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Gastric precancerous changes: carcinogenesis, clinical behaviour immunophenotype study and surveillance.

Gastric cancer (GC) is the second most common cause of cancer-related death worldwide. Two-thirds of the GC patients are diagnosed in advanced stages, when surgery can only be a palliative. When the diagnosis is made at an early stage, the surgical treatment results in 10 years survival rates are higher than 85%. From the critical evaluation of the literature data we can affirm that there are some obstacles to an exclusive acceptance of the idea that the relation of Helicobacter pylori (H. pylori) infection with noninvasive (formerly dysplasia) or invasive neoplastic modifications solely develop by means of chronic gastritis with its atrophic evolution and achlorhydria. Intestinal metaplasia as a precursor of GC has been overemphasized and doubts persist about the real necessity to operate histologically a subdivision into subtypes. The extent of the metaplastic process is probably more important that the metaplastic subtype. The evaluation of the clinical behaviour shows how low grade noninvasive neoplasia is associated with or progressed to GC in about 9% of cases, while high grade noninvasive neoplasia is associated with or progressed to GC in about 75% of cases, thus proving to be a real histological marker of GC. The subdivision of the cases according to the TNM classification demonstrates that, in most of the cases, early GC is present (43/45: 95.5%). An appropriate endoscopy follow-up with biopsies according to well defined criteria increases the likelihood of invasive neoplasia being detected in its early stage with a better postsurgical prognosis. Noninvasive neoplasia is characterized by severe alterations of the immunophenotype profile in association with a high proliferation index and frequent p53 mutations. The choice to address the patients to surgical intervention could be made not only on the basis of histochemical techniques, but also with the help of immunohistochemical evaluations.

Cell Proliferation↗

Transformation in lymphomas--morphological, immunophenotypic and molecular features.

During the course of lymphoma, a clinically more aggressive process with different morphology may develop, referred to as lymphoma transformation. Clonal relationship and pathogenic mechanism of this process are widely debated. The aim of the study was to evaluate morphology, immunophenotype (including EBV status) and clonal relationship in nine cases of lymphoma transformation. Among the six patients with low grade B-cell lymphomas three transformed into high grade B-cell lymphomas (two into diffuse large B-cell lymphoma, one into Burkitt lymphoma) and three into Hodgkin lymphoma. Three other patients with Hodgkin lymphoma presented with transformation into diffuse large B-cell lymphoma in two patients and peripheral T-cell lymphoma in one patient. In all cases there was a sudden clinical change as well as change in morphology and phenotype. In five of the nine patients studied EBV-LMP1 was demonstrated by immunohistochemistry in large transformed lymphoma cells. In two cases molecular studies revealed a different pattern of immunoglobulin gene rearrangement in the large transformed cells as compared to the small cells of primary indolent lymphoma. Thus, they represented secondary, arising de novo neoplasm.

Adult↗

The immunophenotype of hemangiopericytomas and glomus tumors, with special reference to muscle protein expression: an immunohistochemical study and review of the literature.

Glomus tumors and hemangiopericytomas have traditionally been described as neoplasms of pericytes. Ultrastructurally, smooth muscle features have been identified in the cells of the glomus tumor, while the cells of the hemangiopericytoma have been described as more closely resembling normal pericytes. Immunocytochemical studies were performed to demonstrate the immunophenotype of these two tumors and to particularly evaluate expression of muscle-specific actin and desmin. Using the avidin-biotin immunoperoxidase method, formalin-fixed, paraffin-embedded tissue from 16 glomus tumors and 11 hemangiopericytomas was evaluated for the presence of vimentin, low-molecular-weight cytokeratins (35 beta H11), muscle actins (HHF35), desmin (clone 33), S100 protein, nerve growth factor receptor (NGFR5), myelin-associated glycoprotein (CD57), Factor VIII-related antigen, and Ulex lectin. Muscle actins were found in 14 of 16 tumors, and desmin was found in three of 16 of the glomus tumors. None of the 11 hemangiopericytomas expressed either desmin or muscle actins. Variable numbers of both tumors were positive with antibodies to CD57, with the nerve growth factor receptor, and with antibodies to S100 protein. In conclusion, these studies provide immunocytochemical evidence of smooth muscle differentiation in glomus tumors. Although muscle differentiation has been identified in the normal pericyte by expression of muscle-specific actin (HHF35), we find no evidence for analogous differentiation in the population of cells comprising hemangiopericytomas.

