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Lymphoma and pseudolymphoma of the alimentary tract
CORRESPONDENCE S c h w a n n cell c h a r a c t e r i s t i c s a n d w i t h cells c o n t a i n i n g a n g u l a t e d bodies links this t u m o r with the patient's o t h e r b e n i g n tuntors a n d thus reveals it to also be a m a n i f e s t a t i o n o f von R e c k l i n g h a u s e n ' s disease. Tiffs is the first r e c o r d e d instance o f this association, a n d it raises the issue o f w h e t h e r the s y n d r o m e o f m u l t i p l e g r a n u l a r cell t u m o r s h o u l d be c o n s i d e r e d a variant o f yon R e c k l i n g h a u s e n ' s disease that carries the s a m e risk o f m a l i g n a n t t r a n s f o r m a t i o n . ACKNOWLEDGMENT T h e a u t h o r s t h a n k Ed D r u m m o n d h e l p in electron microscopy.
for Iris technical
REFERENCES 1. Abrikossoff A: (Jber Myome, ausgehend yon der quergestreiften wilulkrlichen Muskulatur. Virchows Arch Pathol Anat Physiol 260:215, 1926 2. Murray MR: Cultural characteristics of three granular-cell myoblastomas. Cancer 4:837, 1951
3. Stout AP, Lattes R: Tumors of the Soft Tissues, vol 1, series 2. VCashington, DC, Armed Forces Institute of Pathology, 1967 4. Moscovic EA, Azar HA: Multiple granular cell tumors ("myoblastomas"): case report with electron microscopic observations and review of the literature. Cancer 20:2032, 1967 5. Nistal M, Paniaqua R, Cermenodegiles R: Granular changes in vascular leiom)'osarcoma. Virchows Arch [Pathol Anat] 386:239, 1980 6. Fe.yrter F: Ueber eine eigenartlge Geschwulstform des Nervengewebes m menschlichen verdauungsschlauch. Virchows Arch Pathol Anat Physiol 285:480, 1935 7. Bangle RG: Morphological and histochemical stud)" of granular cell myoblastoma. Cancer 5:950, 1952 8. Fisher ER, Wechsler H: Granular cell myoblastoma: a misnomer. Electron microscopic and histochemical evidence concerning its Schwann cell derivation and nature. Cancer 15:936, 1962 9. Guccion JG, Enzinger FM: Malignant schwannoma associated with yon Recklinghausen neurofibromatosis. Virchows Arch [Pathol Anat] 383:43, 1979 10. Robenson AJ: Malignant granular cell tumor (myoblastoma) of the vuh'a: report of a case and review of literature. Histopathology 5:69, 1981 I 1. Baraf CS, Bender B: Muhiple cutaneous granular cell myoblastomas. Arch Dermatol 89:243, 1964 12. Aparicio SR, Lumsden CE: Light and electron microscope studies on the granular cell myoblastoma of the tongue. J Pathol 97:339, 1969
CORRESPONDENCE LYMPHOMA AND PSEUDOLYMPHOMA THE ALIMENTARY TRACT
OF
To the Editor:--P. Saraga et al., a in their p a p e r o n lymp h o m a s and pseudolymphomas o f the alimentary tract, confirm the difficulty o f differentiating follicular hyperplasia f r o m follicular l y m p h o m a . T h e y follow the criteria d e f i n e d by Faris a n d Sahzstein, ~ w h o suggest that the p r e s e n c e o f t r u e g e r m i n a l centers on the s u r f a c e a n d in the d e p t h o f the lesion be established b e f o r e a f i r m diagnosis o f pseudolymp h o m a is made. T h e presence o f several " b o r d e r l i n e cases" a m o n g those t h e y r e p o r t p r o b a b l y reflects the practical difficult)' o f drawing the line between neoplastic and reactive follicles. I n a review o f l y m p h o p r o l i f e r a t i v e d i s o r d e r s o f the stomach, 3 we w e r e struck by several cases in which we had the o p p o r t u n i t y to o b s e r v e transitional