytoid T-zone cell proliferation in a patient with chronic myelomonocytic leukemia. Histologic and immunohistologic characterization.

The term "plasmacytoid T-zone cells" has been used to describe distinctive cells that occur in clusters in the paracortex of some reactive lymph nodes. Recently, tumorous proliferations of these cells have been described in several patients with myelomonocytic leukemias. Neither the nature of these cells nor their relationship to myeloid leukemia has been conclusively established. We report the case of a 64-year-old woman with chronic myelomonocytic leukemia who developed lymphadenopathy that proved to be due to tumorous accumulation of plasmacytoid T-zone cells in the interfollicular regions of the lymph nodes. She underwent splenectomy because of symptomatic splenomegaly; the resected spleen also contained aggregates of plasmacytoid T-zone cells, in addition to extramedullary hematopoiesis. On treatment with busulphan and prednisone, the lymphadenopathy resolved and did not recur. The patient died 7 years later with blast transformation of her myelomonocytic leukemia and no recurrence of lymphadenopathy. The aggregates of plasmacytoid T-zone cells were architecturally and cytologically distinct from the leukemic infiltrates of myeloid cells in the spleen, and there was no evidence of differentiation of these cells into myeloid or monocytic cells. A panel of monoclonal antibodies on paraffin sections revealed no lineage-specific T- or B-cell markers (UCHL1-, L26-), and the plasmacytoid cells were positive for CD68 (KP1) and L60 (CD43), as well as faintly positive for 4KB5 (CD45RA) and MB1 (CD45R). They did not stain with antibodies to myeloid lineage antigens CD15, lysozyme, or myeloperoxidase. The combination of clinical, morphologic, and immunologic features of plasmacytoid T-zone cells in this case suggests that these cells may be of monocytic lineage but are not direct precursors of mature monocytic or granulocytic cells, and may not be part of the neoplastic clone in patients with myelomonocytic leukemia.

Antibodies, Monoclonal↗
PubMed1991

Carcinomas of the urinary bladder simulating malignant lymphoma. A report of five cases.

We report five carcinomas of the urinary bladder, four of them transitional cell carcinomas and one undifferentiated carcinoma, with unusual features that have received little or no comment in the literature and may be the cause of diagnostic difficulty because of their possible confusion with malignant lymphoma. Four patients were male and one female. They ranged from 61 to 76 years of age. Three tumors from these patients had a prominent (2 cases) or massive (1 case) lymphoid infiltrate that partially obscured the invasive carcinoma in two cases and largely obscured it in the third case, which closely resembled a lymphoepithelioma. The diagnosis of malignant lymphoma was only excluded with confidence in the last case after thorough immunohistochemical study. The lymphoid infiltrate was composed of numerous T-cells (UCHL-1 and Leu 22 positive) and polytypic plasma cells with admixed eosinophils; occasional germinal centers were present in one case. The tumors were deeply invasive in two patients, one of whom is alive with no evidence of disease 4 years after treatment with chemotherapy and radiation therapy; the other two cases are too recent for meaningful follow-up. Two other transitional cell carcinomas had diffuse patterns that simulated lymphoma or plasmacytoma. Recognition of these patterns of vesical carcinoma is important in order to avoid the misdiagnosis of the very rare malignant lymphoma of the urinary bladder.

Aged↗
PubMed1991

Pathology of malignant lymphomas.

Attempts to understand the malignant lymphomas have followed two major lines of investigation: attempts to define the relationship of neoplastic lymphoid cells to stages of normal T- and B-lymphocyte differentiation, and attempts to understand the genetic abnormalities associated with malignant transformation. It is hoped that these two lines of investigation will make it possible to define clinically important entities, so that specific treatment strategies can be developed and tested, and will also point the way to new options for treatment and prevention. Despite the advances in immunology of the last two decades, our understanding of the relationships of lymphoma cells to the normal immune system remains incomplete. Techniques of molecular genetics, which initially promised to resolve questions of clonality and lineage, have proven less definitive than had been hoped. Studies in the field of molecular cytogenetics--the study of chromosomal translocations by molecular techniques--have just begun to unravel some of the mysteries surrounding neoplastic transformation and differentiation. As we enter the last decade of the century, small advances continue to chip away at the uncertainties shrouding the malignant lymphomas. Advances in the past year include the subclassification of low-grade B-cell lymphomas, including so-called intermediate lymphocytic lymphoma and extranodal lymphomas of mucosa-associated lymphoid tissue, the classification of T-cell lymphomas, the definition of Hodgkin's disease and its relationship to anaplastic large cell lymphoma, and new techniques for characterizing lymphoid cells in paraffin-embedded tissue sections.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Polyclonal rearrangement of the T-cell antigen receptor genes in Hodgkin's disease: implications for diagnosis.

