A 65-year-old woman was admitted to our hospital because of gastric tumor which was detected with gastric endoscopy during examination for hematemisis. She was symptom free and physical examination revealed no remarkable change. Gastric endoscopy in our hospital revealed a flat lesion in the middle body of the stomach. Biopsy specimen showed slight lymphoid infiltration. Subtotal gastrectomy was performed on December 24th, 1991. Examination of tissue specimens revealed atypical lymphoid infiltration surrounding the follicles (fig. 1) and involvement of the regional lymph nodes. Lymphoid cells were small to medium sized cells with slight nuclear irregularity (fig. 2). Immunohistochemical study on frozen section demonstrated that neoplastic cells were CD20+, sk-, sl+, slgM+, slgD+, CD5-, CD10-(tab. 1). Ig H gene rearrangement was confirmed with Southern blotting. COP therapy was done twice in February 1992, but was discontinued because of elevation of serum hepatic enzymes. She was diagnosed as drug induced hepatitis and predonisolone was administered. Follow-up biopsy specimens of the stomach and the colon revealed Infiltration of lymphoma in 1993 and in 1994, respectively. In June 1995, CBC test showed increased WBC with lymphocytosis, consistent with leukemic phase of malignant lymphoma. We reexamined the specimen of the stomach in 1991 after the patient showed leukemic change. On frozen sections neoplastic cells were negative for CD23 as in the flow cytometric study of the peripheral blood (tab. 2). Lymphoma cells of the stomach were positive for cyclin D1 with nuclear staining pattern (fig. 3). We have concluded that this case was mantle cell lymphom of the stomach without polypoid lesions.
A 64-year-old man with chronic hepatitis (type C) presented with left abdominal to back pain and cervical lymph nodes swelling in Nov. 1995. Biopsy specimen from cervical lymph nodes was diagnosed as malignant lymphoma. Physical examination revealed systemic lymph nodes swelling, splenomegaly and bone marrow involvement. He received two courses of CHOP and MEVP therapy without much effect and died after five months later. Tissue specimen showed diffuse atypical lymphocytes infiltration and no residual atrophic germinal centers are found. Most of the tumor cells showed medium to large sized and round (without cleaving) nuclei and a predominant nucleolus. Starry sky appearance and frequent mitoses are observed, suggesting rapidly proliferating nature. Immunohistchemical study on paraffin section and flow cytometrical analysis demonstrated that CD5, CD20, CD21, sIgM and sIgD were positive on neoplastic cells but CD3 and CD10 were negative. These morphological and immunohistchemical findings lead us to diagnose this lymphoma as blastoid (centroblastic) variant of mantle cell lymphoma.
A 70 year-old Japanese man noticed a dark-red skin plaque (3 cm in diameter) on his right hip about 25 years ago. The plaque grew gradually upto a fist-sized irregularshaped elevated skin lesion and in recent 5 years the lesion repeated growth and retardation. The lesion was examined 3 times and diagnosed as malignant lymphoma at 67 year of age, 69 year of age and 70 year of age, revealing the same histology. Histologically large anaplastic cells showed Pagetoid intraepidermal growth associating polyclonal T and B cell infiltration in dermis. The large anaplastic cells were CD2+ CD3- CD4- CD5+ CD7+ CD8+ CD25+ CD30+ CD56- T-cells. CD8 Ki-1-posotive large anaplastic cell lymphoma (LAC) was diagnosed. PCR analysis of the DNA extracted from the large anaplastic cells in paraffin section showed oligoclonal bands of T-cell receptor gene B chain, suggesting a neoplastic nature of the cells. But the skin lesion showed involution into small one without any therapy. Dermatologically this lesion was diagnosed as solitary type Pagetoid reticulosis (Woringer-Kolopp disease), because of a long clinical course. Considering the clinical course and the examination results, secondary epidermotrpic large anaplastic cell lymphoma in solitary type Pagetoid reticulosis was suggested. Pagetoid reticulosis might be one of the precurssor lesions of cutaneous Ki-1-positive large anaplastic cell lymphoma.