stages b e t w e e n p e r sistent reactive g e r m i n a l c e n t e r s a n d l y m p h o m a t o u s follicles. T h i s observation led us to speculate t h a t follicular gastritis--which nearly ahvays accompanies gastric l y m p h o m a s - - a n d , p e r h a p s , p s e u d o l y m p h o n m s c o u l d in fact r e p r e s e n t p r e l y m p h o m a t o u s conditions. T h i s h y p o t h esis m i g h t explain why t h e b o r d e r l i n e cases w e r e r e p o r t e d by S a r a g a et al. a n d why t h e y reclassified s o m e as m a l i g n a n t once immunoperoxidase staining demonstrated the m o n o c l o n a l i t y o f t h e infiltrates. I n o u r p a p e r , we c o n s i d e r e d the p r e s e n c e o f follicular c e n t e r cells b e t w e e n follicles as a clue o f malignancy, b u t S a r a g a et al. q u e s t i o n e d t h e validity o f this criterion. H o w ever, follicular c e n t e r cells a r e n o t n o r m a l l y f o u n d o u t s i d e g e r m i n a l centers. O u r later e x p e r i e n c e with gastric biopsies in l y m p h o m a s has r e i n f o r c e d o u r standpoint. T h e r e f o r e , we still believe that the existence o f clusters o f centrocytes (cleaved follicular c e n t e r cells) o r centroblasts ( n o n c l e a v e d follicular c e u t e r cells) o u t s i d e follicular s t r u c t u r e s indicates malignant lymphoma. Routine use o f the functional classifications o f either Kiel o r L u k e s a n d Collins will familiarize the pathologist with the
m o r p h o l o g i c featnres o f t h e s e cells. O p t i m a l fixation a n d a g o o d Giemsa stain are essential for t h e i r identification. B. VAN DEN HEULE, MD R. HEIMANN,MD Department of Pathology Institut Jules Bordet Universit6 Libre de Brttxelles Belgium 1. Saraga P, HurlimannJ, Ozzello L: Lymphoma and pseudolymphoma of the alimentary tract: an immunohistochemical study with clinicopathologic correlations. Hum Pathol 12:713, 1981 2. Faris TD, Saltzstein SL: Gastric lymphoid hyperplasia: a lesion confused with lymphosarcoma. Cancer 17:207, 1964 3. Van Den tleule B, Van Kerkem C, Heimann R: Benign and malignant lymphoid lesions of the stomach: a histological reappraisal in the light of the Kiel classification for non-ttodgkin's lymphomas, ttistopathology 3:309, 1979 CHONDROSARCOMA OF BONE WITH "DEDI FFERENTIATION"
To the Editor:--I h a v e r e a d with interest tile article entitled " C h o n d r o s a r c o m a o f B o n e with D e d i f f e r e n t i a t i o n : A Stud)" o f E i g h t e e n Cases. 'u T h e a u t h o r s h a v e m a d e a valuable c o n t r i b u t i o n to t h e m e d i c a l literature. It is u n f o r tunate, h o w e v e r , t h a t t h e old c o n c e p t o f d e d i f f e r e n t i a t i o n is allowed to c r e e p back into o u r t e r m i n o l o g y a n d t h i n k i n g a b o u t neoplasia. Cells, w h e t h e r n o r m a l o r neoplastic, d o n o t d e d i f f e r e n t i a t e . R a t h e r , t h e y fail to differentiate. It is unthinkable that a mature polymorphonuclear leukocyte w o u l d " d e d i f f e r e n t i a t e " into a myeloblast o r that a c o r n i f i e d e p i d e r m a l cell w o u l d d e d i f f e r e n t i a t e into a basal cell. A m u c h b e t t e r i n t e r p r e t a t i o n o f t h e findings o f M c C a r t h y a n d D o r f m a n is that a c l o n e o f s p i n d l e cells fails to d i f f e r e n t i a t e into neoplastic c h o n d r o c y t e s . M a n y n e o p l a s m s exhibit heterogeneity. It is n o t u n u s u a l to o b s e r v e focal c a r c i n o i d diff e r e n t i a t i o n in a d e n o c a r c i n o m a o f t h e c o l o n , d i f f e r e n t p o p u l a t i o n s o f cells in m e l a n o n m s o r d i f f e r e n t g r o w t h patterns in b r o n c h o g e n i c ~-arcinomas, a n d m y x o i d o r fibrous histiocytoma-like p a t t e r n s in soft tissue sarcomas. H o w t h e
