[Interdigitating dendritic cell sarcoma of lower extremities resistant to high dose chemotherapy BEAM with peripheral blood stem cell transplantation]. / Sarkom z interdigitujících dendritických bunek dolní koncetiny rezistentní k vysokodávkované chemoterapii BEAM s autologní transplantací kmenových krvetvorných bunek--popis prípadu a prehled literatury.

Interdigitating dendritic cell sarcoma is a rare neoplasm forming part of the group of malignancies derived from histocytic cell line. This nosological unit can be detected only by special immunohistochemical exams. A young man aged 25 found a tumorous swelling in the proximal part of his left crus. The pathological process affected proximal tibial epiphysis and adjacent soft tissues. The first FDG-PET examination performed in the process of determining the clinical stage of the disease showed a high activity in the site of primary tumour (SUV 7.71) and in the site of regional inguinal node (SUV 4.25). Histological examination of a diagnostic excision specimen of the tumour in the tibia and the extirpated enlarged regional nodes in the left groin led to the diagnosis of interdigitating dendritic cell sarcoma. The diagnosis was confirmed pathologically by another two centres in the Czech Republic and, due to the unusual nature of the diagnosis, also in Regensburg, Germany. Treatment started with chemotherapy, applied to patients with aggressive lymphomas in the framework of clinical studies, i.e. a combination of MegaCHOP. After 4 cycles, however, there was no visible response on the site of primary tumour. MegaCHOP therapy was therefore discontinued after the 4 cycles. Subsequently, we referred the patient for a high-dose chemotherapy with autologous bone marrow transplantation, similarly to aggressive lymphomas. The collection of blood producing stem cells from peripheral blood was successfully performed after ESHAP chemotherapy. A verificatoin FDG-PET examination was performed before high-dose chemotherapy. Increased activity was detected only in left proximal crus, with an SUV of 4.6. One month after ESHAP chemotherapy, BEAM high-dose chemotherapy with autologous transplantation of blood forming tissue was performed. High-dose chemotherapy was followed up by radiotherapy targeted on the primary tumour in the crus (70 Gy). The third verification FDG-PET examination was performed 3 months after radiotherapy. The examination showed a continuing higher activity in the region of the primary tumour (SUV 2.69) and a new centre of activity was detected in the left inguinal nodes region (SUV4.09). The activity corresponded to the presence of viable tumour tissue in the primary nidus and new metastases in inguinal nodes, without proofs of further proliferation at the time. Nodes of the left groin were removed. Histological examination showed affection of the node by the same type of tumour, i.e. a continuing activity of the disease despite chemotherapy. Due to suspected continuation of viable tumour in the crus judging by the intensity of accumulation of FDG-PET and the proof of a new affection of regional nodes, surgical treatment was preferred after the failure of chemotherapy. After the removal of inguinal nodes, left knee joint exarticulation was performed. This was followed by regional inguinal node region radiotherapy (56 Gy). The last fourth PET-CT examination carried out 4 months after the radiation therapy of the inguinal region showed massive dissemination into the region ofileac and paraaortic nodes (lymphadenopathy up to 6 cm in diameter) with an activity of 5.9 to 6.73 SUV units. Currently, we test the sensitiveness of the disease to 2-chlordeoxyadenosin and look for additional therapeutic options. To our knowledge, the above description is the first documented case of interdigitating dendritic cell sarcoma located in the tibia and crus soft tissue. We have not found any description of high-dose therapy supported by autologous transplantation of blood-forming tissue for this type of tumour in relevant literature. In this case, we record chemoresistance to high-dose chemotherapy and certain radiosensitivty of the tumour at the same time.

[Pseudolymphoma of the breast nipple. The problem overview]. / Pseudolymfom prsní bradavky. prehled problematiky.

