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Using multiparametric flow cytometric analysis, in a cohort of 62 patients with classic Hodgkin lymphoma having a median follow-up period of 69.5 months, we found—patients who experienced primary resistance or disease relapse (DR) had lower percentage of rosetted Hodgkin Reed-Sternberg cells (HRS-cells) as compared with patients who achieved sustained complete remission (SCR) (p=0.022); patients >35 years of age had higher percentage of HRS-cells (p=0.017) and lower percentage of B cells (p=0.017) and the nodular sclerosis subtype had higher percentage of B-cells (p=0.046) and activated B-cells (p=0.03). The proportion of SCR and DR subsets did not differ by histological subtypes, disease stage or age groups.

The authors aimed to develop a tool to assess total cell numbers in a microscope's field of vision, which would provide the denominator for calculating the percentage of positive cells for a given antigen in bone marrow trephine biopsies (BMTBs) of varying cellularities. Precise estimates of cell densities were made from 179 images of BMTBs of varying cellularities using a cell-counting software. The estimates were then validated on an independent set of 20 BMTBs. Among the 179 images, there was a strong linear association between marrow cellularity and cell numbers (Pearson correlation: 0.788). Then standardised cell densities (cells/mm2 of bone marrow) were deduced for BMTBs of varying cellularities. In the validation study, the actual and the estimated cell numbers correlated strongly (Pearson correlation: 0.990). The cell density estimates provided in this study can be adapted for any microscope and the same method can be used for calculation of the percentage-positive cells for any antigen.

Background: Cyclin D1 expression is central to mantle cell lymphoma (MCL) biology. The cyclin D1 gene produces two forms of mRNA: long (D1L) and short (D1S) versions. Aims: To study the relationship between histology, cyclin D1 mRNA (transcript) levels, cyclin D1 transcript type, cyclin D1 protein expression by immunohistochemistry (IHC), and proliferation (Ki-67%). Methods: 17 MCLs were initially studied for: levels of expression of cyclin D1 transcripts and for cyclin D1 transcript type by reverse-transcriptase PCR; intensity and percentage cyclin D1 protein expression by IHC; and Ki-67% by IHC. The relationship between cyclin D1 protein expression and proliferation was further validated on an independent set of 23 MCLs. Results: MCLs expressed variable levels of cyclin D1 at both transcript and protein levels. Furthermore, D1L and D1S were the predominant transcripts in 69% and 31% of cases, respectively. While only 9% of cases with dominance of D1L had blastoid histology, 60% of the cases with dominance of the D1S had blastoid features. Furthermore, the levels of D1L showed direct correlation with cyclin D1 protein expression and Ki-67%. Among these cases, and in the independent set of MCLs (n = 40), the level of cyclin D1 protein expression directly correlated with Ki-67%. Conclusions: MCLs express variable levels of cyclin D1 transcripts and protein, and have variable proliferation (Ki-67%). Cases with dominance of D1S transcripts are more likely to be of blastoid morphology. There is correlation between D1L transcripts levels, cyclin D1 protein expression and Ki-67%.

CD45 is a transmembrane protein tyrosine phosphatase located on most haematopoietic cells. It has several isoforms, and haematopoietic cells express one or more of the isoforms—CD45RO, CD45RA and CD45RB.1,2 CD45 immunoreactivity is recognised to be highly specific for non–Hodgkin’s lymphomas.3,4 CD45-expressing non-haemopoietic tumours are very rare. This was first noted by McDonnell et al 5 in 1987, who reported a primitive sarcoma expressing CD45. Subsequently, Nandedkar et al 6 reported three cases of undifferentiated large-cell, possibly neuroendocrine, carcinomas expressing CD45. Two of them were lymph node metastasis and one was a pulmonary tumour. All the three cases expressed both CD45 and cytokeratin. Two of the cases behaved in an aggressive manner.6 In contrast to CD45, CD5 is expressed in thymic carcinoma and malignant mesothelioma.7,8 To the best of our knowledge, this is the first reported case of a carcinoma expressing both CD45 and CD5. We report a patient in their 60s who presented initially with weight loss over 1 month and bilateral leg weakness with deterioration in mobility of 2 weeks’ duration. On examination, the patient was found to have bilateral cervical lymphadenopathy. Furthermore, the patient was an ex-smoker, and had been treated for chest infection 1 month earlier, but was …

Plasma cell dyscrasias are a heterogeneous group of disorders characterised by the expansion of a single clone of immunoglobulin secreting, terminally differentiated, end-stage B cells.1 Many of their clinical and morphological features are the result of the production and accumulation of excessive amounts of monoclonal immunoglobulin. Intracellular inclusions, both intracytoplasmic (Russell bodies) and intranuclear (Dutcher bodies) are occasionally seen in bone marrow biopsy specimens from patients with plasma cell neoplasms, and less frequently in reactive states.2,3 Extracellular protein deposition also occurs, although less frequently. “Myeloma kidney” with tubular casts composed of a heterogeneous mixture of electron dense homogeneous material and Tamm–Horsfall protein, together with elongated crystals, some with a fibrillar or lattice substructure, is an important cause of myeloma-associated morbidity and mortality.4,15 The formation of extracellular crystalline structures within the cornea, skin, thyroid gland, intravascular space and bone marrow along with other sites has been described.5–9 However, this phenomenon is unusual and is limited to isolated reports. In our department, we see approximately 1200 bone marrow trephines per year, including about 300 cases of multiple myeloma, and they have not previously come to our notice. A 72-year-old man presented with back pain. A spinal x ray carried out six months later showed collapse of the first lumbar vertebra. Further investigations included haemoglobin 9.3 g/dl, creatinine 129 μmol/l, calcium 2.5 mmol/l, β2-microglobulin 3.9 mg/l, IgG …

Squamous cell carcinoma arising in ovarian endometriosis is extremely rare, but a case is reported in a 62 year old woman. If such an ovarian tumour is discovered evidence of teratoma, Brenner tumour, or endometriosis should be sought. Extensive sampling is mandatory as the developing tumour often overgrows the foci of endometriosis, thus obliterating evidence of its origin.