Extensive lymphadenopathy as the first clinical manifestation in systemic lupus erythematosus.

Lymphadenopathy (LAP) is a frequent sign of systemic lupus erythematosus (SLE). The lymph nodes are usually soft, nontender, varying in size from 0.5 cm to several centimeters. However, generalized LAP in SLE is extremely rare, while to our knowledge, the presentation of extensive LAP with blocks of retrosternal, mesenteric, and retroperitoneal nodes has not been previously reported as the first clinical manifestation of the disease. In this report we describe a patient with extensive LAP and active SLE and we point out that generalized LAP should be included among the clinical findings indicating disease activity in SLE patients.

Phenotype of Hodgkin and Sternberg-Reed cells and expression of CD57 (LEU7) antigen.

Possible associations between the immunophenotype of Hodgkin (H) and Sternberg-Reed (S-R) cells, the expression of CD57 (Leu 7) antigen, and the presence of Epstein-Barr virus (EBV) were investigated in lymph node specimens from 50 cases of Hodgkin's disease (HD), including 26 cases of mixed cellularity and 24 cases of nodular sclerosis. Tissues were fixed in 10% neutral formalin, or/and B5 solution. H and S-R cells were CD30+, CD15+ (85% of the cases) and LCA (CD45). A proportion of neoplastic cells positive for either T-cell markers (CD3) or B-cell markers (CD20) was observed in 10% and 34% of the cases, respectively. Membrane positivity for CD57 antigen was found in H and S-R cells in 10 cases (8 cases of mixed cellularity, and 2 cases of nodular sclerosis). Such immunopositivity was only observed in B5-fixed sections. No staining for CD57 antigen was identified in H and S-R cells of any case with CD20 positive neoplastic cells. H and S-R cells of both CD57-positive and CD57-negative cases were further studied by immunohistochemistry for LMP1, by in-situ hybridization for EBER and by polymerase chain reaction (PCR) for EBV-DNA. No association was identified between the expression of CD57 antigen and the presence of EBV sequences, transcripts or proteins. Our findings do not support a B-cell origin for H and S-R cells in CD57-positive cases of Hodgkin's disease and suggest that these neoplastic cells may be related to natural killer (NK) or T-cells expressing CD57 antigen.

Immunohistochemical detection of the c-myc oncogene product in normal, hyperplastic and carcinomatous endometrium.

The expression and the distribution of the c-myc oncogene product (p62) was studied by a 3-step immunoperoxidase technique using the monoclonal antibody myc 1-6 E10 in 22 cases of normal endometrium (11 proliferative and 11 secretory phase), 43 endometrial hyperplasias (24 adenomatous and 19 adenocystic) and 26 endometrial carcinomas. Increased expression of c-myc product appeared in endometrial carcinomas compared with respective non-neoplastic tissue (p < 0.001). The immunolocalization of the c-myc protein shows a consistent difference between the various histologic patterns of non-neoplastic and neoplastic endometrium. Nuclear staining of the c-myc product was demonstrated in epithelial cells of the proliferative phase and predominantly in poorly differentiated forms of endometrial carcinomas. On the other hand cytoplasmic staining was found predominantly in the secretory phase and in well differentiated carcinomatous endometrium. In hyperplastic endometrium an intermediate immunohistochemical pattern was observed. The results of the present study emphasize that c-myc product overexpression and localization plays an important role in initiation, differentiation and progression of endometrial carcinomas.

Langerhans cells and lymphocyte subsets in human gastrointestinal carcinomas. An immunohistological study on frozen sections.

In an immunohistochemical study of 38 human gastric and 40 human colonic carcinomas Langerhans cells, suppressor and helper lymphocytes were identified on frozen sections by using anti-CD1, anti-CD8 and anti-CD4 monoclonal antibodies. Tumours were divided into those with few (< 3 per high power field) and those with many (> 3 per high power field) Langerhans cells as well as into those with high number of CD4 and CD8 cells (> 30 per high power field). No significant difference in the number of Langerhans cells regarding histologic types, degree of differentiation and metastatic/non-metastatic groups of either gastric or colonic carcinomas was found. On the contrary the numbers of Langerhans cells related significantly (p < 0.05) to density of T-cell and especially CD4 cell infiltrations of gastric and colonic carcinomas. This finding supports the role of Langerhans cells as antigen presenting cells and their involvement in T-cell activation against neoplastic cells of human gastrointestinal carcinomas.

