Journal of Clinical and Experimental Hematopathology
Online ISSN : 1880-9952
Print ISSN : 1346-4280
ISSN-L : 1346-4280
Volume 48 , Issue 2
Showing 1-7 articles out of 7 articles from the selected issue
Original Article
  • Masaru Kojima, Kazuhiko Shimizu, Hayato Ikota, Yoshihiro Ohno, Tadashi ...
    2008 Volume 48 Issue 2 Pages 39-45
    Published: 2008
    Released: November 27, 2008
    JOURNALS FREE ACCESS
    Occasionally, the hyaline-vascular type of Castleman's disease (HVCD) contains numerous lymphoid follicles which usually occupy more than 50% of the lesion. Such lesions are called the follicular variant (FV) of HVCD. To clarify the histological and immunohistochemical findings of lymphoid follicles in the FV of HVCD, we examined 11 such cases. Histologically, five types of lymphoid follicles were delineated. Lymphoid follicles ; (i) with normal germinal centers (GCs) ; (ii) showing follicular lysis ; (iii) with progressive transformation of GC (PTGC) ; (iv) where the large nodule of mantle zone lymphocytes contained multiple small atrophic GCs (multiple GC pattern) ; and (v) where the large, often irregularly shaped nodules of mantle cells radically penetrated small vessels with inconspicuous GCs. These nodules somewhat resembled primary lymphoid follicles (primary follicular pattern). The majority of lymphoid follicles in all 11 cases were of the primary follicular pattern and/or multiple GC pattern. However, three lesions also contained normal germinal GC, while two contained normal GC, follicular lysis and PTGC and one other contained normal GC and PTGC. Moreover, in 3 cases of primary follicular pattern, the majority of the lymphoid follicles were surrounded by a pale cuff of mantle cells. Because of the presence of numerous lymphoid follicles, the FV of HVCD should be sometimes differentiated from Hodgkin lymphoma and low-grade B-cell lymphomas showing follicular growth pattern. Recognition of the histological and immunohistochemical findings of the FV of HVCD is needed to avoid overdiagnosis. [J Clin Exp Hematopathol 48(2) : 39-45, 2008]
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Case Study
  • Hitoshi Ohno, Kotaro Isoda
    2008 Volume 48 Issue 2 Pages 47-54
    Published: 2008
    Released: November 27, 2008
    JOURNALS FREE ACCESS
    Here we describe two cases of mucosa-associated lymphoid tissue (MALT) lymphoma with monoclonal immunoglobulins (Igs). The first case was a 77-year-old man with primary lymphoma of the lung. Immunoelectrophoresis detected IgM-κ in serum and κ light chain excretion into urine. Three months after treatment with single-agent rituximab, a large amount of pleural fluid was found to have accumulated. The fluid contained CD5-, CD10-, CD19+, CD38+ and CD138-/+ lymphoma cells with lymphoplasmacytoid appearance. Although a small fraction of the cells were CD20+, the majority of the lymphoma cells were negative and expressed surface-membrane IgM-κ at low levels. The cells possessed a karyotype of 46, XY, t(11;18)(q21;q21). The second case was a 55-year-old man who underwent total gastrectomy due to gastric perforation. Surgical specimens demonstrated the histopathological features of MALT lymphoma associated with plasma cell differentiation. The lymphoma cells had a 46, XY, t(11;18)(q21;q21) karyotype. Monoclonal Igs detected were serum IgA (M)-κ and urinary κ light chain. The patient was subsequently treated with six cycles of R-CVP (rituximab, cyclophosphamide, vincristine and prednisolone) ; however, serum monoclonal Ig levels were not affected. The lymphoma cells in both cases may have contained two populations, a rituximab-sensitive CD20+ population and a rituximab-resistant population that had differentiated into the Ig-secreting plasma cell stage. [J Clin Exp Hematopathol 48(2) : 47-54, 2008]
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  • Masaru Kojima, Shinji Sakurai, Yukio Morita, Naoya Nakamura, Shiro Sug ...
