A UK population-based case–control study of Hodgkin’s disease (HD) in young adults (16–24 years) included 118 cases and 237 controls matched on year of birth, gender and county of residence. The majority (103) of the cases were classified by Epstein–Barr virus (EBV) status (EBV present in Reed–Stenberg cells), with 19 being EBV-positive. Analyses using conditional logistic regression are presented of subject reports of prior infectious disease (infectious mononucleosis (IM), chicken pox, measles, mumps, pertussis and rubella). In these analyses HD cases are compared with matched controls, EBV-positive cases and EBV-negative cases are compared separately with their controls and formal tests of differences of association by EBV status are applied. A prior history of IM was positively associated with HD (odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.10–5.33) and with EBV-positive HD (OR = 9.16, 95% CI = 1.07–78.31) and the difference between EBV-positive and EBV-negative HD was statistically significant (P = 0.013). The remaining infectious illnesses (combined) were negatively associated with HD, EBV-positive HD and EBV-negative HD (in the total series, for ≥2 episodes compared with ≤1, OR = 0.45, 95% CI = 0.25–0.83). These results support previous evidence that early exposure to infection protects against HD and that IM increases subsequent risk; the comparisons of EBV-positive and EBV-negative HD are new and generate hypotheses for further study.

To the Editor: Denis Burkitt first published an account of the tumor that bears his name in 1958.[1][1] In the following years, there was considerable confusion concerning the nature of the tumor, its relationship to other lymphomas, and whether it occurred outside Africa. To clarify this matter,

The epidemiology of Hodgkin’s disease suggests that it is a heterogeneous condition comprising more than one disease entity. The Epstein–Barr virus (EBV) is present in the Reed–Sternberg cells of a proportion of cases and is likely to play a role in the pathogenesis of these cases. In this study we show that EBV association rates vary with age at diagnosis. We suggest that Hodgkin’s disease can be divided into three disease entities on the basis of EBV association and age, thereby providing biological support for the multiple aetiology hypothesis proposed by MacMahon ( Cancer Res 1966; 26: 1189–1290).

The Journal of PathologyVolume 183, Issue 2 p. 247-247 Book Review Book Reviews : Contemporary issues in surgical pathology. Pathology of lymph nodes. LAWRENCE M. WEISS (Ed.). Churchill Livingstone, Edinburgh, 1996. No. of pages:453. Price: £75.00 D. H. Wright, D. H. Wright School of Medicine, Southampton University Hospitals TrustSearch for more papers by this author D. H. Wright, D. H. Wright School of Medicine, Southampton University Hospitals TrustSearch for more papers by this author First published: 19 April 1999 https://doi.org/10.1002/(SICI)1096-9896(199710)183:2<247::AID-PATH842>3.0.CO;2-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume183, Issue2October 1997Pages 247-247 RelatedInformation

Primary Epstein–Barr virus (EBV) infection may manifest itself as a benign lymphoproliferative disorder, infectious mononucleosis (IM). EBV infection has been characterized in lymphoreticular tissues from nine patients with IM using the abundantly expressed EBV-encoded nuclear RNAs (EBERs) as a marker of latent infection. Expression of the virus-encoded nuclear antigen (EBNA) 2 and of the latent membrane protein (LMP) 1 was seen in variable proportions of cells in all cases. Double labelling revealed heterogeneous expression patterns of these proteins. Thus, in addition to cells revealing phenotypes consistent with latencies I (EBNA2−/LMP1−) and III (EBNA2+/LMP1+), cells displaying a latency II pattern (EBNA2−/LMP1+) were observed. Cells expressing EBNA2 but not LMP1 were also detected; whilst this may represent a transitory phenomenon, the exact significance of this observation is at present uncertain. EBER-specific in situ hybridization in conjunction with immunohistochemistry revealed expression of the EBERs mainly in B-lymphocytes, many of which showed features of plasma cell differentiation. By contrast, convincing evidence of latent EBV infection was not found in T-cells, epithelial or endothelial cells. Double-labelling immunohistochemistry revealed expression of the replication-associated BZLF1 protein in small lymphoid cells, often showing plasmacytoid differentiation. There was no unambiguous expression of this protein in other cell types. These results suggest that B-cells are the primary target of EBV infection and that plasma cells may be a source of infectious virus found in the saliva of IM patients. © 1997 John Wiley & Sons, Ltd.