963
for Iris technical
REFERENCES 1. Abrikossoff A: (Jber Myome, ausgehend yon der quergestreiften wilulkrlichen Muskulatur. Virchows Arch Pathol Anat Physiol 260:215, 1926 2. Murray MR: Cultural characteristics of three granular-cell myoblastomas. Cancer 4:837, 1951
3. Stout AP, Lattes R: Tumors of the Soft Tissues, vol 1, series 2. VCashington, DC, Armed Forces Institute of Pathology, 1967 4. Moscovic EA, Azar HA: Multiple granular cell tumors ("myoblastomas"): case report with electron microscopic observations and review of the literature. Cancer 20:2032, 1967 5. Nistal M, Paniaqua R, Cermenodegiles R: Granular changes in vascular leiom)'osarcoma. Virchows Arch [Pathol Anat] 386:239, 1980 6. Fe.yrter F: Ueber eine eigenartlge Geschwulstform des Nervengewebes m menschlichen verdauungsschlauch. Virchows Arch Pathol Anat Physiol 285:480, 1935 7. Bangle RG: Morphological and histochemical stud)" of granular cell myoblastoma. Cancer 5:950, 1952 8. Fisher ER, Wechsler H: Granular cell myoblastoma: a misnomer. Electron microscopic and histochemical evidence concerning its Schwann cell derivation and nature. Cancer 15:936, 1962 9. Guccion JG, Enzinger FM: Malignant schwannoma associated with yon Recklinghausen neurofibromatosis. Virchows Arch [Pathol Anat] 383:43, 1979 10. Robenson AJ: Malignant granular cell tumor (myoblastoma) of the vuh'a: report of a case and review of literature. Histopathology 5:69, 1981 I 1. Baraf CS, Bender B: Muhiple cutaneous granular cell myoblastomas. Arch Dermatol 89:243, 1964 12. Aparicio SR, Lumsden CE: Light and electron microscope studies on the granular cell myoblastoma of the tongue. J Pathol 97:339, 1969
CORRESPONDENCE LYMPHOMA AND PSEUDOLYMPHOMA THE ALIMENTARY TRACT
OF
To the Editor:--P. Saraga et al., a in their p a p e r o n lymp h o m a s and pseudolymphomas o f the alimentary tract, confirm the difficulty o f differentiating follicular hyperplasia f r o m follicular l y m p h o m a . T h e y follow the criteria d e f i n e d by Faris a n d Sahzstein, ~ w h o suggest that the p r e s e n c e o f t r u e g e r m i n a l centers on the s u r f a c e a n d in the d e p t h o f the lesion be established b e f o r e a f i r m diagnosis o f pseudolymp h o m a is made. T h e presence o f several " b o r d e r l i n e cases" a m o n g those t h e y r e p o r t p r o b a b l y reflects the practical difficult)' o f drawing the line between neoplastic and reactive follicles. I n a review o f l y m p h o p r o l i f e r a t i v e d i s o r d e r s o f the stomach, 3 we w e r e struck by several cases in which we had the o p p o r t u n i t y to o b s e r v e transitional stages b e t w e e n p e r sistent reactive g e r m i n a l c e n t e r s a n d l y m p h o m a t o u s follicles. T h i s observation led us to speculate t h a t follicular gastritis--which nearly ahvays accompanies gastric l y m p h o m a s - - a n d , p e r h a p s , p s e u d o l y m p h o n m s c o u l d in fact r e p r e s e n t p r e l y m p h o m a t o u s conditions. T h i s h y p o t h esis m i g h t explain why t