Immunohistochemical detection of estrogen receptors on paraffin sections of normal, hyperplatic and carcinomatous endometrium.

The present study is the first dealing with the demonstration of estrogen receptors (ER) in up to 8-year-old paraffin blocks of endometrial curettage samples routinely fixed in 10% formalin. The Mab ER-ICA was used in a modified peroxidase-antiperoxidase method after pretreatment of paraffin sections with pronase. Eleven cases with proliferative, 11 cases with secretory endometrium, 20 cases with adenocystic, 21 with adenomatous hyperplasia and 27 endometrial adenocarcinomas were tested. The two main parameters, namely the percentage of ER-positive cells and the intensity of the immunostaining, were higher in the proliferative phase followed in a declining sequence by adenocystic hyperplasia, adenomatous hyperplasia, adenocarcinomas and the secretory phase of endometrium. Interestingly, the intensity of the immunostaining showed a positive relationship to the percentage of ER-positive cells (r = 0.93, p less than 0.001). It seems that the immunohistochemical demonstration of ER in paraffin sections of uterine specimens is an easy and reliable method for the mapping of the heterogeneous expression of ER and their comparative study with the well preserved histopathological features even in old archival paraffin-embedded material.

Primary Non-Hodgkin's Lymphomas of the Nasal and Mouth Cavity and the Waldeyer's Ring: A morphological and immunohistochemical study.

Twenty-six non-Hodgkin's malignant lymphomas (ML) of the Waldeyer's ring, the mouth and nasal cavities were studied morphologically and immunohistochemically on paraffin and frozen sections. A B-cell origin was shown in all 14 cases of Waldeyer's ring M.L., while 5 of 7 nasal and 3 of 5 buccal cases were of T-cell nature. Seventy-nine per cent of all the above ML were high-grade malignancies. Combined morphological and immunohistochemical studies of such malignant lymphomas in Western populations have been reported rarely and are rather limited. The documentation of the first nasal and buccal cases of anaplastic Ki-1 positive peripheral T-cell ML is emphasised in conjunction with the more frequent carcinomas of the same anatomical areas under consideration.

Association of serum IgM kappa monoclonicity in patients with Sjögren's syndrome with an increased proportion of kappa positive plasma cells infiltrating the labial minor salivary glands.

Minor salivary gland biopsy specimens from 11 patients with primary Sjögren's syndrome with circulating monoclonal IgM kappa cryoglobulins, seven without cryoglobulins, and four patients with rheumatoid arthritis and Sjögren's syndrome (one with monoclonal and three with polyclonal cryoglobulins) were examined by the peroxidase antiperoxidase bridge technique, using antihuman kappa and lambda antibodies. In 6/11 patients with primary Sjögren's syndrome and in one patient with Sjögren's syndrome and rheumatoid arthritis with monoclonal cryoglobulins a predominance of plasma cells containing intracytoplasmic kappa light chains was found (kappa:lambda greater than 3:1). Two of those seven patients had immunohistological features of immunocytomas. In the other five patients with circulating monoclonal cryoglobulins the kappa:lambda ratio of positive cells did not exceed 3:1, while six out of seven patients without cryoglobulins and the patients with rheumatoid arthritis and Sjögren's syndrome with polyclonal cryoglobulins had almost equal numbers of kappa and lambda stained cells. One of seven patients with primary Sjögren's syndrome without cryoglobulins had an increased number of lambda light chain positive cells, indicating a non-secretory lambda monoclonal population. These findings suggest that the main area of B cell monoclonal expansion in primary Sjögren's syndrome may be the affected exocrine glands.