Actins↗

The impact of cell heterogeneity and immunophenotypic changes on monitoring minimal residual disease in acute myeloid leukemia.

Monitoring of minimal residual disease (MRD) becomes increasingly important for the more accurate stratification of the therapy in acute leukemia. The purpose of this study was to characterize in detail the phenotypes of heterogeneous population in various AML subtypes and to identify the leukemia associated aberrant phenotype (LAP) in individual patients with AML for precise investigation of MRD. The impact of heterogeneity of pathological populations, the effectiveness of location AML blasts on CD45/SSC dot plots in AML patients during follow-up and phenotype changes on MRD monitoring were evaluated in the second step. Bone marrow samples from 63 patients with AML were analyzed at diagnosis, 33 were selected for monitoring of MRD during follow-up and 13 analyzed at relapse using a wide antibody panel in quadruple combinations by multiparameter flow cytometry. In 88% of AML patients at least one LAP was defined at diagnosis, two or more aberrancies coexisted in 60% of them. The total number of LAPs identified by application of various combinations of antibodies was 112 (mean = 2.04 LAP/patient) and the median percentage of blasts carrying the LAP was 53.57%. In half of the patients, we were able to detect the presence of at least two subpopulations, which not always shared the same aberrancy. Although AML cells often have light scattering properties similar to those of normal (myeloid and B-lymphoid precursors, basophiles etc.) in a fraction of cases we found also very useful the location on CD45/SSC dot plots for MRD discrimination. In 13 patients relapse occurred and although we found in 69% changes of phenotype when comparing diagnosis and the first relapse, at least one LAP was constant in 92%. According to our observations, in majority of patients with AML monitoring of MRD by multiparameter flow cytometry is feasible although in some cases could present some specific difficulties owing to their immunophenotypic heterogeneity, similarity with other cell subpopulations or shifts at relapse. In conclusion, investigation of MRD should be based on the phenotypic characteristics of each subpopulation even if it is present in low frequencies.

Acute Disease↗

[Clinicopathological and cell immunophenotypic analysis of 54 cases of malignant nasopharyngeal/nasal lymphoma].

54 cases of nasopharyngeal/nasal non-Hodgkin's malignant lymphoma (NP/N-ML), including 41 cases of NP-ML and 13 cases of N-ML, were analyzed histologically and immunohistochemically and all of these materials were prepared in paraffin sections. They were all of diffuse type but one, of follicular type. Large cell type lymphomas were more commonly seen in this series (53.1%), and immunoblastic type with cell pleomorphism was more common in N-ML. A panel of monoclonal antibodies composed of LCA, L26, LN2, UCHL1, Leu22, Mac387 and Leu7 was used in this study. There were 27 cases exhibiting T-cell phenotype and 21 cases showing B-cell phenotype. No histiocytic type was found. The ratio of T, B cell lymphomas was different in NP-ML(T: B = 17: 18) and N-ML (T: B = 10: 3) groups, and the predominance of T-cell N-ML was obvious. Immunostaining with cytokeratin, LCA, L26, UCHL1 is of great help in differential diagnosis and immunophenotyping.

Adolescent↗

Enzyme negative blastic transformation of chronic myeloproliferative disorders: immunophenotyping of the blastic cell population.

