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An immunohistochemical study of primary lymphomas of the central nervous system
672
Pathology (1985), 17, October
THE ROYAL COLLEGE OF PATHOLOGISTS
a m / genes arise by interchromosomal crossing-over events. I t is propoFed that heterogeneity observed in these gene rearrangements is the result of crossing-over which inactivates 1 gene in some situations.
SERUM BETA-2-MICROGLOBULIN LEVELS IN LY MPHOPROLIFERATIVE DISORDERS: A PRELIMINARY REPORT D. KOTASPK, H . FORD,R. E. SAGEA N D B. M. DALE Departmenf of Hemato fogy/Oncology, The Queen Elizabeth Hospiraf, Woodville, S.A . SO01
Beta 2 microglobulin (B2Mg) is a 100 amino acid polypeptide chain that forms the light chain of the Class 1 HLA antigen on the surface of nucleated cells. Cell membrane turnover is the main source of B2Mg in blood and tissue fluids. Serum concentrations rise with advancing age and deteriorating renal (esp. tubular) function. A number of hematological malignancies are associated with elevated levels of B2Mg with serum levels reflecting events of clinical importance in these diseases. We have analyzed serum B2Mg levels using a commercially available B2Mg radioimmunoassay (Pharmacia) in 139 consecutive patients with hematological malignancies (Table I). Although within normal range, patients with Hodgkin’s disease (HD) had B2Mg level above the mean normal value and this difference was significant (p <0.005). Patients with chronic lymphocytic leukemia (CLL), multiple myeloma (MM) and non-Hodgkin’s lymphoma (NHL) had levels significantly above normal range (p
Disease
B2Mg Mean fSD (mdl)
NHL HD CLL MM
2.92 f 1.43 2.20 f 1.20 3.39f 1.54 4.53 3.22
*
61 17 24 29
Normal
I .67 f 0.60
111
Patient No.
Mean creatinine (mmol/l) 98 82 96 114 N Range 50- 120
thromboplastin). During the past 2 yr, the International Committee for Standardization in Hematology (ICSH), and WHO have recommended a new method of standardization, assigning an International Sensitivity Index (ISI) to each commercial thromboplastin, with reference to the WHO primary standard IRP 67/40 (IS1 = 1). A new method of reporting as an International Normalized Ratio (INR) was also recommended. The commission of the European Communities has prepared lyophilized reference thromboplastins (BCR-RM) which included a special batch of BCT with an IS1 of 1.048 SEM 0.015. ART is now standardized using the new method and the available batch of human BCR-RM. The aim is to obtain an IS1 as near to 1 .O as possible. Because past batches of BCT have been less sensitive than the IRP 67/40, the new batches of ART will be slightly more sensitive and ART ratios could be interpreted to be similar to the INR. Clinicians who have based their control of oral anticoagulant therapy on the British or Dutch systems could, therefore, continue to use the ART ratios without any need of a conversion table. Examples of standardization of recent batches of ART will be presented.
AN IMMUNOHISTOCHEMICAL STUDY OF PRIMARY LYMPHOMAS OF THE CENTRAL NERVOUS SYSTEM B. Susir, W. W. HANCOCK A N D E . SUMITHKAN Prince Henry’s Hospitaf, Sl. Kifda Road, Mefbourne Primary lymphomas of the CNS are not only rare but are often difficult to distinguish histologically from poorly differentiated gliomas and metastatic undifferentiated carcinomas. Paraffin sections of surgical material from 5 cases of primary CNS lymphoma were examined for the presence of immunological markers using the immunoperoxidase technique and a large variety of commercially available and experimental antisera. Paraffin sections of glial turnours and metastatic carcinomas served as controls. All cerebral lymphomas studied gave positive staining reactions with antibodies to leukocyte common antigens and negative reactions with antibodies to keratin and glial fibrillary acidic protein. Metastatic carcinomas and gliomas gave positive staining reactions with antibodies to keratin and glial fibrillary acidic protein respectively. In addition, intracytoplasmic monoclonal antibodies were demonstrated in 2 lymphomas. The histological features of the lymphomas were carefully studied and the tumours subclassified using both the Working Formulation and Rappaport classifications. The data show that the immunoperoxidase method is useful in distinguishing CNS lymphomas from poorly differentiated gliomas and metastatic undifferentiated carcinomas and that at least a proportion of CNS lymphomas are of B lymphocyte origin.