Clinical, pathological, and molecular-genetic features as well as etiology of cutaneous pseudolymphoma (CPL, cutaneous lymphoid hyperplasia, lymphocytoma cutis) of the breast nipple are summarized. CPL presents as a nipple induration and it is often suspected to be Paget carcinoma pre-operatively. Histologically, atypical microscopic features of a dense lymhoid infiltrate with follicles often mislead to the diagnosis of a malignant lymphoma. However, CPL runs a benign course. Rare cases of CPL contain a clonal lymphoid population. A substantial number of CPL in the breast nipple is caused by antigenic stimulation by Borrelia burgdorferi. In some patients a tick bite is documented. CPL of the breast is commonly treated by excision, but some patients may be cured by antibiotic therapy. The presence of Borrelia burgdorferi should be detected using methods of serology, culture, and molecular biology. Beside CPL, the differential diagnosis of the breast nipple lesions further includes Paget carcinoma, eczema, and florid papillomatosis.

[Immunohistochemical detection of follicular dendritic cells in the diagnosis of small B-cell lymphomas]. / Imunohistochemický prukaz folikulárních dendritických bunek v diagnostice lymfomu z malých B bunek.

Our study included 46 cases of B-chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL), 25 mantle cell lymphomas (MCL), and 40 follicular lymphomas (FL). The lymphomas were diagnosed according to current morphological, immunohistochemical, and in some cases molecular-genetic criteria. The patterns of follicular dendritie cells (FDCs) were studied in paraffin sections using the anti CD21, anti CD23, and CNA.42 antibodies. The differences in staining patterns of FDCs among the studied lymphomas were statistically significant. The absence or small number of FDC clusters are typical of B-CLL/SLL, while FDC meshwork limited to peripheral parts of neoplastic follicles is characteristic for FL. In contrast, MCL is characterized by irregular FDC meshwork or by FDC clusters present in the centres of residual follicles. Thus, we have demonstrated that the patterns of FDCs is an independent diagnostic feature for distinguishing between B-CLL, FL, and MCL.

[Role of p27Kip1 protein in the cell cycle and its appearance in lymphoid tissues, particularly non-Hodgkin's B-cell lymphomas. Review]. / Role proteinu p27Kip1 v bunecném cyklu a jeho výskyt v lymfoidních tkáních, zvláste v nehodgkinských B-lymfomech. Prehled problematiky.

Cell cycle progression is governed by cyclin dependent kinases (CDK) that are activated by cyclin binding and inhibited by CDK inhibitors. Protein p27Kip1 functions as a CDK inhibitor, which controls the progression from G1 to S phase. Further, p27Kip1 may have a positive regulative influence. In nonneoplastic tissues and in the majority of tumors investigated so far, the immunohistochemical positivity of p27Kip1 showed an inversely proportional relationship to the proliferation index. Among B-cell non-Hodgkin lymphomas, the exceptions to this rule are represented by mantle cell lymphoma, hairy cell leukemia, and the immunoblastic Epstein-Barr virus latent membrane antigen positive diffuse large B-cell lymphoma in AIDS patients. The loss of p27Kip1 expression is a negative prognostic factor in numerous tumors, including the majority of B-cell lymphomas.

[Lymphoproliferative disease after transplantation]. / Lymfoproliferativní choroba po transplantaci.

Herein we describe 7 cases of posttransplantation lymphoproliferative disease (PTLD), 5 in men and 2 in women (aged from 25 to 62 years), occurring from 4 months to 12 years (mean, 7 years) after transplantation. Our patients were recipients of kidney, kidney and pancreas, heart, and autologous peripheral haematopoetic stem cells. Four cases were diagnosed as monomorphic and three as polymorphic type of PTLD according to the WHO classification. Monoclonal immunoglobuline heavy chain gene rearrangement was detected in two monomorphic lesions and one polymorphic lesion by polymerase chain reaction (PCR). In the two cases of polymorphic and the one case of monomorphic PTLD, the presence of EBV was visualised by immunohistochemical staining of some transformed lymphoid cells for latent membrane protein (LMP) of EBV. The presence of type A EBV was demonstrated by PCR. The patients were treated by reduction or discontinuation of immunosuppression and by chemotherapy. In 2 cases, a part of the organ affected by lymphoma (sigmoid colon and pancreas) was surgically resected. Four patients died of causes related to PTLD (2 to 15 months after the diagnosis), mainly of infectious complications. Two other patients who achieved remission died of unrelated causes. Only the youngest man is alive and in the complete remission 10 months after the diagnosis of PTLD.