Enzyme negative blast cells from 27 patients with chronic myeloproliferative disorders (CMPDs) in blastic transformation were analysed with a panel of monoclonal antibodies (MoAbs). According to morphologic features of the bone marrow and laboratory data, the 27 cases were divided into 8 cases of myelofibrosis (MF), 3 cases of chronic megakaryocytic granulocytic myelosis (CMGM) and 16 cases of chronic myeloid leukaemia (CML). Of the 27 cases, 23 showed a positive reaction with myeloid MoAbs, but in 12 cases expressing myeloid markers, megakaryocytic, monocytic or lymphoid cell features were also detected. In 7 cases of MF, 1 case of CMGM and 1 case of CML a bilineage, myelo-megakaryocytoid immunophenotype of peripheral blast cells was seen. Of the 4 patients with CML expressing lymphoid markers, 2 showed early B-cell, 1 T-cell surface antigens, and 1 both myeloid and early B-cell features. In this group of cytochemically immature blastic transformation of CMPD, only 1 case was termed "undifferentiated" blastic transformation.

Adult↗

Immunophenotypization of cells involved in local immune response and serum antibodies in cephalosporin-treated mice.

The in vivo potency of cefodizime (HR 221), tiprotimod (a new synthetic thiazole derivative of HR 221, HBW 538) and cefotaxime to modulate the initiation of immune response in the draining lymph node (LN) after subcutaneous injection of SRBC was evaluated. The timing and sequence of events in the regional LN was investigated by immunophenotypization of node cells with monoclonal antibodies, and the systemic reaction was estimated as primary antibody response to SRBC. From the results it is possible to conclude that: (1) subcutaneous administration of a small dose (2.5-3.0 mg/kg) of cephalosporins, together with antigen, enhanced primary antibody production and persistence; (2) the increase in serum antibodies was preceded by a change in percentage of L3T4+ cells within the regional (popliteal) lymph node. In comparison to antigen alone, cephalosporins (during early immune response) increased the percentage of L3T4+ cells; (3) LN cellularity was strongly enhanced by cephalosporins; (4) cefotaxime influenced the kinetics of the cellularity and the L3T4/Lyt-2 index differently than cefodizime and HBW 538. HBW 538 had either a similar or stronger effect than cefodizime, as judged by the adjuvant effect on antibody production and the appearance of L3T4+ cells during the immunizing period.

Animals↗

Methods in pathology. Identification of T-cell lymphomas in paraffin-embedded tissues using polyclonal anti-CD3 antibody: comparison with frozen section immunophenotyping and genotypic analysis.

While L26 (CD20) is now well established as a B-cell marker of high specificity for use in paraffin-embedded tissues, paraffin-reactive T-cell antibodies (UCHL1, MT1, Leu-22, DF-T1, and MT2) have not shown comparable lineage specificity. A new commercially available polyclonal antibody directed against a synthetic peptide sequence of the CD3 (T-cell) antigen has recently become available for use on paraffin sections. In order to evaluate the utility of this antibody, we studied CD3 expression in conjunction with L26 and leukocyte common antigen (LCA) in 15 T-cell and 20 B-cell non-Hodgkin's lymphomas (NHL), all genotypically confirmed by DNA hybridization and immunophenotyped by immunoperoxidase studies in frozen tissue. Ten of 15 T-cell NHLs (67%) showed unequivocal immunolabeling of neoplastic cells with anti-CD3 in paraffin-embedded tissue. Of the five negative cases, three were lymphoblastic lymphomas, and two were peripheral (postthymic) lymphomas (one anaplastic large cell, Ki-1 positive and one large cell, immunoblastic). CD3 expression was identical in paraffin and cryostat sections (100% concordance). Twenty of 20 B-cell NHLs were positive with L26 and LCA but were negative with anti-CD3. Other neoplasms examined, including three granulocytic sarcomas and 45 nonhematopoietic tumors, were similarly negative with anti-CD3. We conclude that polyclonal anti-CD3 is a sensitive and highly specific T-cell marker in paraffin-embedded tissue and, when used in conjunction with LCA and L26, that it can determine cell lineage in the majority of non-Hodgkin's lymphomas.

Antigens, CD↗

[Variant hairy-cell leukemia: immunophenotypic and ultrastructural study of a case].

