Composite lymphomas: Experience from a tertiary cancer center in Kerala, South India.

OBJECTIVES: Composite tumors are defined as tumors in which there are two different intermixed histologic types. Our objective was to study the clinical and pathologic features of five cases of composite lymphoma. MATERIALS AND METHODS: Our study included five patients of composite lymphoma diagnosed over a period of 5 years. Clinical presentation, hematological parameters including peripheral smear, bone marrow aspirate, and histopathological examination of lymph node including immunohistochemistry (IHC) were studied. Treatment and follow-up details were also noted. RESULTS: All the five cases were in the adult age group ranging from 44 to 72 years. All the cases were composite follicular lymphoma (FL) and mixed cellularity classical Hodgkin lymphoma (CHL). Diagnosis in all cases was suspected on morphology by identification of distinct neoplastic follicles in FL and classic Reed-Sternberg cells in CHL and confirmed by IHC. CONCLUSION: Although rare, composite lymphomas should be kept in mind. Careful histopathological examination of lymph node with identification of distinct morphological features along with IHC helps to arrive at the definitive diagnosis.

Primary Mixed Cellularity Classical Hodgkin lymphoma of the Lumbar spine - An unusual presentation.

UNLABELLED: Primary spinal epidural lymphoma (PSEL) is a subset of lymphoma. For the diagnosis of PSEL there should be no other recognizable sites of lymphoma other than the spine at the time of diagnosis. The incidence of this subset of lymphomas is very low. Hodgkin lymphoma (HL) usually presents with painless enlargement of peripheral lymph nodes and only a small percentage arises from extra nodal regions.Very few patients with HL develops spinal cord compression due to an epidural tumor at some time during the course of their disease. But patients with HL presenting with isolated primary involvement of the epidural spinal region is very rare with very few reports available in the literature. CASE: A 19-year-old male presented to the local hospital with history of low back pain for almost one year. An initial biopsy was non-contributory and was reported as showing inflammatory change. The patient was empirically started on antituberculosis medication but his condition worsened and within weeks he developed paraplegia. MRI of the spine showed a large paraspinal mass with compression of L1 vertebral body. Urgent surgical decompression was done and final histopathology showed a mixed cellularity classical Hodgkin lymphoma (MCCHL). Systemic work-up did not show evidence of nodal disease. Following surgery, he received chemotherapy. CONCLUSION: We report this case because of the unusual presentation of HL as a primary spinal mass. We would also like to highlight that apart from common causes, a differential diagnosis of HL should also be entertained while dealing with spinal masses. Otherwise diagnosis can be missed leading to delay in treatment and complications.

Altered expression of jack fruit lectin specific glycoconjugates in benign and malignant human colorectum.

Lectins bind to terminal non reducing sugars of glycoconjugates in cell membranes and secretions. These glycoproteins can be very characteristic, both for the differentiation state of a tissue and for its grade of malignancy. The carbohydrate structures of cellular glycoconjugates in normal, adenoma, and carcinoma of human colorectum were analysed using HRP conjugated Jack Fruit Lectin (JFL). Fifty two rectal carcinomas, 18 adenomas and 25 normal rectal tissues were used for the study. Diaminobenzidine (DAB) was used as the visualant. Normal rectal tissues showed positive reaction with intense staining in more than 60% of the cells. Adenomas were seen to have moderate to intense staining with a range of 30 to 60% positive cells. The lowest levels of JFL staining were observed in invasive tumours. JFL binding was found to decrease with carcinomatous cells compared to adenomas and normal cells. A significant negative association was found between JFL binding and histologic abnormality (r = -0.85, P <0.0000). These results suggest that there are alterations in the carbohydrate structures of cellular glycoconjugates, which can be related to goblet cell differentiation, in normal, benign and malignant human colorectal tissue.

Changes in the glycosaminoglycans, glycoproteins and lipid components of erythrocyte membrane in neuroacanthocytosis.

Changes in the glycosaminoglycans (GAG), glycoproteins (GP) and lipid components of erythrocyte membrane were studied in two patients of neuroacanthocytosis, as compared to normal, control subjects. Concentration of GAG, decreased in the erythrocytemembrane in patients of neuroacanthocytosis while the carbohydrate components of the glycoproteins showed alterations both quantitatively and qualitatively. The ratio of W6 to W3 fatty acids showed increase in the erythrocyte membrane in neuroacanthocytosis patients while the ratio of cholesterol to phospholipids was decreased.