T細胞リンパ腫142例をLSG分類で分類し,ATLA陰性リンパ腫(47例)をATLA陽性リンパ腫(ATLL 95例)と免疫臨床病理学的に比較検討することにより,ATLA陰性T細胞リンパ腫の病理像の解析を試みるとともにATLLの再検討を行った。
ATLA陰性T細胞リンパ腫は,ATLA陽性のものに比し予後良好で,臨床像でも白血化及び皮膚浸潤率は低く,高カルシウム血症も1例を除き認めなかった,一方,異常ガンマグロブリン血症を高率に認めた。組織像では組織球,形質細胞,反応性リンパ濾胞などの多彩な反応性成分を随伴する例が多く,さらにその約半数は“Lennert lymphoma”,“T-zone lymphoma”あるいは“IBL-like T cell lymphoma”のいずれかの特徴的な組織像を呈し,ATLA陰性T細胞リンパ腫の中核を形成する一群と考えられた。
一方ATLA陽性T細胞リンパ腫では,多形細胞型に限らず,脳回状核巨細胞あるいは“かえでの葉”状の核をもつ中型リンパ腫細胞の増殖がみられるとともに多形細胞型の例と共通の臨床像,予後を示すものが多く,これらは一括して多形細胞型として取り扱うべきであると考えられた。免疫学的には,ATLA陰性T細胞リンパ腫の多くはATLA陽性のもの同様helper/inducerの形質を示すが,T4陽性細胞とT8陽性細胞が混在する例もかなりみられた。Tac抗原はATLA陽性T細胞リンパ腫で高い陽性率がみられたが,ATLA陰性T細胞リンパ腫ではTac抗原陰性のものが多かった。

抄録全体を表示

A case of primary malignant lymphoma of the stomach is reported. A 66-year-old man had an abdominal operation for subtotal gastrectomy due to massive bleeding from a stomach tumor.
Under light microscopy, the tumor was identified to be a diffuse large cell lymphoma, large non-cleaved, according to the Working Formulation. It was quite unusual that also there were numerous cells which exhibited Russell bodies, among the typical large non-cleaved ones.
Some of these cells with Russell bodies, had the same atypical nuclei as lymphoma cells, and these Russell bodies were positive for PAS stain. By the immunohistochemical analysis (ABC method) for IgA, λ and J chains, Russell bodies stained strongly positive and some of the lymphoma cells were also positive though in a spotty form, but for IgG, IgM and κ chains, all stained negative.
These results indicate that those cells with Russell bodies, which did not appear as of the reactive component, had monoclonality and that some cells within, originated from lymphoma cells and produced IgA-λ type immunoglobulin which led to the formation of Russell bodies. Clinically, the patient was induced to a complete remission state by the combination chemotherapy of VEPA (vincristine, endoxan, prednisolone, adriamycin), and he has been maintaining the complete remission for two years now.

抄録全体を表示

Immunohistochemical study was performed on skin and lymph node frozen sections from 59 adult T cell leukemia/lymphoma (ATLL) and 10 cutaneous T cell lymphoma (CTCL) patients.
Lymphoma cells of ATLL-infiltrating lymph nodes were of a mature helper/inducer phenotype (OKT4+, OKT8-) in 70.7% of patients, a double helper and suppressor phenotype (OKT4+, OKT8+) in 19.5%, and a defective T cell phenotype /(OKT4-, OKT8-, OKT11+) or (OKT4+, OKT8-, OKT11-)} in 9.8%. In addition, site- or time-dependent phenotypic heterogeniety was found in three of eight patients with repeat biopsies.
There was no apparent relation between histopathological features and reactivities to various monoclonal antibodies except for Ki-1 and FTF-148.
All Ki-1 positive ATLL cases were of large cell type.
FTF-148 was positive mainly in multinucleated giant cells of ATLL.
NK cells (Leu7+), B cells (Leu12+), interdigitating reticulum cells (OKT6+), and histiocytes (LeuM3+) were not significant components in lymph nodes of ATLL.
A number of Langerhans cells (OKT6+ cells) were found in close association with tumor cells in dermal lesions in ATLL as well as in CTCL.
Proliferating cell ratio of ATLL (ratio of Ki-67+ cells) was unexpectedly low (mean: 11.2% in the lymph nodes, 2.9% in the skin). This results suggest that factors other than proliferating potential of tumor cells may play an important role in clinical aggressiveness of ATLL, and the skin may not be a suitable organ for ATLL cell proliferation in despite of cutaneous affinity of ATLL cells.
Monoclonal antibodies, FTF-148 and LeuM3 were useful for distinction between ATLL-involved skin and CTCL.

抄録全体を表示

A new monoclonal antibody, designated UFT-4, raised against rat Kupffer cells was produced using a sinusoidal liver cell-fraction as immunogen. In immunohistochemistry, UFT-4 reacted with Kupffer cells, interdigitating cells (IDC), sinus endothelial cells of the spleen, some reticulum cells, smooth muscle fibers and choroid plexus epithelia. Immunoelectron microscopy gave a positive reaction for a part of cytosol of Kupffer cells, IDCs, sinus endothelial cells of the spleen and some reticulum cells in a linear or filamentous fashion with some periodicity. On the other hand, blood monocytes and most macrophages in lymphatic sinus, lymphoid follicle, splenic red pulp and connective tissue were negative. The former cells, positive for UFT-4, almostly belong to a narrow spectrum of the classical reticuloendothelial system, explaining a close relationship between some endothelia and some macrophages or reticulum cells. The present result disclosed that UFT-4 is very usefull to study Kupffer cells and further to reestimate their origin and peculiar character in reticuloendothelial system.