The recent introduction of new methods to identify different lymphocytic subsets has made it possible to recognise a rare variant of the classic hairy cell leukaemia, showing intermediate features between prolymphocytic leukaemia and hairy cell leukaemia. A 37-year-old patient is reported who followed a mildly aggressive clinical course and had massive splenomegaly without lymph node enlargement. Moderate leucopenia with lymphocytosis was present, with frequent hairy cells carrying one prominent nucleole. The cytochemical pattern include tartrate-sensitive acid phosphatase positivity, and the immunophenotype of such cells was CD22++, CD11++, CD24-, CD25-, CD2-, CD5-, CD19++. No lamellar ribosomal complex was seen in the ultrastructural study of the hairy cells. The patient was diagnosed as having variant hairy cell leukaemia and achieved partial response after splenectomy. The clinical, diagnostic and therapeutic aspects of this rare variant are discussed.

Adult↗

Inflammatory pseudotumor of the spleen. Morphological, radiological, immunophenotypic, and ultrastructural features.

A case of inflammatory pseudotumor of the spleen is described. Its rapid enlargement, demonstrable by ultrasound studies and computed tomographic scan, its gross appearance, and some of its histologic features suggested malignant lymphoma. However, a characteristic circumferential zonal pattern and polytypic immunophenotype helped to establish the correct diagnosis. In retrospect, the zonal pattern was also identified radiologically.

Adult↗

Immunophenotypic characterisation of monocytoid differentiation markers in acute non-lymphoblastic leukaemias.

The FAB classification of acute non-lymphoblastic leukaemias has been shown to have some clinical use in the prognostication of patient survival. ANLL with monocytoid features (M4, M5) fare worse than those which are predominantly myeloblastic (M1, M2). Classification is, however, sometimes difficult if non-specific esterase activity is not strongly expressed. Monoclonal antibody characterisation of myeloid differentiation antigens may be of some use as a supplementary aid. We immunophenotyped the blast cells from 26 cases for HLA-Dr, CD14 (Mo2, My4), CD13 (My17) and CD33 (My9) expression using the APAAP method. A combination of CD14 and CD33 used together was useful in differentiating myeloblastic from monocytoid acute non-lymphoblastic leukaemias. We conclude that the use of surface markers is a useful adjunct to the diagnostic means presently available.

Antibodies, Monoclonal↗

Human monoblastoid cell line U-937 cultured in protein-free medium: immunophenotype, cytochemical and biochemical markers.

Human monoblastoid cell line U-937 was adapted to grow in protein-free (protein-free hybridoma--PFH) medium and cloned by limiting dilution. Resulting cell subline (U-937/PF) cultured in protein-free medium was characterized by immunological, cytochemical and biochemical techniques. There were no major differences in immunophenotype (determined by FACS analysis with monoclonal antibodies directed to HLA and CD antigens) and cytochemical markers between the U-937/PF cells cultured in protein-free cell culture medium and parental U-937 cell cultured in serum-supplemented medium. Maximal cell density was slightly decreased in protein-free culture as compared to the parental cell line in FCS-supplemented medium. Cell viability and cell DNA histograms (determined by propidium iodide cytofluorimetry) showed no major differences between parental U-937 and U-937/PF cells. Phorbol ester (TPA)-induction of differentiation-associated cell markers resulted in a proliferation arrest and accumulation of G0/G1 cells in both sublines. All-trans retinoic acid and, to a lesser extent, TPA-stimulated NBT reduction was higher in parental U-937 cells cultured in serum-supplemented medium as compared to U-937/PF cells. Quantitative differences in the expression and inducibility of some cytochemical markers (beta-glucuronidase, chloroacetate esterase) were found between both examined sublines. Described U-937/PF subline cultured in a protein-free cell culture medium (PFH) appeared as a potential tool for studies of in vitro inducing agents and serum components with differentiation promoting (or inhibiting) activities.

Acid Phosphatase↗

Peripheral blood and bone marrow immunophenotypic and functional modifications induced in acute leukemia patients treated with interleukin 2: evidence of in vivo lymphokine activated killer cell generation.

