Lawrence M. Weiss

Epstein-Barr virus (EBV) has been implicated in the pathogenesis of a variety of lymphoproliferative disorders and several epithelial neoplasms, including undifferentiated nasopharyngeal carcinoma (UNPC; lymphoepithelioma). Lymphoepithelioma-like carcinomas (LEC) are tumors with morphologic features identical to UNPC that occur outside the nasopharynx. To determine whether EBV is associated with LEC, the authors conducted a comprehensive literature review of all pathologically documented LEC reported to date in the English literature. In summary, EBV is associated consistently with LEC from only four anatomic sites: stomach, salivary gland, lung, and thymus. Racial and/or geographic factors influence the association of EBV with LEC in some of these organs. Specifically, the association of EBV with LEC of the salivary gland and lung is restricted to Asian patients, whereas the association of EBV with gastric and thymic LEC is independent of race. The presence or absence of EBV in LEC does not appear to be prognotically important in those cases studies to date.

Clear cell tumors of the lung (CCTL) are rare neoplasms of uncertain differentiation. A previous study of eight CCTL demonstrated a lack of epithelial features, but their exact nature remained unknown. In the current study of nine CCTL, immunohistochemistry using preliminary enzymatic digestion showed strong reactivity with the antimelanocytic markers HMB-45 (seven cases) and HMB-50 (six cases) and focal positivity for S-100 (nine cases), neuron-specific enolase (three cases), synaptophysin (one case), and Leu-7 (one case). Staining for cytokeratin, epithelial membrane antigen, chromogranin, and glial fibrillary acid protein was uniformly negative. Frozen-section immunoreactivity for vimentin and the antimelanocytic monoclonal preparation NKI/BETEB was noted in the one CCTL for which snap-frozen tissue was available. Ultrastructural examination of three glutaraldehyde-fixed CCTL showed rare neoplastic cells containing the full spectrum of melanosomes in two, one of which also contained neurosecretory-type granules. Aberrant melanosomal forms were identified in the third case. Melanosomes were not identified in the remaining five CCTL studied from formalin- or paraffin-retrieved material. The findings indicate that CCTL exhibits melanocytic differentiation. This feature may be of considerable value in distinguishing CCTL from other clear cell neoplasms.

We reviewed our experience with 30 nodal and extranodal lymphoid lesions from 17 patients with common variable immunodeficiency (CVID). Immunohistochemical studies were performed on biopsies from 15 patients, in situ hybridization for Epstein-Barr virus in nine cases, and gene rearrangement analysis on seven lesions. The biopsies were classified into four groups: malignant lymphoma (two cases); atypical lymphoid hyperplasia (eight cases); reactive lymphoid hyperplasia (14 cases); and chronic granulomatous inflammation (six cases). The two malignant lymphomas were diagnosed using histologic criteria; tissue was not available for the assessment of clonality. In one neoplasm, Epstein-Barr virus was identified in the tumor cells by in situ hybridization. The cases of reactive lymphoid hyperplasia and chronic granulomatous inflammation had no atypical architectural, cytologic, or immunohistochemical features. The cases of atypical lymphoid hyperplasia were of particular interest, as these patients had either widespread involvement or massive disease. The diagnosis of lymphoma was considered likely by the clinicians and, in three cases, the histologic slides were originally interpreted as malignant lymphoma by the referring pathologists. Although the architecture of these lesions appeared to be effaced on hematoxylin and eosin-stained sections, immunohistochemical analysis demonstrated preserved architecture with florid expansion of B-cell and T-cell compartments. In addition, clinical follow-up of these patients was benign, and gene rearrangement analysis in three lesions revealed no evidence of clonality. We conclude that the majority of lymphoid lesions in patients with CVID are benign. Immunohistochemical and gene rearrangement studies are particularly helpful in the assessment of cases of atypical lymphoid hyperplasia.

Breast involvement by non-Hodgkin's lymphoma is rare. Differences between primary and secondary breast lymphoma have been reported, and a relationship between primary breast lymphoma and lymphomas of mucosa-associated lymphoid tissue has been suggested. We reviewed 61 cases of breast lymphoma (41 primary, 13 secondary, and 7 unclear) that included 28 right-sided masses at presentation, 17 left-sided, 12 bilateral, and 4 in which the side was not known. A subgroup of bilateral breast lymphomas was identified that occurred in young women, four of which were pregnant or postpartum. A high incidence of intermediate- and high-grade lymphomas were present in both cases of primary and secondary lymphomas as was a high frequency of B-cell phenotype. Additional immunohistochemical studies failed to demonstrate evidence of marginal or mantle cell differentiation in seven of eight cases studied. Lymphoepithelial lesions were identified in a majority of cases, including 67% of primary and 64% of secondary lymphomas. This study failed to demonstrate a morphologic difference between primary or secondary lymphomas of the breast and suggests that breast lymphomas differ from other extranodal lymphomas in that the latter are frequently low grade.