抄録全体を表示

The existence of two kinds of IgE Fc receptors which are high affinity IgE Fc receptor on mast cell and basophil, and low affinity IgE Fc receptor, differing in their affinity, has been reported. Low affinity IgE Fc receptor (FcεR) was successively analysed on the human lymphoid cells and macrophages. Present authors tried to examine the distribution of FcεR in the lymph nodes and the extranodal tissues (Kimura's disease, Warthin's tumor, thyroid disorder and tonsillitis) by immunohistochemical method with specifically reacting monoclonal antibody to FcεR (H107). In the germinal centers (GCs) of the lymph follicles in above mentioned tissues, FcεR distribute with lacy network pattern which were proven electron microscopically to coinside with the surface of the follicular dendritic cells (FDCs). Besides, lymphoid cells occupying in corona of lymph follicle were positive for FcεR. The positivity were detected irrespective of positivity of IgE in GCs. FcεR, in the GCs, was positive in the light zone and not in the dark zone which was DRCl positive area. IgE positive GCs in Kimura's disease always bearing hypergammaglobulinemia E and in Warthin's tumor were positive for FcεR in their entire portion, and the expansion of positive area was due to increase of FcεR positive FDCs. Moreover, IgE positive GCs revealed positive reaction for FcεR more intensively than IgE negative GCs and the difference of positive intensity depend on number of FcεR positive lymphoid GC cells. These findings indicate that FcεR on FDCs has close relation to IgE immune response and also was a indicator for functional phase of differentiation of FDCs.

抄録全体を表示

An autopsy case with atypical adult T cell leukemia lymphoma (ATL) was reported. A 24-year-old male who had skin lesions and respiratory distress as premonitory symptoms from his childhood. Skin lesions appeared in the form of vasculitis. Infiltration of ATL cells were not recognizable in the skin and peripheral blood. On his admission, before four months of his death, ATLA (antibody to ATL virus associated antigen) was detected to be positive in his serum and simultenously also in the serum of his mother whose native place south-west region of Japan (Kagawa prefecture). After admission, acute abdominal symptoms occurred and roentgenography revealed multiple intestinal ulcers. He was treated with surgical operations three times, however, massive alimentary bleeding has continued and died on July, 1, 1987.
The infiltration of atypical lymphoid cell of T cell character (Leu 1 positive) was observed in the ulcerated walls of intestine surgically resected. Autopsy revealed systemic swelling of lymph nodes of their cell components being in agreement with picture of pleomorphic type of ATL Invasion of ATL cells were found in various organs, i.e. liver, kidneys, spleen, gastrointestinal tract, adrenals and bone marrow. Moreover, remarkable haemophagocytic cells appeared in the lymph nodes, spleen and liver. Lymphoid cells had pleomorphic contour and large, irregular shaped, convoluted nuclei. Immunocytochemically, these cells were positive for Leu 1 and faintly positive for OKIa. On the other hand, reaction for MT-1, MB-1, immunoglobulins and histiocytic markers were negative. Phagocytic histiocytes positively reacted for lysozyme, α₁-antitrypsin, and CEA, but negatively for S100 protein. No pulmonary infection was recognized. From clinical and anatomical evidences the patient developed typical ATL having duration of more than ten years with insidious course but without leukemic manifestation. This picture corresponded to smoldering ATL proposed by Takatsuki and Yamaguchi.

抄録全体を表示

In order to clarify the pathology of familial amyloidotic polyneuropathy, 9 autopsy cases and 5 biopsy cases of the disease occurring in Arao city of the Kumamoto Prefecture, Japan, were examined pathologically, histochemically, immunohistochemically and electron microscopically. The autopsy cases were 4 males and 5 females, and their age of death ranged from 36 to 56 years (45.2 years in average). Biopsy was performed from the sural nerves in 4 males and one female of the same families at the age of 26 to 48 years (39.6 in average). In the autopsy cases, amyloid deposition was marked in the peripheral nerve tissues, choroid plexuses, cardiovascular system, kidneys and thyroid. In the cardiovascular system, amyloid favorably deposited in the wall of small blood vessels, particularly arteries, and in their surrounding tissues. In the cardiac conduction system, the sinoatrial node and both bundle branches were severely affected, accompanied by amyloid deposition, whereas the atrioventricular node and His bundle were less involved. In the sural nerves of the biopsy cases, degenerative changes corresponding in degree to the duration of their clinical course were observed particularly in the endoneurium and amyloid deposition occurred around the blood vessels. On electron microscopy, degenerative changes were confirmed in the axon, myelin sheath and Schwann cells, accompanied by irregularity of the cytoplasmic processes, increased numbers of collagen fibers and regeneration of myelinated nerve fibers. The morphometric study showed decreased numbers of small-calibred myelinated fibers during the early stage. In the kidneys, amyloid deposition was found in almost all the glomeruli and diffusely around the renal tubules. However, amyloid deposition in the liver, bone marrow, lymph nodes or central nervous system were less marked. Histochemically, the amyloid deposits were resistant to KMnO₄ treatment in Congo red stain, and immunohistochemistry demonstrated the amyloid precursor protein to be prealbumin.

抄録全体を表示