The effect of treatment with interleukin 2 (IL2) on the phenotypic and functional immune system of acute leukemia patients was investigated. Fifteen acute myeloid leukemia and acute lymphoid leukemia patients with evidence of persistent disease were further subdivided into two groups according to the percentage of bone marrow (BM) blasts: group a had 6-15% blasts and group b had 30-65%. Following two cycles of IL2 (Glaxo Imb, Geneva, Switzerland) given i.v. by continuous infusion at escalating doses, no major changes in the proportion of CD3-, CD4-, and CD8-positive cells were encountered in the blood or in the marrow of either group of patients. When these could be retested after four cycles of IL2, a significant increase of CD3+ and CD4+ cells was documented in the peripheral blood (PB), as well as a significant increase of CD3+ cells in the BM. Irrespective of the number of cycles administered, the proportion of CD16+ cells increased significantly in the blood in both groups of patients and in the marrow of group a patients only. The expression of CD25 was significantly enhanced in all samples tested. Following IL2 administration, an enhancement of the natural killer compartment was documented. This was consistently more evident in patients with more limited disease. A significant amplification of the in vitro-induced lymphokine-activated killer function was noted in the BM of the treated patients. Furthermore, we documented the presence both in the PB and in the BM of "spontaneous" lymphokine-activated killer cells generated in vivo following IL2 administration. These results demonstrate that in acute leukemia of both myeloid and lymphoid origin, treatment with IL2 is capable of inducing profound immunophenotypic and functional modifications in PB and in BM lymphocytes, particularly in patients with more limited disease. The evidence of the in vivo activation of cytotoxic cells, particularly in the BM, may help to explain the clinical responses preliminarily observed in individual acute leukemia patients.

Acute Disease↗

Immunophenotypic analysis of acute lymphoblastic leukemia using routinely processed bone marrow specimens.

Monoclonal antibodies have been recently developed that react with antigens expressed on T and B lymphocytes in routinely processed, paraffin-embedded lymphoid tissues. In this study, we assessed bone marrow clot and/or core biopsy sections of 19 cases of acute lymphoblastic leukemia (ALL) using routinely decalcified, B5- or formalin-fixed, paraffin-embedded sections and a panel of monoclonal antibodies, including LN1, LN2, L26, Leu-22, UCHL-1, and LCA. Each case had been previously phenotyped using freshly obtained aspirate material and a standard immunophenotypic protocol. Our results demonstrate the utility of the LN2 antibody in differentiating between precursor B-cell (pre-B) and precursor T-cell ALL. The LN2 antibody stained 11 of 12 cases of pre-B ALL and did not react with any of the seven T-cell ALLs. The other antibodies tested were less helpful. The Leu-22 antibody stained both pre-B and T-cell ALLs, while the results with UCHL-1 revealed peculiar nuclear staining of pre-B and T-cell ALLs; this we attributed to processing artifact. The L26 antibody reacted with only one case of pre-B ALL (also CD20 antigen positive), while the LN1 antibody did not react with any pre-B ALLs. Neither L26 nor LN1 stained any cases of T-cell ALL. The LCA antibody stained in only four (21%) of 19 cases, two pre-B and two T-cell ALLs. The results also suggest that this panel of antibodies may be useful in differentiating ALL from mature B-cell and T-cell lymphomas involving the bone marrow.

Antibodies, Monoclonal↗

[Clinical significance of immunophenotype in diffuse non-Hodgkin's lymphoma: with special emphasis on the clinical characteristics of T-cell lymphoma].

The clinical significance of immunophenotyping of the non-Hodgkin's lymphomas (NHL) is still controversial. Therefore, we evaluated the prognostic significance of T- and B-cell phenotype in 102 patients having diffuse non-Hodgkin's lymphoma who had been treated in a majority with Adriamycin-containing regimens. The significant differences in pretreatment clinical variables between the two patient groups were the higher frequency of markedly elevated LDH (greater than or equal to X 2 normal) and the lower frequency of decreased cholesterol level in B-NHL (p less than 0.05). Patients with B-NHL had a higher complete remission (CR) rate (77% vs 59%: p = NS), a significantly better overall survival (62% vs 34% at 3-years: p less than 0.05) and longer duration of remission for all patients (50% vs 27% at 3-years: p less than 0.05). Among forty-five patients with stages III and IV disease of nodal origin (excluding those with diffuse small cleaved histology), the B-cell group was associated with a better prognosis; a higher CR rate (68% vs 41%: p = NS) and a longer duration of remission for all patients (44% vs 12% at 2-years: p less than 0.05). Furthermore, for patients with T-cell phenotype, the primary site was the only prognostic factor; the patients whose disease originated from Waldeyer's ring, nasal cavity, and paranasal sinuses, achieved a better CR rate (92% vs 40%: p less than 0.05) and a longer duration of remission for all patients (48% vs 15% at 2-years: p less than 0.05). We conclude that advanced T-cell lymphoma of nodal origin is a subgroup of patients with very poor prognosis if treated with less intensive chemotherapeutic regimens.

