The author examined the immunophenotype and expression of Epstem-Barr virus RNA (EBERs) used in the situ hybridization technique in 20 cases of conventional malignant lymphoma and 28 cases of polymorphic reticulosis and malignant lymphoma with features of polymorphic reticulosis occured in the upper aerodigestive tract including the upper digestive tract(palatine tonsil), and upper respiratory tract(nasal cavity, paranasal sinus, nasopharynx). The results obtained were summarized as followings; 1. The favorable site of malignant lymphoma that occured in the upper aerodigestive tract was in the palatine tonsil(11 out of 20 cases, 55%), those of polymorphic reticulosis and malignant lymphoma with features of polymorphic reticulosis were nasal cavity and nasopharynx(19 out of 28 cases, 78%). 2. The immunophentype of malignant lymphoma that occured in the upper aerodigestive tract was mostly B-cell phenotype (15 out of 20 cases, 75%), and that of polymorphic reticulosis and malignant lymphoma with features of polymorphic reticulosis was predominantly T-cell phenotype(22 out of 28 cases, 79%).
3. The EBERs positivity of malignant lymphoma that occured in the upper aerodigestive tract was 25%(5 out of 20 cases), but that of polymorphic reticulosis and malignant lymphoma with features of polymorphic reticulosis was 57%(16 out of 28 cases). 4. The positive cases for EBERs revealed angiocentricity with necrosis(16 out of 21 cases, 76%), predominantly T-cell phenotype(19 out of 21 cases, 90%), and favorably involved the nasal cavity and nasopharynx(16 out of 21 cases, 76%). Based on the above results, it was concluded that polymorphic reticulosis and malignant lymphoma with features of polymorphic reticulosis that occurred in the upper respiratory tract was an EBV-positive angiocentric T-cell lymphoma favorably involving the nasal cavity and nasopharynx.
Polymorphic reticulosis(PMR) is a unique clinicopathological entity of unknown etiology, which commonly present as an aggressive, necrotizing lesion of the upper respiratory tract. It is a separate nosologic entity from Wegener's granulomatosis and idiopathic mildine destructive disease.
The origin of the cells composing polymorphic reticulosis has been controversial. We reviewed 15 cases of polymorphic reticulosis with respect to clinical and histologic bases, and immunohistochemical studies were done using UCHLI (CD45RO), as a T cell marker, CD-20 as a B cell marker and alpha- I -antichymotrypsin as a histiocytic marker. Almost all cases showed characteristic histologic and immunohistochemical features similar to those of peripheral T cell lymphoma. Thus, this study indidcated that polymorphic reticulosis is a type of malignant lymphoma of T cell lineage.
Malignant lymphomas of the upper respiratory tract are relatively common in the Orient including Korea. They have a marked clinicopathologic and immunophenotypic diversity. We retrospectively reviewed 20 cases of malignant lymphomas with features of polymorphic reticulosis in the upper respiratory tract. Histopathologic findings consisted of polymorphism of lymphoid cells in 17 cases(85%), angiocentricity in 14 cases(70%), coagulation necrosis in 12 cases(60%), and epitheliotropism in 8 cases(40%). By Working Formulation, 14 cases(70%) were classified as diffuse large cell type, 4 cases(20%) as diffuse mixed small cleaved and large cell type, one case as immunoblastic type, and one case as anaplastic large cell type. On immunostaining, one showed B-cell phenotype and 19 cases showed T-cell phenotype. The B-cell type was histologically diffuse large cell type. From these results, we concluded that polymorphic reticulosis is a type of peripheral T-cell lymphoma with angiocentricity.
In Korea, the proportion of B-cell and T-cell lymphomas has not yet been clearly estimated. In the present study, we analysed clinicopathologic and immunophenotypic findings in 60 cases of non-Hodgkin's lymphomas(NHL) and in 17 cases of polymorphic reticulosis. Immunohistochemical studies for monoclonal antibodies, such as MB2, UCHL-1, Kappa/Lambda light chains, and IgG/IgM/IgD heavy chains were performed on formaldehyde-fixed paraffin embedded tissue sections. Among 60 cases of NHL, 28 cases(46.7%) expressed B-cell markers, 29 cases(48.3%) T-cell markers, and 3 cases(5.0%) lacked detectable markers, whereas 16 of 17 cases(94.2%) of polymorphic reticulosis reacted with T-cell markers. The mean survival of the 16 cases of T-cell lymphoma group was shorter than that of the lymphoma group positive for B-cell markers.