There is good evidence for an association between Epstein-Barr virus (EBV) and Hodgkin's disease (HD). In approximately one-third of cases, the EBV genome is detectable in Reed-Sternberg (RS) cells and there is expression of the viral nuclear antigen EBNA-1 and the latent membrane protein LMP-1. Expression of LMP-2 has been demonstrated at the mRNA level, and it is presumed that the protein is expressed alongside LMP-1. The LMP-2 protein is known to contain an epitope presented to cytotoxic T-cells which is restricted through the HLA class I antigen A*0201 in healthy seropositive individuals. Since most HLA-A*02-positive Caucasians are HLA-A*0201-positive, it was hypothesized that HLA-A*02-positive individuals would be under-represented among Caucasians with EBV-associated HD. HLA-A*02 status was determined, using flow cytometry and/or the polymerase chain reaction, for 276 individuals including 176 cases of HD. There was no significant difference between the frequency of HLA-A*02 positivity in HD cases and controls, and between EBV-associated and non-associated cases of HD. The A*02 alleles of 14 cases of EBV-associated HD were further subtyped using nested PCR; all except one case were found to be A*0201-positive. We therefore investigated whether there was any evidence for mutation of the epitope representing amino acids 426-434 of LMP-2a which is restricted through HLA-A*0201. In 10/11 cases the nucleotide sequence encoding this epitope was identical to the published sequence; in the remaining case there was a mutation which would not be expected to alter the conformation of the epitope. Overall, our data suggest that other mechanisms of immune escape must be operative in EBV-associated HD.

We present an immunohistochemical study of accessory cells in acute appendicitis and ulcerative colitis (UC). By comparing these two diseases, it is possible to distinguish between changes associated with inflammatory bowel disease and those resulting from nonspecific intestinal inflammation. Nine total colectomy specimens from patients with UC, in which the appendix was also involved, were compared with nine cases of acute appendicitis. Accessory cells were stained for CD68 (PGM1), ACPI (acid cysteine proteinase inhibitor), S100 protein, MAC387 (calgranulin), CD1a, factor XIIIa, and WR18 (HLA class II). In ulcerative colitis, but not acute appendicitis, there was extension of a network of S100 positive dendritic cells into the cryptal mucosa, and these S100-positive dendritic cells were closely aligned with the epithelium. The epithelium in UC, but not in acute appendicitis, showed intense upregulation of HIA class II, and this was particularly marked at the crypt bases. Dendritic, MAC387-positive cells were seen only in UC. In both diseases there were abundant ACPI-positive accessory cells in the cryptal areas, a population normally restricted to the dome areas. Factor XIIIa- and PGM1-positive cells, although abundant in both conditions, had distributions similar to those that we had previously shown in normal controls. No CD1a-positive cells were identified in either UC or acute appendicitis. We hypothesize that S100 identifies a subpopulation of activated macrophages. The concentration of this subpopulation, in close contact with the epithelium, which also shows altered expression of HLA class II antigens, suggests that a component of the immune response is targeting this area in UC. In addition, we also suggest that the identification of MAC387-positive dendritic cells in UC reflects increased macrophage turnover in inflammatory bowel disease.

