Small noncleaved, non-Burkitt's (Burkit-Like) lymphoma: cytogenetics predict outcome and reflect clinical presentation.

PURPOSE: To correlate cytogenetic abnormalities with clinical presentation and outcome in Burkitt-like, small noncleaved non-Burkitt's lymphoma (SNC-NB). PATIENTS AND METHODS: Thirty-nine patients with SNC-NB lymphoma and a clonal karyotype were evaluated between January 1989 and January 1996. All were from British Columbia, Canada, underwent uniform clinical staging, and were treated on investigational protocols by a small group of clinicians. RESULTS: Three groups of patients were identified by clonal karyotype on cytogenetic analysis: (1) those with a c-myc translocation (n = 11); (2) those with dual translocation of c-myc and bcl-2 (n = 13); and (3) those with other cytogenetic abnormalities (n = 15). The c-myc group was younger, presented with earlier stage de nova disease, and had a better clinical prognostic factor profile. The dual-translocation and other groups were older and presented in advanced stage with poorer prognostic features, and a larger proportion of the dual-translocation group patients had transformed from previously diagnosed follicular lymphoma. The median overall survival (OS) time for all patients was 5 months. The median OS time for the dual-translocation group was only 2.5 months, as compared with 7 months and 8 months for the c-myc and other group, respectively (P < .001). There were no survivors beyond 7 months among the dual-translocation group, as opposed to 32% and 25% 2-year OS rates in the c-myc and other group. CONCLUSION: SNC-NB lymphoma is a clinically and cytogenetically heterogenous disease. Dual translocation of c-myc and bcl-2 is characterized by a rapid clinical course and extremely poor outcome. This latter entity may represent the most clinically aggressive lymphoma thus far characterized and warrants intensive investigational treatment where feasible.

Radiation-induced atypia of endocervical epithelium: a histological, immunohistochemical and cytometric study.

Radiation-induced changes of the endocervical glandular epithelium have not been well characterized. Ten specimens (nine from hysterectomy, one from biopsy) from patients with therapeutic radiation to the pelvis for genitourinary or gastrointestinal cancer were examined by histological, immunohistochemical, flow cytometry and image cytometry analysis, and comparison was made to 10 cases of adenocarcinoma in situ (ACIS) of the cervix. Patients ranged from 34 to 68 years of age and received at least 3600 cGy total dosage to the pelvis. Hysterectomy or biopsy was performed six weeks to 17.5 years after completion of radiotherapy. Gross examination of the hysterectomy specimen revealed fibrosis, induration, stenosis, surface irregularity or an unremarkable cervix. Microscopic examination of endocervical glandular epithelium showed sparse, widely spaced glands which were tubular or dilated. Epithelium was simple cuboidal or flattened and consisted of large cells with at most a slight increase in N/C ratio, well-defined intercellular borders and eosinophilic or finely vacuolated cytoplasm. Nuclei frequently showed loss of polarity, one or two prominent eosinophilic nucleoli, and evenly dispersed chromatin; only occasional hyperchromatic cells were seen. Rare scattered cells were immunoreactive for carcinoembryonic antigen in seven of nine cases. One case was hyperdiploid by both flow cytometry and image cytometry. The remaining cases were diploid by flow cytometry and either diploid (five cases) or hypodiploid (four cases) by image cytometry. These findings indicate that pelvic radiation therapy causes characteristic histologic changes in endocervical glandular epithelium that are distinct from those of ACIS of the cervix. Cytoplasmic CEA staining frequently is focally positive and does not allow distinction from ACIS.