[Syndecan-1 (CD138): an immunohistochemical marker of plasma cell tumors]. / Syndecan-1 (CD138): imunohistochemický marker nádoru z plazmatických bunek.

The immunohistochemical detection of syndecan-1 (belonging to the cluster CD138) is a sensitive and reliable method for identifying normal and neoplastic plasma cells. It may be used in paraffin-embedded bone marrow specimens, as well as in extramedullary tumours of unknown origin. The three anaplastic tumours reported by us in the lymph node, the gingiva, and pleura were negative for other markers, but the syndecan-1 positivity elucidated their plasmocytic histogenesis.

[Consultation (second opinion on biopsies) as an instrument of quality control in histopathologic diagnosis]. / Konzultacní cinnost (druhé ctení biopsií) jako nástroj kontroly kvality histopatologické diagnostiky.

As the whole spectrum of morphological patterns encountered in surgical pathology cannot be, in its entirety, diagnosed correctly by a general pathologist alone, one has to seek consultation for difficult or unusual cases with specialised experts. In the Czech Republic, the consultation practice performed by specialists from different medical institutions is the only way to assess the quality of histopathological diagnostic performance, i.e. it represents an audit system. Audit systems functioning in other countries are described here. A proposal of a standard consultation process as well as problems concerning the financial costs and increased workload of consultants are discussed.

[Intestinal T-cell lymphoma]. / Intestinální T lymfom.

In our study, 7 bioptical specimens of intestinal T-cell lymphoma are described. This tumour occurs in the small intestine of adults who may have a history of malabsorption. The patients present clinically with intestinal perforation, enterorrhagia, or ileus. The gross appearance varies: the tumour may take the form of multiple ulcers or of a huge exulcerated lesion. The cytomorphological features are variable. Bizarre multinucleated cells may be sometimes present. The reactive cellular background is usually dominated by histiocytes or eosinophilic granulocytes. Immunohistochemically, the tumour cells stain in reactions with antibodies to pan T-cell markers, occasionally to CD8 and CD30. The positivity of tumour cells for markers of intraepithelial T-cells and for cytotoxic molecules has been demonstrated previously.

[Comments on the proposal of a new WHO classification of non-Hodgkin's malignant lymphoma]. / Poznámky k návrhu novej klasifikácie non-Hodgkinových malígnych lymfómov podla SZO.

Newly proposed WHO classification of non-Hodgkin's malignant lymphomas (17) is based on the principles of the REAL classification. According to these principles, the classification represents a list of tumor disease entities, which have been accepted by clinical practice. The entities are defined by a multiparameter approach, which involves morphology, immunophenotype and genotype of the tumor cells, as well as clinical presentation and course of the disease requiring an appropriate therapy. All the categories of the WHO classification are briefly described, together with their relationship to the categories of the Kiel classification.

Oncocytic cystadenoma of the parotid gland with tyrosine-rich crystals.

A case of benign oncocytic cystadenoma with abundant intraluminal tyrosine-rich crystals involving the parotid gland is described.

Liver preneoplastic changes in mice treated with the herbicide fomesafen.