BACKGROUND:Amyloidosis is a rare complication of non-Hodgkin's lymphoma. Most of the reported patients have had systemic amyloidosis and have died as a result of complications of this disease.MATERIALS AND METHODS:The clinical cases of two patients with lymphoplasmacytic non-Hodgkin's lymphoma who presented with lymphadenopathy due to localised amyloid deposition are reviewed. Immunohistochemical studies were performed on the amyloid deposits and adjacent lymphoma.RESULTS:The amyloid deposits in both patients were derived from monoclonal light chains of the same isotype as those expressed by the lymphoma cells and were localised to areas adjacent to the lymphoma despite the presence of circulating light chains. Both patients had an indolent clinical course and treatment appeared to have little influence on the amyloid deposition.CONCLUSIONS:Non-Hodgkin's lymphoma may be associated with localised amyloidosis secondary to local production and deposition of amyloid from monoclonal light chains synthesised by the lymphoma cells. This is a rare cause of lymphadenopathy which does not respond to treatment of the underlying lymphoma.

We present a study which describes the immunophenotype and distribution of accessory cells in 13 resections of terminal ileum from patients with Crohn's disease, A panel of antibodies working in paraffin-embedded tissue was employed and these included PGM1 (CD68), S-100 protein, WR18 (HLA class II), factor XIIIa and acid cysteine proteinase inhibitor. This study revealed a heterogeneity of accessory cell populations which was profoundly influenced by local inflammatory and repair mechanisms, Both acid cysteine proteinase activity and S-100 protein positive cells are identified in more actively inflamed areas, The acid cysteine proteinase activity positive dendritic cell population was particularly numerous in ulcer bases, S-100 protein positive dendritic cells had a more limited distribution in close proximity to the epithelium in inflamed but otherwise intact mucosa adjacent to the areas of ulceration, PGM1 revealed normal distribution of macrophages within histologically uninvolved areas and, in addition, also stained granulomas and large numbers of dendritic cells in the inflamed, ulcerated and scarred areas, Factor XIIIa positive dendritic cells were especially numerous in areas of active scarring where they co-localized with PGM1 positive cells. They were largely absent from the more superficial ulcerated areas, HLA class II was strongly expressed on mononuclear inflammatory and dendritic cells, The strength of epithelial staining for HLA class II reflected the intensity of adjacent inflammation, except on ulcer-associated epithelium which consistently showed up-regulation independent of the severity of the inflammatory process, This study shows that localized alterations in the accessory cell distribution in Crohn's disease correlate with different states in the evolution of the inflammatory and repair process of the disease, The more acute lesions are associated with recruitment of acid cysteine proteinase activity and S-100 protein positive dendritic cells while factor XIIIa stained dentritic cells are especially numerous in areas of scarring.

We report a study of the organization of accessory cell populations, in normal mucosal lymphoid tissue from small intestine (8 cases), large intestine (6) and appendix (9) using a panel of monoclonal antibodies and polyclonal antisera in paraffin-embedded tissue. Two populations were identified in dome areas, one positive for acid cysteine proteinase inhibitor and HLA class II (WR18) only and the second positive for S-100 protein, CD68, and WR18 and negative for acid cysteine proteinase inhibitor and factor XIIIa. Superficial colonic mucosal and small intestinal villous tip macrophages stained positively with CD68 and WR18 only, while deeper cryptal and submucosal populations exhibited additional positivity for factor XIIIa, but both populations were negative for acid cysteine proteinase inhibitor and S-100 protein. Germinal centre macrophages were positive for CD68, WR18 and acid cysteine proteinase inhibitor and negative for factor XIIIa, and S-100 protein. T zone dendritic cells included a population which stained positively for S-100 protien, WR18 and were negative for factor XIIIa, CD68 and acid cysteine proteinase inhibitor, an immunophenotype typical of interdigitating dendritic reticulum cells. This distribution of phenotypically identifiable accessory cell subpopulations was apparent at all three sites examined. We suggest that the specialized subpopulations of dendritic cells staining for S-100 protein and for acid cysteine proteinase inhibitor which are restricted to the dome areas, may have a potential role in the transfer of antigen across the epithelium to the germinal centres, while factor XIIIa appears to identify a tissue macrophage population with a potential role in stromal modulation distant from direct antigen challenge.