Distinction between Hodgkin's disease and peripheral T-cell lymphoma can be difficult, based on routine morphologic and immunohistologic stains. To assess the utility of Southern blot analysis, we investigated the genes for the beta (T beta) and gamma (T gamma) chains of the T-cell antigen receptor and immunoglobin heavy and light chains in 15 unselected cases of Hodgkin's disease. Following digestion with the restriction enzyme EcoRI, the intensity of the germline band corresponding to the first constant region of T beta was reduced when compared with the intensity of the second constant region germline band, a pattern consistent with polyclonal rearrangement of this gene. Hybridization of EcoRI-digested DNA with a probe recognizing the joining regions of T gamma revealed multiple rearranged bands corresponding to the known limited recombinatorial possibilities of this gene. Clonal rearrangement of T beta and T gamma was never demonstrated, although the banding pattern seen with T gamma could easily be misinterpreted as such. The findings in Hodgkin's disease were identical to those obtained in hyperplastic lymph nodes, normal thymuses, and normal peripheral blood enriched for T-cells. We then examined the status of T-cell receptor and immunoglobulin genes in six cases that could not be definitely classified as either Hodgkin's disease or T-cell lymphoma by either morphology or immunohistology. Clonal T-cell receptor gene rearrangement was found in three cases, supporting the diagnosis of T-cell lymphoma. Our study confirms the polyclonal lineage of the major fraction of T-cells and B-cells in Hodgkin's disease, a finding that may have diagnostic importance.

Adolescent↗
PubMed1991

Coexpression of CD15 and CD20 by Reed-Sternberg cells in Hodgkin's disease.

The immunophenotype of the Reed-Sternberg cells in Hodgkin's disease is heterogeneous among different cases; this heterogeneity has contributed to the continuing uncertainty regarding the normal counterpart of the Reed-Sternberg cell. In this study, the authors demonstrate coexpression of the B-cell marker, CD20, and the granulocyte associated antigen, CD15, by Reed-Sternberg cells in three of 20 cases of nodular sclerosis and mixed cellularity Hodgkin's disease using a double-labelling technique in one case and staining of serial sections in three cases. Additionally, the authors found that expression of CD20 occurred more often in tumors with a monomorphous proliferation of mononuclear and binucleate Hodgkin's and Reed-Sternberg cells, without numerous eosinophils or polymorphonuclear neutrophils. In contrast, expression of CD15 by Reed-Sternberg cells was associated with a greater granulocyte infiltrate. The presence or absence of fibrosis, plasma cells, and histiocytes did not correlate with antigen expression. These results suggest that there may be a continuum of antigen expression by Reed-Sternberg cells, with some cells expressing CD20, some CD15, and others expressing both antigens; cells coexpressing both CD15 and CD20 may represent an unstable intermediate in the process of antigen switching. The possibility that antigen expression by the neoplastic cells in a given case may modulate depending on the background infiltrate could explain the heterogeneity of immunophenotype among cases of Hodgkin's disease.

Antigens, CD↗
PubMed1991

Nasal lymphoma. A clinicopathologic study with immunophenotypic and genotypic analysis.