Adolescent↗

The spectrum of lymphoma in Malaysia: a histopathological study utilizing immunophenotyping.

A retrospective study was made to determine relative incidence of lymphoma subtypes in Malaysia. High grade non-Hodgkin's lymphoma was found to be common. Low grade non-Hodgkin's lymphoma and Hodgkin's disease were relatively rare in this Malaysian series. Non-Hodgkin's lymphoma of B-cell immunophenotype was four times as common as that of T-cell lineage. There was a high incidence of primary extranodal non-Hodgkin's lymphoma.

Adolescent↗

Immunophenotypic characteristics of cerebrospinal fluid cells in children with acute lymphoblastic leukemia at diagnosis.

The presence of meningeal involvement in children with acute lymphoblastic leukemia (ALL) may have important prognostic and therapeutic implications. Conventional methods of diagnosing central nervous system (CNS) leukemia rely on the interpretation of cerebrospinal fluid (CSF) cell morphology, which may produce ambiguous results in the presence of minimal leukemic involvement. A methodology has been developed for immunophenotyping small numbers of CSF cells while preserving cell morphology. CSF samples from 33 children with CD10 (common ALL antigen [CALLA]) positive ALL were examined at initial presentation using both conventional morphology and this combined immunohistopathologic technique. Six (18%) of the samples contained lymphoblasts or cells considered morphologically suspicious for leukemic involvement. Nine additional samples (27% of the total) had normal CSF morphology, but contained increased numbers of CALLA positive cells. Twelve of the 33 samples were also examined for the simultaneous presence of nuclear terminal deoxynucleotidyl transferase (TdT) and demonstrated increased numbers of cells positive for both TdT and CD10. These data suggest that a large proportion of children with ALL may have abnormalities of CSF cells at initial diagnosis consistent with the presence of occult leukemic involvement.

Adolescent↗

Methods in pathology. Immunophenotype of hairy cell leukemia in paraffin sections.

The immunophenotype of hairy cell leukemia (HCL) was investigated using 20 routinely fixed paraffin-embedded tissue sections (12 bone marrows, six spleens, one liver, one lymph node) from 12 patients known to have this disease. A panel of antibodies was used, including anti-leukocyte common antigen (anti-LCA), B-lineage antibodies (LN2, MB2, L26), T-lineage reagents (MT1, UCHL1), monocytic (anti-cathepsin B) and myelomonocytic (anti-lysosyme, Mac 387) antibodies, and other less lineage-specific markers (anti-S-100, anti-alpha-1-antichymotrypsin (anti-alpha 1-ACT), anti-alpha 1-antitrypsin (anti-alpha 1-AT), anti-vimentin). Anti-LCA stained hairy cells in seven of the 12 bone marrows and consistently recognized hairy cells in the spleen, liver, and lymph nodes. Hairy cells generally reacted with B-lineage antibodies and were not labeled by T-lineage markers. No reactivity was noted with myelomonocytic antibodies, anti-S-100, anti-alpha 1-ACT, or anti-alpha 1-AT. Vimentin was expressed in the majority of cases. Tartrate-resistant acid phosphatase reactivity was demonstrated in three of the 20 routinely processed tissue sections. These data suggest that immunohistochemical studies of hairy cell leukemia in routinely processed tissue may be useful in diagnostic hematopathology and surgical pathology.

Acid Phosphatase↗