An autopsy case of primary adrenal malignant B cell lymphoma in a 66-year-old female is reported. Autopsy revealed a clearly demarcated tumor (6.5×5×3cm) in the left adrenal gland, while no tumor formations were observed in other organs or systemic lymph nodes. The adrenal tumor histologically showed diffuse growth of lymphoma cells, which was classified as diffuse, large sized cell type in the LSG classification and diffuse, centroblastic lymphoma in the Kiel classification. Immunohistochemically, the lymphoma cells were positive for CD20, CD22 and HLA-DR on frozen section, and L26 and LN-2 on paraffin section. T cell markers and Factor VIII related antigen were negative. Microscopic involvement of small vessels, presenting as a picture of intravascular lymphomatosis, was found in systemic organs including central nervous system. Examination of peripheral blood smear disclosed the presence of atypical lymphoid cells in about 1%. Therefore, this adrenal lymphoma was considered to have transformed to a subleukemic state.

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A case of primary splenic histiocytic sarcoma is reported.
A 29-year-old man was admitted to Fukushima Medical College Hospital for pretibial edema. Physical examination showed splenomegaly without lymphadenopathy and hepatomegaly. Laboratory findings revealed thrombocytopenia and hypoproteinemia, and bone marrow aspirate and biopsy were normal. Clinically, splenic malignant lymphoma was suspected and surgical splenectomy was performed. His symptoms resolved after the treatment.
The spleen weighed 730g and a well-defined reddish-colored tumor was observed on cut surface. The tumor was composed of an intense infiltration of variable sized histiocytic cells, from 8μm to 20μm in diameter, containing abundant eosinophilic cytoplasm and large round to oval nuclei.
Mitotic figures were a few and multinuclated giant cells were occasionally seen. The tumor cells were considered as monocyte/histiocyte series based on cellular morphology and immunological charactaristics for monocytic markers and germline of immunogloblin heavy chain (JH) and T-cell recepter beta chain (Cβ₁) genes. Flow-cytometric DNA analysis showed a hypodiploidy pattern. These findings indicate that the present case is primary splenic histiocytic sarcoma with low grade malignancy.

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We report here an autopsy case of T-cell angiotropic lymphoma with atypical clinical course. A 47-year-old male was admitted because of a speech disturbance. His brain CT revealed intracerebral hemorrhage, and an evacuation of intracranial hematoma was performed. The examination of the brain tissue resected at the operation showed hemorrhagic cerebral infarction. He was discharged on the 25th postoperative day without symptoms. Four weeks later, he was re-admitted because of high fever and dyspnea on effort. His laboratory findings showed mild hypoxemia and elevated serum LDH (6075IU). Six days after the admission, he abruptly presented tonic convulsion. His brain CT revealed hemorrhage in the left occipital lobe, and he admitted to NCU. Though steroid pulse therapy and artificial respiration were performed, respiratory failure and DIC progressed, and he died fifteen days after the admission.
At autopsy, the histological examination showed a multifocal proliferation of lymphoma cells within the lumens of small blood vessels in almost all of the organs. These tumor cells had T-cell surface markers, so final pathological diagnosis was T-cell angiotropic lymphoma.
Most cases of angiotropic lymphoma (neoplastic angioendotheliosis) reported in the literature are derived from B-cell lymphoma, and T-cell angiotropic lymphoma is very rare.
The clinical course of our case was a rapidly progressive one, and he presented various symptoms such as hemorrhagic cerebral infarction, respiratory failure and DIC. This is the first report of intracranial hemorrhage in angiotropic lymphoma.

