Correlations between immunologic markers and histopathologic classifications: clinical implications.
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Biomedical subjects
Publications and source records attributed to R D Collins.
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By application of combined structural and functional analyses, most lymphoid neoplasms may be categorized as of T- or B-cell origin. T lymphocyte neoplasms include types of acute and chronic lymphocytic leukemias, certain cutaneous and node-based lymphomas, and lymphomas of thymocytes (convoluted lymphocytic lymphomas). Although much less frequent than B-cell neoplasms, these T-cell neoplasms are important because their recognition has therapeutic and prognostic significance. Relatively specific histopathologic, histochemical, and immunologic criteria have been defined for each neoplasm. These neoplasms are also significant because homogeneous populations of T neoplastic cells have been used successfully in a few cases to study the normal biology of the immune system.
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Leukemic cells from 29 cases of acute lymphocytic leukemia (ALL), studied for T and B cell markers by the use of sheep erythrocyte rosetting and surface immunoglobulin determinations, were examined by electron microscopy. The majority of patients (76%) were found to have non-T, non-B neoplasms composed predominantly of relatively small, inactive-appearing cells with frequent nuclear folds. T cell cases (21%) were associated with mediastinal masses and were predominantly composed of large, active-appearing cells with nuclear irregularity and little rough endoplasmic reticulum. One case of B cell origin was not morphologically distinct from the non-T, non-B cell cases.
In a continuing study of patients with lymphoproliferative diseases, six adult patients were encountered with a distinctive malignant lymphoma of peripheral T-lymphocyte origin. Cell suspensions from lymph nodes of these patients contained a pleomorphic, cytologically atypical population of lymphocytes, of which an average 58% marked as T cells in the E-rosette test. The average percent of surface immunoglobulin-bearing B cells in these suspensions was 6%; they were of polyclonal distribution. Lymph node biopsies revealed a malignant lymphoma with certain characteristic features of the organization of the infiltrate, the morphology of the lymphoid cells, and the nature of non-lymphoid cellular elements. The average age of the patients was 67 years; they presented with generalized lymphadenopathy, anorexia, and significant loss of weight. Four patients hd lung and/or pleural involvement by lymphoma at presentation. The immunologic, pathologic, and clinical features of these patients serve to characterize this recently recognized malignant lymphoma further.
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The ultrastructural features of Reed-Sternberg cells from 17 patients with Hodgkin's disease were compared with those of histiocytes and transformed lymphocytes in both benign and malignant conditions. Transformed lymphocytes and Reed-Sternberg cells appeared to have similar features, including large nuclei with dispersed chromatin, large nucleoli, and great numbers of cytoplasmic polyribosomes. Histiocytes contained abundant cytoplasmic lysosomal granules and microfilaments. These results are indicative of the origin of Reed-Sternberg cells from lymphocytes.
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Lymphomas with histologic features indicating a follicular center cell (FCC) origin were analyzed from 26 patients of a group of 45 consecutive non-Hodgkin's lymphoma patinets whose tumors were studied for B- and T-cell characteristics. They were compared with benign, reactive lymphoid tissue from 14 patients. Cell suspensions from biopsy material, blood, or bone marrow were examined for surface Ig and for rosette formation with sheep erythrocytes (E rosettes). Of the 26 patients with FCC lymphomas, 22 had 40% or more Ig-bearing cells; all patients with FCC lymphoma tissues had 25% or less E rosette-forming cells. Cells from most FCC lymphomas of the cleaved type had surfac IgM; those from several FCC lymphomas had both IgM and IgD. Cells from lymphomas of noncleaved cell type had surface IgG or IgA. Light-chain analysis showed that cells from FCC lymphomas bore a predominant light-chain type, which indicated their monoclonal nature. Neoplastic cells from several FCC lymphomas synthesized the surface Ig which they bore. Reactive tissues usually contained fewer Ig-bearing and more E rosette-forming cells than FCC lymphomas; the Ig-bearing cells, with one exception, had a polyclonal distribution. Correlation of histologic and immunologic observations indicates that most lymphomas identified as FCC in origin by light micorscopic criteria mark as B cells with the use of immunologic techniques and that FCC lymphomas are the most common type of non-Hodgkin's lymphoma.
Tissues from malignant lymphomas with both nodular and diffuse growth patterns, thought by light microscopy to be composed of cells of follicular center cell (FCC) origin, Were examined by electron microscopy; the tumor cells were similar to lymphoid cells found in reactive follicular centers. Tumor cells from neoplasms thought to be composed of cleaved FCC often had more pronounced nuclear folding than did cleaved FCC of reactive follicles, whereas cells in tumors of noncleaved FCC type were indistinguishable from their presumed counterparts in reactive follicles. Large cell noeplasms, previously classified as "histiocytic" lymphomas were composed of cells with ultrastructural characteristics of transformed lymphocytes; they showed neither ultrastructural nor cytochemical features of mononuclear phagocytes. These findings support the concept that a major group of lymphomas arises from lymphocytes of follicular centers.
Our recently proposed functional approach to and classification of the malignant lymphomata based upon the T and B cell systems, lymphocyte transformation and their development as blocks or a "switch on" in lymphocyte transformation has been reviewed. This functional classification contains 5 major groups: (a) U cell or undefined for those proliferations without specific markers; (b) T cell; (c) B cell; (d) histiocytes as macrophages; (e) unclassifiable for those technically insufficient for specific cytological classification. Retrospective study of several case populations indicates that the majority of non-Hodgkin's lymphomata exhibit features of follicular centre cell (FCC) lymphomata of either cleaved or non-cleaved types. The prognostically favourable status of nodular lymphomata seems to result from the retained capability of follicle formation by FCC types with limited abnormality. Lymphomata of large cell types previously classified as histiocytic lymphoma or reticulum cell sarcoma predominantly resemble transformed lymphocytes and rarely exhibit features of histiocytes as macrophages. They are designated "immunoblastic sarcoma" when they occur as large transformed lymphocytes and may have either T or B cell immunological markers. Immunoblastic sarcoma has been observed to develop in individuals with chronic abnormal immune states, Sjögren's syndrome, alpha chain disease, in patients on immunosuppression therapy for graft rejection and in senescence. There is accumulating evidence of lymphomata of T cells but none are firmly established. These include Sézary's syndrome, mycosis fungoides and the convoluted lymphocyte type, prev-ously included designated as acute lymphocytic leukaemia with mediatinal mass. The results of initial functional studies provide support for the proposed classification and indicate that the modern pathological investigative approach requires the collection of fresh lymphomatous tissue and an integrated immunocytochemical and morphological approach for the precise characterization of human lymphoma cell types.
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