Proliferation, apoptosis and p53 protein expression in adult T-cell leukemia (ATL) cells were investigated. Twenty peripheral blood tissue specimens (PBTS) comprising 7 cases of acute type ATL, 7 cases of chronic type ATL and 6 other leukemias were examined by means of antigen retrieval and the polymer method employing anti-Ki67 antigen (MIB-1), anti-cleaved caspase-3, anti-single stranded DNA and three kinds of anti-p53 protein antibodies including DO7. Most acute and chronic cases of ATL included more than 10% MIB-1-positive proliferating leukemia cells and more than 1% cleaved caspase-3-positive apoptotic cells. Some cells which were positive for both MIB-1 and anti-cleaved caspase-3 antibody were observed in acute type ATL. Nuclear deposition of p53 protein labeled by DO7 was often found in acute type (p < 0.05). Within the medium-sized population of ATL cell nuclei, DO7-positive ATL cells had a smaller nuclear area factor (long axis x short axis) than DO7-negative ATL cells. A few proliferating ATL cells entered apoptosis, and the appearance of a subclone of ATL cells with nuclear deposition of p53 protein labeled by DO7 characterized acute type. [J Clin Exp Hematopathol 48(1) : 1-10, 2008]

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The pathology of B-lymphocytes in the bone marrow of patients with idiopathic thrombocytopenic purpura (ITP) has not been well described, even though B-lymphocytes may be involved in the etiology of ITP. We retrospectively reviewed the medical records of 73 ITP patients between January 1997 and June 2005 with platelet counts of < 50 x 10⁹/L. Bone marrow clots were available for pathological review in 56 patients who were classified into 3 groups based on the results of the bone marrow clot examination : Group A (21 patients) had increased CD20⁺ lymphocytes (≧1% of nucleated cells) and megakaryocytes with morphologic changes ; Group B (21 patients) had morphologic changes but no increase in CD20⁺ lymphocytes ; and Group C (14 patients) had neither morphologic changes nor increased CD20⁺ lymphocytes. Multivariate analysis showed that, compared to Group A, Group B had a significant prognostic factor (p = 0.04 ; odds ratio, 6.65 ; 95% confidence interval, 1.09 to 40.54) for achieving complete response, while Group C had a significant prognostic factor for any treatment response (p = 0.04 ; odds ratio, 14.26 ; 95% confidence interval, 1.08 to 188.02). Thus, ITP patients can be classified with different clinical outcomes based on immunohistopathological examination of bone marrow clots. [J Clin Exp Hematopathol 48(1) : 11-15, 2008]

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The purpose of this study is to show that the histopathological type of an orbital lymphoma can differ from the systemic follicular lymphoma that precedes it. A 44-year-old man (Patient #1) and a 50-year-old man (Patient #2) presented with generalized lymphadenopathy due to grade 1 follicular lymphoma proven on lymph node biopsy. Patient #1 was followed without treatment for 16 years when he developed a right orbital mass. Patient #2 underwent several courses of combination chemotherapy as well as radiation but relapsed. The second biopsy of the lymph node nine years later showed the same histopathological type of follicular lymphoma. He developed an orbital mass on the right side 16 years after the initial presentation. In Patient #1, excisional biopsy of the orbital masses showed extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). In Patient #2, biopsy revealed the orbital mass to be T-cell/histiocyte-rich diffuse large B-cell lymphoma. In Patient #1, when comparing the original lymph node biopsy to the orbital biopsy obtained years later, no evidence for clonality was noted by polymerase chain reaction. In Patient #2, the amplification by polymerase chain reaction of the immunoglobulin heavy chain gene rearrangement in the lymph node lesion and the orbital lesion gave rise to a single discrete band with the same DNA sequence except for five nucleotide changes, indicating the same clonality in the presence of genomic changes. In conclusion, orbital lymphomas can occur as a second lymphoma with a different histopathological type in the long-term follow-up of systemic lymphomas. The original and subsequent lymphomatous lesions may or may not share neoplastic cell clonality and all genomics. [J Clin Exp Hematopathol 48(1) : 17-24, 2008]

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Intravascular large B-cell lymphoma (IVL) is rare aggressive disseminated lymphoma associated with poor outcomes. Rituximab is a novel molecular agent that can reportedly improve outcomes for patients with diffuse large B-cell lymphoma. However, the safety and efficacy of rituximab in patients with IVL are unclear. A 76-year-old woman was hospitalized due to altered consciousness, fever and respiratory abnormalities. Definitive diagnosis of IVL was obtained following repeated biopsies of bone marrow. The patient received chemotherapy consisting of cyclophosphamide, vincristine, doxorubicin, prednisolone, and rituximab (R-CHOP), and achieved complete remission after 3 courses of treatment. She has remained in complete remission for over 3 years after diagnosis. This report suggests that rituximab-containing regimens could be safe and effective for elderly patients with IVL. [J Clin Exp Hematopathol 48(1) : 25-28, 2008]

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