1. Effect of the diphenyl ether herbicide fomesafen on liver preneoplastic changes and porphyrin biosynthesis was examined in male C57BL/6J mice (0.23% in the diet for 14 months) and ICR mice (0.3% in the diet for 50 weeks). Fomesafen treatment resulted in preneoplastic changes (liver nodules and foci of altered hepatocytes) in both strains, uroporphyria developed only in ICR mice. 2. Iron pretreatment (600 mg/kg as a single dose) accelerated the development of fomesafen-induced preneoplastic changes in both mouse strains. The number of foci containing altered hepatocytes, as well as the number and size of liver nodules, were increased in iron-pretreated animals. 3. A single injection of iron induced marked uroporphyria in C57BL/6J mice after 14 months (liver porphyrin content 102 nmol/g). This uroporphyria was further potentiated by fomesafen administration (208 nmol/g). 4. In ICR mice, liver histology was apparently normal after a 3 month recovery from fomesafen treatment (0.32% for 9 months). Liver porphyrin content (260 nmol/g) started to decrease immediately after fomesafen withdrawal, but was still significantly elevated after 3 months (5 nmol/g), as compared to controls (1 nmol/g). 5. It is concluded that the toxicological evaluation of fomesafen should focus on liver porphyrin biosynthesis.

[Recommended procedure for histopathologic processing of lymph node biopsy]. / Doporucený postup pro histopatologické zpracování biopsií lymfatických uzlin.

A standard procedure of sampling, transportation, fixation and further processing for microscopical investigation of lymph node biopsies is presented. It points out the importance of a perfectly stained survey section and well done immunohistochemical reactions as well as of sense of the second opinion for precise histopathological diagnosis.

[Bioptic typing and classification of Hodgkin's lymphomas--status in 1998]. / Bioptická typizácia a klasifikácia Hodgkinových lymfómov--prehl'ad stavu v roku 1998.

In the submitted review the authors give an account on the development of views regarding bioptic typing and classification of Hodgkin's lymphomas, incl. the REAL classification and the classification prepared at present by WHO. Hodgkin's lymphomas are divided into the nodular type with a predominance of lymphocytes--nodular paragranuloma and classical Hodgkin's lymphomas. In addition to a brief morphological description, the authors give also an account on immunohistochemical features of different types, short comments on the biology and evolution of tumourous diseases as well as basic data on the differential diagnosis of Hodgkin's lymphomas.

[Needle-like inclusions in liver cells are specific diagnostic signs of porphyria cutanea tarda]. / Jehlicovité inkluze v jaterních bunkách jsou specifickým diagnostickým znakem porphyria cutanea tarda.

Needle-shaped cytoplasmic liver cell inclusions are considered to represent a feature typical of porphyria cutanea tarda (PCT). Histological sections of 849 liver biopsies were stained with ferricyanide reduction reaction for demonstration of the inclusions. They were detected in 18 cases, and in all of them the diagnosis PCT was clinically and/or biochemically confirmed. In our group of patients, PCT was associated with alcoholic liver disease in three cases, with chronic hepatitis C in three cases and with hepatocellular carcinoma in two cases. In the liver with hepatocellular carcinoma, the inclusions were present only in non-neoplastic liver tissue, not in the tumourous tissue. No inclusions were found in the liver tissue of patients without clinical signs of PCT.

[Primary cutaneous B-cell lymphoma: present views]. / Primární lymfomy kuze z b-bunek: soucasný pohled.

Most lymphoproliferative B cell cutaneous lesions do represent primary lymphomas, not a secondary lymphomatous spread or pseudolymphoma* A description of the development of classification systems for primary cutaneous B lymphomas is given concerning especially some newly defined lesions: primary cutaneous marginal zone B cell lymphoma, primary cutaneous follicular centre cell lymphoma and large B cell lymphoma of the legs. Majority of primary cutaneous B lymphomas answer well the treatment and have a favourable prognosis.

Cytoplasmic liver cell inclusions--a typical feature of porphyria cutanea tarda--are absent in porphyria-related hepatic neoplasias.