Average age (yr)
A CASE OF “ROUND HEADED” SPERMATOZOA
60 40 65 68
Clinical Pathology and Medical Research and Department of Obstetrics and Cynaecofogy, Westmead Centre, Westmead, N.S. W . 2145 Morphological assessment of spermatozoa is an important investigation to be performed early in the investigation of infertile couples. Pleomorphism is characteristic of human semen but predominance of a single abnormal type is rare. This poster demonstrates such a case. The subject is a normal 28 yr-old man with primary infertility of 18 mth known duration. He has a normal endocrine status. Semen examined on 4 occasions showed normal volumes (2.6-5.0 ml) and spermatozoa1 densities (25.0-44.0 M/ml) but markedly reduced spermatozoal motility (21-39%) with 52.58% staining as non-vital. Motile spermatozoa were capable of penetrating periovulatory cervical mucus and no anti-spermatozoa1 antibodies were present in the patient’s serum or o n the spermatozoa themselves. However, consistently, more than 90% of the spermatozoa were of the characteristic “round headed” form and immature germ cells, “pin head” and duplicate forms were present.
43
THE AUSTRALASIAN REFERENCE THROMBOPLASTIN (ART) UPDATE ON STANDARDIZATION P . R. L. LAM-PO-TANGDepartment of Haematology, Prince of Wales Hospital, Randwick, N . S . W . 2031 Since its introduction in 1972, ART has been standardized against human thromboplastin from Manchester. Initially, it was the Manchester Comparative Reagent (MCR: a phenol saline suspension), then the British Comparative Thromboplastin (BCT: a lyophilized plain
S. M. B. STEVENS, J . P . P . TYLER A N D R. A . BOADLE Institute of
Pathology (1985), 17, October
THE ROYAL COLLEGE OF PATHOLOGISTS
a m / genes arise by interchromosomal crossing-over events. I t is propoFed that heterogeneity observed in these gene rearrangements is the result of crossing-over which inactivates 1 gene in some situations.
SERUM BETA-2-MICROGLOBULIN LEVELS IN LY MPHOPROLIFERATIVE DISORDERS: A PRELIMINARY REPORT D. KOTASPK, H . FORD,R. E. SAGEA N D B. M. DALE Departmenf of Hemato fogy/Oncology, The Queen Elizabeth Hospiraf, Woodville, S.A . SO01
Beta 2 microglobulin (B2Mg) is a 100 amino acid polypeptide chain that forms the light chain of the Class 1 HLA antigen on the surface of nucleated cells. Cell membrane turnover is the main source of B2Mg in blood and tissue fluids. Serum concentrations rise with advancing age and deteriorating renal (esp. tubular) function. A number of hematological malignancies are associated with elevated levels of B2Mg with serum levels reflecting events of clinical importance in these diseases. We have analyzed serum B2Mg levels using a commercially available B2Mg radioimmunoassay (Pharmacia) in 139 consecutive patients with hematological malignancies (Table I). Although within normal range, patients with Hodgkin’s disease (HD) had B2Mg level above the mean normal value and this difference was significant (p <0.005). Patients with chronic lymphocytic leukemia (CLL), multiple myeloma (MM) and non-Hodgkin’s lymphoma (NHL) had levels significantly above normal range (p
Disease
B2Mg Mean fSD (mdl)
NHL HD CLL MM
2.92 f 1.43 2.20 f 1.20 3.39f 1.54 4.53 3.22
*
61 17 24 29
Normal
I .67 f 0.60
111
Patient No.