    2008 Volume 48 Issue 2 Pages 55-59
    Published: 2008
    Released: November 27, 2008
    JOURNALS FREE ACCESS
    We report here a case of idiopathic CD4+ T-lymphocytopenia (ICL) associated with Epstein-Barr virus (EBV)+ lymphoproliferative disorder (LPD) terminating in Burkitt lymphoma (BL). A 33-year-old Japanese male was admitted to the hospital showing severe CD4+ lymphocytopenia and neutropenia that was diagnosed as ICL in 1993. Twenty months after the onset of disease, right cervical lymphadenopathy was detected. Biopsy of the specimen showed reactive lymph node hyperplasia and interfollicular B-cell hyperplasia. Ninety-one months later, polypoid tumors were resected from the bilateral nasal cavities and were diagnosed as BL. Immunohistological studies suggested the reactive nature of the initial lymph node biopsy specimen. Polymerase chain reaction (PCR) analyses of immunoglobulin heavy-chain gene (IgH) demonstrated a polyclonal pattern in the initial lymph node lesion. However, the subsequent BL demonstrated a clonal band in the PCR assay for the IgH gene. As demonstrated in human immunodeficiency virus (HIV)-patients, clonal expansion of EBV infected B-cells in the initial lymph node lesion may progress to BL in this patient. The present case did not associate with severe opportunistic infections during the course of disease. EBV+ BL may be the first manifestation of severe immunodeficiency of the ICL in this patient. [J Clin Exp Hematopathol 48(2) : 55-59, 2008]
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  • Tatsuya Ihara, Daisuke Okamura, Naoki Takahashi, Mika Kohri, Hidekazu ...
    2008 Volume 48 Issue 2 Pages 61-64
    Published: 2008
    Released: November 27, 2008
    JOURNALS FREE ACCESS
    Rhabdomyosarcoma is exceedingly rare in adults. A 62-year-old woman was referred to our hospital because of general pain. Computed tomography revealed a solid tumor in the right nasal cavity. Histopathological examination showed solid proliferation of atypical small round cells, having cytologic features reminiscent of lymphomas, and lacking the fibrovascular stroma. The cells were CD56+, desmin+, vimentin+, HHF35+, myogenin+ and MyoD1+. The patient was positive for the PAX3-FKHR fusion gene. The patient was diagnosed as having alveolar rhabdomyosarcoma. We conclude that rhabdomyosarcoma should be included in the differential diagnoses of CD56+ small round cell tumor, and immunohistochemical and cytogenetic studies should be performed. [J Clin Exp Hematopathol 48(2) : 61-64, 2008]
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  • Fuminori Sano, Taizo Tasaka, Hirotake Nishimura, Takashi Akiyama, Yasu ...
    2008 Volume 48 Issue 2 Pages 65-69
    Published: 2008
    Released: November 27, 2008
    JOURNALS FREE ACCESS
    Differential diagnosis between plasmacytoid dendritic precursor cell leukemia (pDC leukemia) and acute myeloid leukemia (AML) with monocytic differentiation is difficult due to shared clinicopathological features ; however, such diagnosis is critical because the two leukemias are treated differently. Here we report a peculiar case of AML mimicking pDC leukemia. A 22-year-old man presented with leukocytopenia and bone marrow involvement of atypical plasmacytoid cells with a prominent nucleolus. In spite of positive cytochemical staining for NaF-sensitive naphthyl butyrate esterase, this case was diagnosed as pDC leukemia because the abnormal cells were positive for CD4, CD56, and CD123, and negative for myeloperoxidase and lysozyme. The patient achieved complete remission after 4 courses of combination chemotherapy, but relapsed four months later with leukemic manifestation and skin involvement. The morphology of the leukemia cells became myelomonoblastic, and some were immunohistochemically positive for lysozyme, suggesting AML. Although the patient received allogenic stem cell transplantation twice, he died of progressive disease. This case demonstrates the importance of cytochemical staining for naphthyl butyrate esterase in differential diagnosis between AML and pDC leukemia coexpressing CD4, CD56, and CD123. [J Clin Exp Hematopathol 48(2) : 65-69, 2008]
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