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One hundred twenty-nine cases of B-cell lymphoma were immunohistologicaly examined for the expression of CD5 antigen and other B-cell associated antigens. CD5 antigen was detected in 4 of 10 cases of diffuse small cell lymphoma, 11 of 16 cases of diffuse medium sized cell lymphoma, and 11 of 83 cases of diffuse large cell lymphoma. None of 17 follicular lymphoma cases expressed this antigen. CD5 positive diffuse small cell lymphoma (CD5+small) cases had common clinical and immunohistological findings and were diagnosed as chronic lymphocytic leukemia. CD5 positive diffuse medium sized cell lymphoma (CD5+medium) cases also formed a group with clinical and immunohistological features which corresponded to those of intermediate lymphocytic lymphoma. Both of them had an advanced disease on admission and a phenotype of CD5+CD10-sIgD+. On the other hand, CD5 positive diffuse large cell lymphoma (CD5+large) cases had various clinical and histological findings. Their phenotype was CD5+CD10-sIgD+/-. The relationship between CD5+ large and CD5+small or CD5+medium remains unclear. Most of CD5 negative diffuse small and medium sized cell lymphoma cases presented with localized extranodal disease involving ocular adnexa, lung, intestine and so on, in contrast to the findings that CD5+small and CD5+medium cases had an advanced disease. They expressed a CD5-CD10-sIgD-phenotype. These findings suggest that there are three distinct disease entities within the low grade B-cell lymphomas: 1) follicular low grade lymphoma, 2) CD5 positive diffuse low grade lymphoma, 3) CD5 negative extranodal low grade lymphoma.

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Immunohistochemical and genotypic (bcl-1 and bcl-2 gene) studies were performed on 43 cases with B cell lymphoma to clarify the histogenesis of mediumsized B cell lymphoma of follicular lymphoma, medium-sized cell type and of diffuse lymphoma, medium-sized cell type.
The cases examined were classified according to LSG classification; 26 cases of diffuse lymphoma, medium-sized cell type (DL-medium), 8 cases of follicular lymphoma, medium-sized cell type (FL-medium), 7 cases of FL, mixed type (FL-mixed), and 2 cases of FL, large cell type (FL-large).
Southern blotting analysis revealed that rearranged band of bcl-1 gene were observed in 6 cases (23%) of DL-medium, whereas no rearrangement was found in FL cases. Immunohistochemically, 22 cases (85%) expressed at least one of alkaline phosphatase (ALPase), sIgD and CD5, which are thought to be characteristic of mantle zone lymphocyte (MZL) of secondary follicles. In addition, among 6 cases with bcl-1 gene rearrangement, 5 cases (83%) showed CD5 expression. In contrast, bcl-2 gene rearranged band, using major breakpoint region probe were detected in 6 cases of FL (36%; 3 cases of FL-medium and 3 cases of FL-mixed), whereas all cases of DL-medium were in germline configuration. Five cases (83%) among 6 cases with bcl-2 gene rearrangement expressed CD10, which is characteristic of follicular center cell (FCC). The correlation between CD10 expression and bcl-2 gene rearrangement was statistically significant (p<0.05%) in follicular lymphomas. The genetic data support that DL-medium B cell lymphomas with a phenotype of MZL are of primary follicle or MZL of secondary follicle origin. In addition, there is a close correlation between CD10 expression and bcl-2 gene rearrangement.
In conclusion, the histogenesis of DL-medium and FL-medium are not only immunohistochemically but also genotypically distinguishable by their configuration of bcl-1 and bcl-2 gene rearrangement.

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A rare case of hybrid acute leukemia is presented. The patient, a 37-year-old man, was admitted to our hospital in September, 1991, suffering from lassitude, fever, lumbago, and slight leukocytosis associated with increased lymphoid blast cells. The bone marrow was remarkably infiltrated by similar blast cells. The blast cells were negative for cytochemical myeloperoxidase (MPO), Sudan black B, non-specific esterase, and specific esterase. MPO activity was not detected in the blast cells even by electron microscopy. Nonetheless, the blast cells were positive for immunocytochemical MPO. A surface marker analysis of the blast cells showed that they were positive for CD13, 19, 33 and 34; that is, the blast cells had both myeloid and lymphoid natures. Moreover, rearranged patterns of immunoglobulin heavy chain gene and T-cell receptor β-chain gene were confirmed in the blast cells. Thus, a diagnosis of hybrid acute leukemia was made. An intensive chemotherapy for acute lymphoblastic leukemia was effective, and a complete remission was achieved. The present case seems rare in the following points. (1) The blast cells possessed both myeloid and T-/B-lymphoid characteristics. (2) Although the blast cells were negative for cytochemical MPO, they were positive for immunocytochemical MPO. This fact suggests that immunocytochemical MPO staining is much more sensitive than cytochemical one, and is useful to detect faint myeloid characteristics.