h e b o r d e r l i n e cases w e r e r e p o r t e d by S a r a g a et al. a n d why t h e y reclassified s o m e as m a l i g n a n t once immunoperoxidase staining demonstrated the m o n o c l o n a l i t y o f t h e infiltrates. I n o u r p a p e r , we c o n s i d e r e d the p r e s e n c e o f follicular c e n t e r cells b e t w e e n follicles as a clue o f malignancy, b u t S a r a g a et al. q u e s t i o n e d t h e validity o f this criterion. H o w ever, follicular c e n t e r cells a r e n o t n o r m a l l y f o u n d o u t s i d e g e r m i n a l centers. O u r later e x p e r i e n c e with gastric biopsies in l y m p h o m a s has r e i n f o r c e d o u r standpoint. T h e r e f o r e , we still believe that the existence o f clusters o f centrocytes (cleaved follicular c e n t e r cells) o r centroblasts ( n o n c l e a v e d follicular c e u t e r cells) o u t s i d e follicular s t r u c t u r e s indicates malignant lymphoma. Routine use o f the functional classifications o f either Kiel o r L u k e s a n d Collins will familiarize the pathologist with the
m o r p h o l o g i c featnres o f t h e s e cells. O p t i m a l fixation a n d a g o o d Giemsa stain are essential for t h e i r identification. B. VAN DEN HEULE, MD R. HEIMANN,MD Department of Pathology Institut Jules Bordet Universit6 Libre de Brttxelles Belgium 1. Saraga P, HurlimannJ, Ozzello L: Lymphoma and pseudolymphoma of the alimentary tract: an immunohistochemical study with clinicopathologic correlations. Hum Pathol 12:713, 1981 2. Faris TD, Saltzstein SL: Gastric lymphoid hyperplasia: a lesion confused with lymphosarcoma. Cancer 17:207, 1964 3. Van Den tleule B, Van Kerkem C, Heimann R: Benign and malignant lymphoid lesions of the stomach: a histological reappraisal in the light of the Kiel classification for non-ttodgkin's lymphomas, ttistopathology 3:309, 1979 CHONDROSARCOMA OF BONE WITH "DEDI FFERENTIATION"
To the Editor:--I h a v e r e a d with interest tile article entitled " C h o n d r o s a r c o m a o f B o n e with D e d i f f e r e n t i a t i o n : A Stud)" o f E i g h t e e n Cases. 'u T h e a u t h o r s h a v e m a d e a valuable c o n t r i b u t i o n to t h e m e d i c a l literature. It is u n f o r tunate, h o w e v e r , t h a t t h e old c o n c e p t o f d e d i f f e r e n t i a t i o n is allowed to c r e e p back into o u r t e r m i n o l o g y a n d t h i n k i n g a b o u t neoplasia. Cells, w h e t h e r n o r m a l o r neoplastic, d o n o t d e d i f f e r e n t i a t e . R a t h e r , t h e y fail to differentiate. It is unthinkable that a mature polymorphonuclear leukocyte w o u l d " d e d i f f e r e n t i a t e " into a myeloblast o r that a c o r n i f i e d e p i d e r m a l cell w o u l d d e d i f f e r e n t i a t e into a basal cell. A m u c h b e t t e r i n t e r p r e t a t i o n o f t h e findings o f M c C a r t h y a n d D o r f m a n is that a c l o n e o f s p i n d l e cells fails to d i f f e r e n t i a t e into neoplastic c h o n d r o c y t e s . M a n y n e o p l a s m s exhibit heterogeneity. It is n o t u n u s u a l to o b s e r v e focal c a r c i n o i d diff e r e n t i a t i o n in a d e n o c a r c i n o m a o f t h e c o l o n , d i f f e r e n t p o p u l a t i o n s o f cells in m e l a n o n m s o r d i f f e r e n t g r o w t h patterns in b r o n c h o g e n i c ~-arcinomas, a n d m y x o i d o r fibrous histiocytoma-like p a t t e r n s in soft tissue sarcomas. H o w t h e
963