This paper presents a description of the patterns of distribution of accessory cells in helicobacter gastritis and low-grade gastric MALT lymphomas. The use of gastric resection specimens afforded abundant, well-orientated lymphoid tissue. Fifteen cases were selected from patients with MALT lymphomas, three with gastritis alone, and six histologically normal controls. A panel of antibodies working in paraffin-embedded tissue, identifying differing accessory cells, was used. These comprised antibodies to HLA class II (WR18), acid cysteine proteinase inhibitor (ACPI), CD68 (PGM1), Factor XIIIa, S100 protein, CD23 (BU38), CD106 (V-CAM1), CD55 (BRIC 128), and CD21 (1F8). CD68-positive macrophages in the gastritis cases were abundant in the superficial mucosa. Factor XIIIa also identified dendritic cells at deeper sites but these were absent from both the acquired and the neoplastic lymphoid tissue. Antibodies to both S100 protein and ACPI stained dendritic cells localized to areas within and adjacent to the lymphoid tissue only. S100 protein-positive cells were concentrated in close contact with glandular epithelium immediately above the germinal centres, while ACPI-positive dendritic cells were identified, especially around the more blastic reactive follicles, in the intervening space between the germinal centres and the overlying epithelium. Similar patterns of organization were also seen in the areas of mucosal lymphoma. The follicular dendritic markers revealed overlapping but distinct sub-populations within the germinal centres which appeared to alter depending on the activity of the germinal centres. While both ACPI and CD55 stained the germinal centre dendritic reticulum cell networks only, CD21 and CD106 also stained the mantle dendritic cells. The proportion staining with CD23, which stains dendritic reticulum cells within the centrocyte-rich areas of the germinal centres only, was greatest in the more quiescent germinal centres. Similar patterns of staining were also seen in germinal centres within the gastric MALT lymphomas. It is proposed that the sub-populations of dendritic cells staining with S100 protein and ACPI may facilitate helicobacter antigen delivery to the germinal centres. The follicular dendritic cells then promote a sustained B-cell response to the luminal pathogen.

Specimens from 23 patients with enteropathy-associated T cell lymphoma were studied by immunohistochemistry after antigen retrieval. Specimens from 14 of these patients were investigated for the presence of clonal T cell gene rearrangements in both the tumor and the adjacent enteropathic intestine by the polymerase chain reaction. Primers for T cell receptor beta and gamma genes were used in a combination that permits the identification of approximately 90% of T cell receptor rearrangements. Clonal rearrangements of the T cell receptor were found in 13 of the 14 tumors studied. Specimens of enteropathic bowel resected with the tumor, but showing no morphological or immunohistochemical evidence of tumor involvement, showed clonal T cell receptor gene rearrangements in 11 cases. In 10 of these, the amplified DNA was of the same molecular weight in the enteropathic bowel as in the corresponding tumor. In 2 cases, sequencing the polymerase chain reaction product showed identical T cell receptor gene rearrangements in the tumor and in the adjacent intestine. Uniform staining for p53 was seen in 22 of the 23 tumors. In 9 of 19 cases studied, collections of small lymphocytes in the enteropathic bowel expressed p53. In all but one of these specimens, a clonal rearrangement of the T cell receptor genes was identified. We interpret these findings as support for the concept that enteropathy-associated T cell lymphoma arises on a background of gluten-sensitive enteropathy with evolution of neoplastic T cell clones from the reactive T cell population present in the enteropathic bowel.