Brief Reports1 January 1985Hodgkin's Disease in Homosexual Men with Generalized LymphadenopathySONJA L. SCHOEPPEL, M.D., RICHARD T. HOPPE, M.D., RONALD F. DORFMAN, M.D., SANDRA J. HORNING, M.D., ANN C. COLLIER, M.D., TERRENCE G. CHEW, M.D., LAWRENCE M. WEISS, M.D.SONJA L. SCHOEPPEL, M.D., RICHARD T. HOPPE, M.D., RONALD F. DORFMAN, M.D., SANDRA J. HORNING, M.D., ANN C. COLLIER, M.D., TERRENCE G. CHEW, M.D., LAWRENCE M. WEISS, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-102-1-68 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe syndrome of persistent, generalized lymphadenopathy not attributable to an identifiable cause in homosexual men was first described in 1982 (1). Biopsy samples of the enlarged lymph nodes have shown a characteristic pattern of follicular or paracortical hyperplasia, or both (2, 3). These studies have suggested that this unexplained lymphadenopathy in homosexual men, the lymphadenopathy syndrome, may be part of the spectrum of the acquired immunodeficiency syndrome.We have recently noted Hodgkin's disease developing in patients with the lymphadenopathy syndrome. This finding is provocative because Hodgkin's disease and the lymphadenopathy syndrome are both associated with cellular immunodeficiencies (4-6). Also, these...References1. Persistent generalized lymphadenopathy among homosexual males. MMWR. 1982;31:249-51. MedlineGoogle Scholar2. METROKACUNNINGHAM-RUNDLESPOLLOCK CSM. Generalized lymphadenopathy in homosexual men. Ann Intern Med. 1983;99:585-91. LinkGoogle Scholar3. BRYNESCHANSPIRAEWINGCHANDLER RWTEF. Value of lymph node biopsy in unexplained lymphadenopathy in homosexual men. JAMA. 1983;250:1313-7. CrossrefMedlineGoogle Scholar4. BROWNHAYNESFOLEYGODWINBERARDCARBONE RHHHCP. Hodgkin's disease: immunologic, clinical, and histologic features of 50 untreated patients. Ann Intern Med. 1967;67:291-302. LinkGoogle Scholar5. TWOMEYRICE JL. Impact of Hodgkin's disease upon the immune system. Semin Oncol. 1980;7:114-25. MedlineGoogle Scholar6. GOTTLIEBGROOPMANWEINSTEINFAHEYDETELS MJWJR. The acquired immunodeficiency syndrome. Ann Intern Med. 1983;99:208-20. LinkGoogle Scholar7. YOUNGPERCYASIRE JCA. Cancer incidence and mortality in the United States. Natl Cancer Inst Monogr. 1981;57:72-84. Google Scholar8. MOSSBACCHETTIGORMAN APM. AIDS in the "gay" areas of San Francisco [Letter]. Lancet. 1983;1:923-4. CrossrefMedlineGoogle Scholar9. SMITHBUTLER JJ. Skin involvement in Hodgkin's disease. Cancer. 1980;45:354-61. CrossrefMedlineGoogle Scholar10. CASTELLINODUNNICKGOFFINETROSENBERGKAPLAN RNDSH. Predictive value of lymphography for sites of subdiaphragmatic disease encountered at staging laparotomy in newly diagnosed Hodgkin's disease and non-Hodgkin's lymphoma. J Clin Oncol. 1983;1:532-6. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Stanford University Stanford, California University of Washington Seattle, Washington Saint Francis Hospital San Francisco, California PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByLymphoma in Other DiseasesCutaneous lymphoproliferative diseases and related disordersHodgkin's DiseaseAIDS and Its Ophthalmic ManifestationsSecondary extension of Hodgkin's disease to the skin with positive staining for EBV-encoded latent membrane proteinTumortherapie bei HIV-InfektionAIDS and lymphadenopathySecondary extension of Hodgkin's disease to the skin with positive staining for EBV-encoded latent membrane proteinHIV-Associated Hodgkin LymphomaBiology of Non-Hodgkin's LymphomaHodgkin's Disease in Patients Infected with Human Immunodeficiency Virus: Frequency, Presentation and Clinical OutcomeKaposi Sarcoma After Treatment of Hodgkin's Disease in a Young Adult Non-AIDS PatientHIV-assoziierte TumorerkrankungenPrimary Cutaneous Hodgkin's Disease with Evolution to Systemic DiseaseFNB diagnosis of breast carcinoma associated with HIV infection: A case report and review of HIV associated malignancyHodgkin's disease as an indicator of AIDSMolecular Pathogenesis of Aids-Related LymphomasChicken pox and acute monocytic leukaemia skin lesions in an HIV-seropositive manCombined antineoplastic and antiretroviral therapy for patients with hodgkin's disease and human immunodeficiency virus infection. 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