Crystalline cytoplasmic needle-shaped inclusions in hepatocytes are considered to represent a specific morphological feature of porphyria cutanea tarda (PCT) and experimental PCT-like porphyrias. The cytoplasmic inclusions, however, are absent in hyperplastic hepatic nodules and hepatocellular carcinomas arising in the course of these conditions. It is assumed that porphyrins and related substances accumulated in hyperplastic and neoplastic hepatic lesions differ from those found in non-neoplastic liver tissue: the highly carboxylated porphyrins are stored in both sites, the crystal-forming substance only in non-proliferating liver tissue.

[Mantle cell lymphoma (MCL)--histopathology and clinical features]. / Lymfom z plást'ových bunek (MCL)--histopatologické a klinické znaky.

Mantle cell lymphoma (MCL) has been established as a clinicopathologic entity in 1991. A histopathologic and immunohistochemical study of 16 cases of MCL was performed in order to demonstrate differential diagnostic aspects. MCLs were composed of small and medium-sized B cells assuming the appearance of centrocytes. The growth pattern was diffuse in 9 cases and that of follicle mantle zone type within at least partially present nodular parts in 16 cases. The immunohistochemical staining for CD23 antigen was negative in tumour cells whereas the strong immunoreactivity of follicular dendritic cells (FDC) decorated residual FDC network. Seven cases of MCL were examined for the presence of translocation t(11;14)(q13;q32) using polymerase chain reaction. Despite histomorphological features compatible with a diagnosis of low-grade lymphoma, MCL has a worse prognosis and more aggressive behaviour than other types of small cell lymphomas, such as small lymphocytic lymphoma and follicle centre lymphoma.

[Morphologic findings in liver tissue in mice after long-term administration of the herbicide fomesafan]. / Morfologické nálezy v jaterní tkáni mysí po dlouhodobém podávání herbicidu fomesafenu.

Administration of herbicide fomesafen and of fomesafen combined with one dose of iron to 44 mice during 3 to 14 months caused hyperplastic and preneoplastic changes in the liver tissue which had been described in experimental carcinogenesis* small groups of altered hepatocytes storing glycogen or lipids and foci of small basophilic liver cells occurred as early as after 3 months. Altered hepatocytes were found more frequently in mice getting fomesafen and iron. Later nodular hyperplasia of liver cells developed with nodes 3-20 mm in diameter which mostly consisted of altered hepatocytes with plenty of glycogen. After 12 and 14 month-lasting administration of fomesafen and fomesafen with iron, the hepatocellular carcinoma was proved in 5 mice. In 4 mice, the preneoplastic changes in liver tissue were accompanied by micronodular hyperplasia of liver cells which did not participate on the development of big nodes and hepatocellular carcinoma.

Phyllodes tumour of the breast: immunohistochemical study of 37 tumours using MIB1 antibody.

In our study, the expression of Ki-67 antigen in phyllodes tumours of the breast was investigated in order to estimate its significance in assessing the grade of malignancy and in predicting the clinical behaviour of these tumours. Formalin-fixed and paraffin-embedded tissue specimens of 37 cases of phyllodes tumour of the breast (eight graded as malignant and 29 as benign according to histopathological criteria) and 20 breast fibroadenomas were stained by an immunoperoxidase technique, using the monoclonal antibody MIB1 directed against cell proliferation-associated Ki-67 antigen. A MIB1 index was calculated to express the percentage of MIB1 positive proliferating stromal cells. Our data indicate that there are statistically significant differences in MIB1 indices between histologically benign and malignant phyllodes tumours (alpha = 0.001), between benign phyllodes tumour and fibroadenoma (alpha = 0.01), and between malignant phyllodes tumour and fibroadenoma (alpha = 0.001). Our results also indicate a good correlation between the conventional grading of phyllodes tumours based on histological criteria and MIB1 indices. However, little predictive value of the MIB1 index in phyllodes tumours of the breast can be derived from our study.