CD is a gluten-sensitive enteropathy, strongly associated with expression of the DQA1*0501, DQB1*0201 genotype. CD patients have an increased risk of malignancy, particularly EATCL. However, it is controversial as to whether adults with EATCL represent a subgroup of patients with CD or should be regarded as a distinct entity. To investigate the genetic relationship between CD and EATCL, HLA class II DRB1, DQA1, and DQB1 typing of peripheral blood, frozen or paraffin-embedded biopsy tissue obtained from Caucasian patients with CD (n = 91) or EATCL (n = 47) was performed by PCR-SSOP typing. Genotype frequencies were compared with those observed in 151 unrelated control individuals. A total of 83 (91%) of 91 CD patients were of DQA1*0501, DQB1*0201 genotype (pc < 10(-6), RR = 522.2), compared with 40 (93%) of 43 EATCL patients (pc < 10(-6), RR = 44.2) with amplifiable DNA versus 35 (23%) of 151 controls. DRB1*03 frequencies were also elevated in both patient groups (79 of 91 in CD [87%; pc < 10(-6), RR = 24.5] and 38 of 40 in EATCL [95%; pc < 10(-6), RR = 70.7]) compared with controls (32 of 151, 21%). These results confirm previous studies of HLA associations in CD and also suggest that EATCL arises in individuals with the DQA1*0501, DQB1*0201 CD-predisposing genotype. However, the frequency of DRB1*03,04 heterozygotes was significantly increased in the EATCL group (16 of 40, 40%) compared with both control individuals (3 of 151, 2%; pc < 10(-6), RR = 32.9) and uncomplicated CD patients (6 of 91, 7%; pc = 0.04, RR = 9.4).(ABSTRACT TRUNCATED AT 250 WORDS)

We have studied 14 cases of low‐grade, splenic marginal zone, B‐cell non‐Hodgkin's lymphoma. The clinical presentation in all cases was with splenomegaly and, in 10 cases, circulating neoplastic lymphoid cells in the peripheral blood with involvement of bone marrow. In all cases the splenic white pulp was hyperplastic with expansion of marginal zones and varying degrees of infiltration of germinal centres by neoplastic cells. The cells were a mixture of medium sized lymphocytes with moderate amounts of cytoplasm and finely dispersed nuclear chromatin, together with occasional blast cells with small nucleoli. Satellite red pulp aggregates of tumour cells centred on small epithelioid cell clusters were seen in all cases. These appear to be a characteristic and diagnostically important feature of splenic marginal zone lymphoma. The tumour cells expressed CD20, CD45RA, bcl‐2 and the antigens detected by MB2. All cases expressed IgM with light chain restriction. In addition, IgD was expressed in four cases. The follicular dendritic cell network was disrupted in those follicles which were infiltrated by tumour cells. A network of stromal myoid cells, at the periphery of the marginal zone, identified by expression of α‐smooth muscle actin, was preserved. Alpha‐smooth muscle actin positive dendritic cells were also seen within and around satellite tumour nodules in the red pulp.

The enigma of Hodgkin’s disease (HD) is captured in two editorials published in The Lancet. The first, a quarter of a century ago, was entitled ‘The Hodgkin’s maze’;’ the second, a little over a year later, ‘Further in the Hodgkin’s maze’.2 The uncertainties of that time are illustrated by two questions posed in the second editorial: ‘Infection or neoplasm (or neither)?’ and ‘One entity or two (or more)?’. Twenty-four years on, with all the intervening advances in cellular and molecular biology, are we out of the Hodgkin’s maze? Lukes and Butler identified six subtypes of Hodgkin’s disease, subsequently reduced to four in the Rye classification. They proposed that classic Reed-Sternberg (RS) cells are found in all subtypes and that the background cells represented different host responses to the disease, reflected in the good prognosis of the lymphocytepredominant category and the rapid downhill course of the lymphocyte-depleted subtype^.^ This concept of one disease with transitions between subtypes received strong support at the time4 but is no longer tenable. Lymphocyte-predominant Hodgkin’s disease is a B-cell proliferation, phenotypically and biologically distinct from classic HD.5 Since it bears no relationship to HD, either historically or pathologically, it is better designated by the non-committal term ‘nodular paragranuloma’. Many studies of lymphocyte-depleted HD, over recent years, have shown this to be a much misdiagnosed category, encompassing a range of high-grade, non-Hodgkin’s lymphomas and other anaplastic tumours. The recognition, in recent years, of large cell anaplastic lymphoma (LCAL) has all but eliminated lymphocytedepleted HD, leaving only nodular sclerosing and mixed cellularity as recognized subtypes, with increasing evidence of the concept long advocated by epidemiologists6.’ that these represent two disease entities. The answer to the question ‘Infection or neoplasm?’ may be both. HD/RS cells show growth characteristics of neoplastic cells in immunedeficient mice. They may exhibit aneuploidy and