We studied 13 cases of malignant lymphoma involving the nasal cavity, in six men and seven women, from 27 to 92 years of age (mean, 56 years; median, 55 years). All lymphomas had a diffuse pattern, with 10 of large-cell type (six immunoblastic polymorphous, one immunoblastic, three large cleaved cell), one of mixed small- and large-cell type and one of small cleaved-cell type. One case could not be subclassified. Angioinvasion and prominent necrosis were seen in 10 cases. Pseudoepitheliomatous hyperplasia of the overlying epithelium was present in five cases. Immunohistochemical studies on frozen or paraffin sections in nine cases revealed that the atypical cells were T cells in four cases (CD8+ in two cases) and B cells with monotypic immunoglobulin in two cases. In three cases, the findings were suggestive but not diagnostic of T lineage. Genotypic analysis in one of two cases of T-cell lymphoma revealed clonal rearrangement of the genes for beta and gamma chains of the T-cell receptor. Patients were treated initially with local radiation therapy (10 cases) or with radiation and chemotherapy (three cases). Eight patients (62%) had no relapse and were free of disease between 9 months and 23 years (mean, 6 years 5 months; median 2 years 1 month) after diagnosis. Five patients developed recurrent disease, three of whom were successfully salvaged. One patient was alive with tumor at the time of last follow-up and one died with tumor. Among cases of malignant lymphoma presenting with involvement of the nasal cavity, we find a high proportion of angioinvasive, diffuse large-cell lymphomas, with a predominance of T-cell type, and a relatively good prognosis when treated with radiation therapy.

Adult↗
PubMed1990

Expression of the activation antigen, 4F2, by non-Hodgkin's lymphomas of B-cell phenotype.

The monoclonal antibody, 4F2, which reacts with an antigen expressed by activated and proliferating cells, was applied to frozen sections of nine reactive lymphoid lesions, 146 B-cell non-Hodgkin's lymphomas (NHL), and six plasmacytic neoplasms. In reactive cases, the 4F2 antigen was expressed by germinal center cells and interfollicular immunoblasts, the activated or proliferating lymphoid cells, and histiocytes. In the malignant cases, the 4F2 antigen was expressed by 94 (64%) B-cell NHL and all six plasma cell tumors. The incidence of positivity and intensity of expression loosely correlated with the three morphologic grades of NHL identified in the Working Formulation. Approximately one half of all low-grade lymphomas, two thirds of intermediate-grade lymphomas, and all high-grade lymphomas were 4F2 positive. Similarly, the mean intensity of 4F2 antigen expression increased with higher grade. However, for certain histologic subtypes, 4F2 antigen expression did not correlate with morphologic grade. For example, in the intermediate-grade category less than one half of diffuse small cleaved cell lymphomas were 4F2 positive, and expression was weak, similar to that of low-grade lymphomas. In contrast, all other histologic subtypes of lymphoma in the intermediate-grade category were strongly 4F2 positive. Expression of 4F2 antigen also correlated with plasmacytoid differentiation. Seventy-three percent of plasmacytoid small lymphocytic lymphomas (compared with 31% of cases of non-plasmacytoid small lymphocytic lymphoma/chronic lymphocytic leukemia) and all plasma cell neoplasms expressed the 4F2 antigen, the latter cases strongly.

Adolescent↗
PubMed1990

Distribution and consensus of branch point signals in eukaryotic genes: a computerized statistical analysis.

An intermediate stage in the process of eukaryotic RNA splicing is the formation of a lariat structure. It is anchored at an adenosine residue in intron between 10 and 50 nucleotides upstream of the 3' splice site. A short conserved sequence (the branch point sequence) functions as the recognition signal for the site of lariat formation. It has been generally assumed that the branch point is recognized mainly by the presence of its unique sequence where the lariat is formed. However, the known branch point consensus sequence is found to be distributed nearly randomly throughout the gene sequence with only a slightly higher frequency in the expected lariat region. Further, the known consensus sequence is found to be clearly inadequate to specify branch points. These observations have implications for understanding the mechanism of branch point recognition in the process of splicing, and the possible evolution of the branch point signal.

Animals↗
PubMed1990

Immunohistologic analysis of small lymphocytic infiltrates of the orbit and conjunctiva.