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In order to elucidate the epidemio-etiological factors of NHL in Jilin Province, a comparative study on 116 cases of the 3rd Hospital of Norman Bethune University of Medical Science (1977-1990) and 252 cases of the Akita University Hospital (1972-1992) was histologically and immunohistochemically performed, applying the modified classification of the Working Formulation by Nathwani. (Jilin Province and Akita Prefecture which respectively situated at lat. 44° and 40° N. and both have great agricultural activities.) The results obtained were as follows: 1. Overall mean age was 39.0 and 55.2 years in Jilin and in Akita, respectively. The age distribution curve of Jilin showed a bimodal pattern with peaks at 20-29 and 40-59 years of age, and the analysis in Akita revealed a peak at 50-69 years. 2. The male to female ratio was 2.9:1 in Jilin and 1.6:1 in Akita. 3. In Jilin, the commonest affected site was the intestine, particularly the small intestine, and mesenteric lymph node. The higher incidence of the intestine in Jilin suggests intestinal inflammation (by infection of pathogenic organisms, or intake of water or vegetables contaminated by agricultural chemicals) as an important risk factor. In Akita, cervical lymph node and Waldeyer's ring were the two commonest sites. 4. The incidence of follicular lymphomas in Jilin was higher than that in Akita, because of its higher incidence in the small intestine cases. The incidence of diffuse lymphomas in Jilin was similar to that in Akita. 5. The B/T ratio indicated 4.0:1 and 2.8:1 in Jilin and in Akita, respectively. DLnc was the commonest histological subtype of B cell lymphomas both in Jilin and Akita, which even prominent in Jilin. The incidence of T cell lymphomas in Jilin was slightly lower than that in Akita, possibly due to absence of the case of ATLL subtype in Jilin.

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We investigated the heterogeneity of the surface morphology and cellular distribution of Ia antigen molecules in macrophages activated with a bacterial antigen OK-432 using scanning electron microscope, digitized fluorescent microscope, and flow cytometer.
Four types of rat peritoneal macrophages were identified by scanning electron microscopy, namely; small and oval cells (type A), medium size cells with long processes (type B), large dish-like cells with processes (type C), and large flat cells with processes (type D).
An intraperitoneal injection of OK-432 resulted in the marked reduction of type A and the gradual increase of types C and D.
Digitized fluorescence microscopy showed that four types of cellular distribution of Ia antigen molecules on the macrophage surface were distinguishable by the contrastenhanced video image analysis; central type, diffuse type, ring type, and peripheral patch type. A and B type cells tended to show ring or peripheral patch type-Ia antigen distribution. In contrast, type C and D cells showed central or diffuse type-Ia antigen distribution.
The expression of Ia antigen molecules on macrophages increased in proportion to the surface area of the cells, while for the four types of macrophages the relative amount of Ia antigen per unit surface area was almost constant.
The local graft-versus-host reaction assay revealed that the addition of Ia antigen positive macrophage. subset activated with OK-432 resulted in a significant increase in the graft-versus-host reactivity of parental thymocytes, while Ia antigen negative macrophages exerted no such effect.
The results suggest that Ia antigen positive macrophages show a great heterogeneity in both morphology and phenotypic expression, and play an essential role in the acquisition of alloantigen reactivity by immature thymocytes in vivo.

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