The immunotoxin BU12-SAPORIN was constructed by covalently coupling the single-chain ribosome-inactivating protein saporin to the anti-CD19 monoclonal antibody BU12 via a disulphide linker using the heterobifunctional reagent SPDP. The immunoreactivity and specificity of BU12-SAPORIN was identical to that of unmodified native BU12 antibody. BU12-SAPORIN was selectively cytotoxic in vitro in a dose-dependent manner for the CD19+ human common acute lymphoblastic leukaemia (cALL) cell line NALM-6 but exhibited no toxicity for the CD19- T-cell acute lymphoblastic leukaemia (T-ALL) cell line HSB-2. The survival of severe combined immunodeficient (SCID) mice with disseminated NALM-6 leukaemia was significantly prolonged compared with sham-treated control animals by a course of therapy with BU12-SAPORIN but not with the irrelevant anti-CD7 immunotoxin HB2-SAPORIN. BU12-SAPORIN had no therapeutic effect in SCID mice with disseminated CD19- HSB-2 leukaemia. These preclinical studies have clearly demonstrated the selective cytotoxicity of BU12-SAPORIN for CD19+ target cells both in vitro and in vivo. This, taken together with the lack of expression of the CD19 molecule by any normal life-sustaining tissue and its ubiquitous and homogeneous expression by the majority of cALL and B-NHL cells, provides the rationale for undertaking a phase I trial of systemic therapy with BU12-SAPORIN.

Epstein-Barr virus (EBV)-infected cells may sustain three distinct forms of virus latency. In lymphoblastoid cell lines, six EBV-encoded nuclear antigens (EBNA1, 2, 3A, 3B, 3C, -LP), three latent membrane proteins (LMP1, 2A, 2B), and two nuclear RNAs (EBERs) are expressed. This form of latency, termed latency III, is also encountered in some posttransplant lymphoproliferative disorders. In EBV-positive cases of Hodgkin's disease, the EBERs, EBNA1, and the LMPs are expressed (latency II), whereas in Burkitt's lymphoma (BL) only the EBERs and EBNA1 have been detected (latency I). We have studied the expression of EBV proteins in 17 cases of EBV-positive endemic BL by immunohistology. Expression of LMP1 was seen in variable proportions of tumor cells in two cases and EBNA2 was detected in some tumor cells in three other cases. Also, the BZLF1 trans-activator protein was expressed in a few tumor cells in 6 cases, indicating entry into the lytic cycle. A phenotypic drift from latency I to latency III has been observed previously in some BL cell lines. Our results suggest that a similar phenomenon may occur in BL in vivo and indicate that the operational definition of EBV latencies is not easily applied to human tumors.

HistopathologyVolume 24, Issue 1 p. 97-99 Lymphomas of Waldeyer's ring D.H. WRIGHT, D.H. WRIGHT University Department of Pathology, Level E, South Block, Southampton General Hospital, Tremona Road, Southampton SO9 4XY, UKSearch for more papers by this author D.H. WRIGHT, D.H. WRIGHT University Department of Pathology, Level E, South Block, Southampton General Hospital, Tremona Road, Southampton SO9 4XY, UKSearch for more papers by this author First published: January 1994 https://doi.org/10.1111/j.1365-2559.1994.tb01281.xCitations: 13AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume24, Issue1January 1994Pages 97-99 RelatedInformation