In a prior study we reported that monotypic immunoglobulin expression significantly correlated with an increased risk of dissemination by small lymphocytic infiltrates (SLIs) of the orbit and conjunctiva. However, less than half of all monotypic SLIs disseminated. In this study, we applied a large panel of monoclonal antibodies to cryostat sections of orbital and conjunctival SLIs to address two questions. First, might immunohistologic results other than immunoglobulin staining predict which patients with monotypic SLIs will develop disseminated lymphoma? Second, what is the usefulness of these findings in the diagnosis of orbital and conjunctival SLIs? We found that immunohistologic results did not significantly predict or correlate with disseminated lymphoma in patients with monotypic SLIs, either at time of presentation (ie, staging evaluation positive) and/or subsequently. However, three monotypic infiltrates (10%) had a proliferative rate (Ki-67-positive) of 20% or greater, and all three cases disseminated. Regarding the usefulness of the antibody panel, a B to T cell ratio of 4 or greater (76%), anomalous pan-T cell antigen expression by B cells (38%), and pan-B cell antigen loss (15%) were found exclusively in monotypic SLIs. Combining these results, 80% of monotypic SLIs had additional immunophenotypic criteria of lymphoma. Thus, these findings appear to be useful, although less helpful than immunoglobulin staining, and provide another means of immunophenotypic diagnosis when the results of immunoglobulin staining are technically unsatisfactory or difficult to interpret. We were unable to detect anomalous antigen expression or antigen loss in polytypic infiltrates, including one lesion which locally recurred 30 months later as a histologically indistinguishable, clearly monotypic SLI. We attribute the absence of these findings in polytypic SLIs to their relatively infrequent occurrence in monotypic infiltrates and/or to our inability to detect small clones of malignant cells (if present) by our immunohistologic methods.

Adult↗
PubMed1990

Probabilistic belief networks for genetic counseling.

This paper describes a program, GenInfer, which uses belief networks to calculate risks of inheriting genetic disorders. GenInfer is based on Pearl's (J. Pearl, Artif. Intell. 29 (1986) 241-288) algorithm for fusion and propagation in probabilistic belief networks. It is written in Common Lisp. GenInfer can calculate genotypes for any family affected with any single-gene inherited disorder. Besides considering both negative and positive information in the pedigree. GenInfer takes into account additional information about the specific disorder as well as supplementary information for family members. The output consists of genotype probabilities for all family members and estimated genetic risks for prospective children of the consultands. Belief networks provide a way to calculate probabilities for systems of conditionally dependent variables. The impacts of various pieces of information are propagated and fused in such a way that, when equilibrium is reached, each proposition can be assigned a degree of belief consistent with the axioms of probability theory. In Pearl's algorithm, information is communicated through the network by messages sent between nodes. Pearl's basic algorithm cannot directly handle multiple-connected networks, which arise in the genetic counseling domain whenever a family pedigree includes consanguinity or more than one child per couple. GenInfer makes use of two cycle breaking methods, clustering and conditioning, to handle these situations.

Bayes Theorem↗
PubMed1990

Plasma cell myeloma with cleaved, multilobated, and monocytoid nuclei.

The neoplastic cells in most cases of multiple myeloma closely resemble normal plasma cells. The authors report six cases of myeloma in which most of the neoplastic cells had cleaved, multilobated, or monocytoid nuclei and presented some diagnostic difficulty. All cases were clinically aggressive (five patients with stage III disease and one patient with stage II disease). Three patients died during their initial hospitalization, and three patients are alive with progressive disease from 5 to 14 months after combination chemotherapy. Immunohistochemical studies on paraffin-embedded tissue demonstrated monotypic immunoglobulin in each case (three lambda and three kappa). Recognition of these morphologic variants of neoplastic plasma cells is important to the pathologist to avoid erroneous diagnoses and to alert the clinician to an aggressive form of myeloma associated with a poor prognosis. Immunohistochemical studies on paraffin-embedded tissue sections are useful in the diagnosis of this tumor.

Aged↗
PubMed1990

Lymphoid infiltrates of the stomach. Evaluation of histologic criteria for the diagnosis of low-grade gastric lymphoma on endoscopic biopsy specimens.