Mean creatinine (mmol/l) 98 82 96 114 N Range 50- 120
thromboplastin). During the past 2 yr, the International Committee for Standardization in Hematology (ICSH), and WHO have recommended a new method of standardization, assigning an International Sensitivity Index (ISI) to each commercial thromboplastin, with reference to the WHO primary standard IRP 67/40 (IS1 = 1). A new method of reporting as an International Normalized Ratio (INR) was also recommended. The commission of the European Communities has prepared lyophilized reference thromboplastins (BCR-RM) which included a special batch of BCT with an IS1 of 1.048 SEM 0.015. ART is now standardized using the new method and the available batch of human BCR-RM. The aim is to obtain an IS1 as near to 1 .O as possible. Because past batches of BCT have been less sensitive than the IRP 67/40, the new batches of ART will be slightly more sensitive and ART ratios could be interpreted to be similar to the INR. Clinicians who have based their control of oral anticoagulant therapy on the British or Dutch systems could, therefore, continue to use the ART ratios without any need of a conversion table. Examples of standardization of recent batches of ART will be presented.
AN IMMUNOHISTOCHEMICAL STUDY OF PRIMARY LYMPHOMAS OF THE CENTRAL NERVOUS SYSTEM B. Susir, W. W. HANCOCK A N D E . SUMITHKAN Prince Henry’s Hospitaf, Sl. Kifda Road, Mefbourne Primary lymphomas of the CNS are not only rare but are often difficult to distinguish histologically from poorly differentiated gliomas and metastatic undifferentiated carcinomas. Paraffin sections of surgical material from 5 cases of primary CNS lymphoma were examined for the presence of immunological markers using the immunoperoxidase technique and a large variety of commercially available and experimental antisera. Paraffin sections of glial turnours and metastatic carcinomas served as controls. All cerebral lymphomas studied gave positive staining reactions with antibodies to leukocyte common antigens and negative reactions with antibodies to keratin and glial fibrillary acidic protein. Metastatic carcinomas and gliomas gave positive staining reactions with antibodies to keratin and glial fibrillary acidic protein respectively. In addition, intracytoplasmic monoclonal antibodies were demonstrated in 2 lymphomas. The histological features of the lymphomas were carefully studied and the tumours subclassified using both the Working Formulation and Rappaport classifications. The data show that the immunoperoxidase method is useful in distinguishing CNS lymphomas from poorly differentiated gliomas and metastatic undifferentiated carcinomas and that at least a proportion of CNS lymphomas are of B lymphocyte origin.
Average age (yr)
A CASE OF “ROUND HEADED” SPERMATOZOA
60 40 65 68
Clinical Pathology and Medical Research and Department of Obstetrics and Cynaecofogy, Westmead Centre, Westmead, N.S. W . 2145 Morphological assessment of spermatozoa is an important investigation to be performed early in the investigation of infertile couples. Pleomorphism is characteristic of human semen but predominance of a single abnormal type is rare. This poster demonstrates such a case. The subject is a normal 28 yr-old man with primary infertility of 18 mth known duration. He has a normal endocrine status. Semen examined on 4 occasions showed normal volumes (2.6-5.0 ml) and spermatozoa1 densities (25.0-44.0 M/ml) but markedly reduced spermatozoal motility (21-39%) with 52.58% staining as non-vital. Motile spermatozoa were capable of penetrating periovulatory cervical mucus and no anti-spermatozoa1 antibodies were present in the patient’s serum or o n the spermatozoa themselves. However, consistently, more than 90% of the spermatozoa were of the characteristic “round headed” form and immature germ cells, “pin head” and duplicate forms were present.
43
THE AUSTRALASIAN REFERENCE THROMBOPLASTIN (ART) UPDATE ON STANDARDIZATION P . R. L. LAM-PO-TANGDepartment of Haematology, Prince of Wales Hospital, Randwick, N . S . W . 2031 Since its introduction in 1972, ART has been standardized against human thromboplastin from Manchester. Initially, it was the Manchester Comparative Reagent (MCR: a phenol saline suspension), then the British Comparative Thromboplastin (BCT: a lyophilized plain
S. M. B. STEVENS, J . P . P . TYLER A N D R. A . BOADLE Institute of