Low-grade gastric lymphomas may be difficult to distinguish from benign inflammatory infiltrates on endoscopic biopsy specimens. Recent reports have suggested that so-called lymphoepithelial lesions (infiltration of lymphocytes into glandular epithelium) are characteristic of primary gastric lymphomas. We evaluated the presence and prominence of lymphoepithelial lesions and other histologic criteria in 25 low-grade gastric lymphomas (21 primary) and 58 benign inflammatory infiltrates to evaluate their utility in distinguishing benign from malignant gastric lymphoid infiltrates. The following features were associated only with lymphomas: (a) prominent (2-3 +) lymphoepithelial lesions (eight of 24 versus none of 58; p less than .0001); (b) Dutcher bodies (three of 25 versus none of 58, p = .05); and (c) moderate cytologic atypia (nine of 25 versus none of 58, p less than .0001). One or more of these features was seen in 18 of 25 gastric lymphomas (72%). Features more often associated with, but not limited to, lymphomas were dense (2-3 +) lymphoid infiltrates (25 of 25 versus five of 58, p less than .0001), rare or questionable lymphoepithelial lesions (11 of 24 versus 17 of 58, p = .01), muscularis mucosae invasion (20 of 20 versus 20 of 47, p less than .0001), ulceration (12 of 24 versus five of 58, p less than .0001), and mild cytologic atypia (eight of 25 versus six of 58, p less than .005). Germinal centers, crypt abscesses, and reactive epithelial atypia were seen with equal frequency in both types of infiltrate. Acute inflammation (2-3 +) was associated more often with inflammatory infiltrates (two of 25 versus 27 of 58, p less than .001). Our results suggest that dense lymphoid infiltrates with either prominent lymphoepithelial lesions, moderate cytologic atypia, or Dutcher bodies are highly suggestive and may be diagnostic of lymphoma. This constellation of findings is present in about 70% of endoscopic biopsy specimens of low-grade gastric lymphoma. In addition, the majority of cases of primary low-grade gastric lymphoma have morphologic, immunophenotypic, and clinical features that justify their inclusion in the category of low-grade lymphomas of mucosa-associated lymphoid tissue, whereas a minority are examples of lymphomatous polyposis of the gastrointestinal tract (centrocytic lymphoma).

Adult↗
PubMed1990

Variable expression of Epstein-Barr virus genome as demonstrated by in situ hybridization in central nervous system lymphomas in immunocompromised patients.

In situ hybridization, using a biotinylated sequence from the internal repeat (IR1) region of Epstein-Barr virus (EBV), was performed on two well characterized EBV-infected cell lines, B95-8 (productively infected) and Namalwa (latently infected), and on eighteen formalin-fixed paraffin-embedded primary central nervous system (CNS) lymphomas. Ten of the lymphomas were from immunocompetent patients, and eight were from immunocompromised patients (five had acquired immunodeficiency syndrome (AIDS), two had renal allografts, and one had X-linked immunoproliferative (XLP) disease). Both fresh and paraffin-embedded B95-8 cells showed detectable hybridization signal in 5 to 10% of cells, with other cells showing lower signal. Fresh Namalwa cells showed signal in every cell and in 40% of paraffin-embedded cells. Evidence of EBV genome was seen in seven of eight lymphomas from immunocompromised patients and in none of the lymphomas from immunocompetent ones. In the EBV-positive lymphomas, three patterns of hybridization were recognized: +3, more than 60% of tumor cells positive, +2, 20 to 60% of tumor cells positive, and +1, less than 20% of tumor cells positive. There was no definite relationship between survival after diagnosis and hybridization pattern type. While the signal in Namalwa cells was uniform, a wide variation in the degree and intensity of signal was noted among the seven positive tumors and even in different areas of the same tumor. This heterogeneity raises the possibility of lytic or secondary infection in a small number of the latently infected tumor cells.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Primary lymphoma of bone. A B-cell neoplasm with a high frequency of multilobated cells.

Primary lymphoma of bone is an uncommon neoplasm that can be difficult to diagnose and subclassify. Only in a few cases has the immunophenotype been determined with monoclonal antibodies. We evaluated the histological features and immunophenotype of 12 cases of primary lymphoma of bone. The patients ranged in age from 16 to 80 years (mean, 41 years) with a male:female ratio of 1:1. The sites involved included femur (three cases), humerus (two cases), tibia (three cases), pelvis (two cases), ulna (one case), and scapula (one case). All cases were diffuse large-cell lymphomas: nine large-cleaved (eight with multilobated cells), two large-cell not otherwise specified, and one immunoblastic. Sclerosis was noted in six cases. Immunohistochemical studies on frozen-tissue sections demonstrated staining with the following antibodies: 11 of 11 with CD45, 12 of 12 with CD20, eight of 12 with monotypic immunoglobulin (six IgG, two IgM, seven kappa, one lambda). Tumor cells were negative for T-cell markers in each case. Ten patients are alive and well 0.5-4.5 years (median, 1.5 years) following treatment with radiation or chemotherapy. Two patients had recurrence at another site 0.75 years and 4 years after the initial diagnosis, respectively. Primary bone lymphoma is a B-lineage large-cell lymphoma with an unusually high incidence of large-cleaved and multilobated cells. The frequency of IgG heavy chain expression suggests a post-germinal center stage of differentiation. Frozen section immunohistologic studies are useful in the diagnosis of this tumor. Aggressive therapy has resulted in a favorable outcome in most cases.

Adolescent↗
PubMed1989

Diffuse large cell lymphoma with discordant bone marrow histology. Clinical features and biological implications.

In patients with diffuse large cell lymphoma (LCL), bone marrow involvement at the time of diagnosis is a poor prognostic sign. Since 1980, the authors have encountered 13 patients LCL who had simultaneous bone marrow involvement by small cleaved cell lymphoma (11 cases) or mixed small and LCL (two cases), a phenomenon known as "discordant" or "divergent" bone marrow histology. The patients ranged in age from 33 to 85 years (median, 61 years) and presented most commonly with Stage III or IV disease, independent of bone marrow involvement. Seventy-seven percent achieved complete remission (CR) with combination chemotherapy; 50% of these eventually relapsed and died of their disease. One patient died of unrelated causes. No recurrences of low-grade lymphoma were observed, as judged either by clinical behavior or rebiopsy. The survival of the patients with discordant bone marrow histology was compared with that of patients with LCL with or without bone marrow involvement by LCL. Of the 11 patients with discordant marrow histology followed for a minimum of 2 years, four (36%) are long-term survivors; this is comparable to the 2-year survival of patients with LCL without bone marrow involvement (45%). In contrast, 89% of patients with bone marrow biopsy specimens positive for LCL died within 18 months from the time of diagnosis (mean survival, 5.7 months). All diffuse LCL tested were of B-lineage. The authors attempted to determine whether the presence of discordant bone marrow histologic types indicated an underlying low-grade B-cell lymphoma in these patients by evaluating the peripheral blood of the long-term survivors for the presence of clonal excess. Of the three surviving evaluable patients tested, one had evidence of clonal excess in the peripheral blood. For patients with LCL who have a simultaneous bone marrow biopsy positive for low-grade lymphoma (discordant marrow histology), survival is no different from that of patients with negative marrows, and markedly better than that for patients with marrows positive for diffuse LCL. The biological significance of discordant bone marrow histology is not clear at this time.

Adult↗
PubMed1989

Immunohistologic features predict clinical behavior of orbital and conjunctival lymphoid infiltrates.

The natural history of lymphoid infiltrates of the orbit and conjunctiva is poorly understood. To determine if immunohistologic features could predict clinical outcome, these features were evaluated in 61 patients with orbital and conjunctival lymphoid infiltrates, including 44 patients with lesions localized to one or both orbits or conjunctivae. Using histologic criteria, 20 infiltrates were classified as malignant lymphoma (cytologically atypical), 14 cases were classified as benign (follicular hyperplasia or inflammatory pseudotumor), and 27 infiltrates (44%) were dense infiltrates of small lymphocytes without cytologic atypia, which could not be confidently classified as benign or malignant (histologically indeterminate). Based on expression of monotypic immunoglobulin, 20 of these cases were reclassified as small lymphocytic lymphoma. For all cases, monotypic immunoglobulin expression correlated with reduced survival (P less than .05) and increased likelihood of dissemination (P less than .001). Monotypic immunoglobulin expression also correlated with increased risk of dissemination for all histologically indeterminate (small lymphocytic) infiltrates (P less than .05). Separate analysis of the localized infiltrates showed that monotypic immunoglobulin expression significantly correlated with an increased likelihood of dissemination for all 44 cases (P less than .005) and for the 22 histologically indeterminate lesions (P = .06). For the localized small lymphocytic infiltrates, monotypic immunoglobulin expression conferred a 50% risk of dissemination. In contrast, no patients with polytypic small lymphocytic infiltrates have disseminated, although one lesion locally recurred 30 months later as lymphoma. Thus, monotypic immunoglobulin expression significantly correlates with reduced patient survival and increased risk of dissemination by orbital and conjunctival lymphoid infiltrates. Monotypic small lymphocytic infiltrates without cytologic atypia behave as do low grade B-cell malignant lymphomas with a significant risk of dissemination and an indolent clinical course. The relationship of polytypic small lymphocytic infiltrates to lymphoma remains to be determined.

Adult↗