Histogenesis
o f Splenic
H o d g k i n ' s
Lesions
in
Disease
LUNG T. YAM, M.D., AND CHIN-YANG L I , M.D.
From the Division of Hematology and Clinical Pathology, Scripps Clinic and Research Foundation, La Jo and the Division of Hematology-Oncology, Veterans Administration Hospital, Department of Medicine, of Louisville School of Medicine, Louisville, Kentucky ABSTRACT
T H E HISTOLOGIC FEATURES of splenic Hodg-
kin's disease have been well described.4,9,11'14 The histogenesis of these splenic lesions however, has, not been clearly delineated, partly due to the fact that conventional
Received May 1, 1975; received revised manuscript January 22, 1976; accepted For publication January 22, 1976. Supported in pari by a grant from the Louisville Medical Research Foundation and From the Veterans Administration Research Fund. Address reprint requests to Dr. Yam: Veterans Administration Hospital, 800 Zorn Avenue, Louisville, Kentucky 40206. Dr. Li's present address is Division oF Surgical pathology, Mayo Clinic, Rochester, Minnesota.
paraffin-embedded sections stained with hematoxylin and eosin do not lend themselves to clear identification of the cytologic nature and structural elements of the spleen. Recently, specific histochemical markers for various cellular and structural elements of the human spleen have been developed. 12,20 Using these markers, it is now possible to delineate the cellular and structural elements of the spleen with greater accuracy. This report describes the application of such chemical markers in the study of histogenesis of splenic lesions in Hodgkin's disease.
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Yam, LungT., and Li, Chin-Yang: Histogenesis of splenic lesions in Hodgkin's disease. Am J Clin Pathol 66: 976-985, 1976. Histochemical markers were used to identify the various cellular and structural components of the human spleen, and to investigate the histogenesis of the splenic lesions of Hodgkin's disease. T h e early lesions appear in areas near the central artery (periarterial lymphatic sheath) in the white pulp. T h e white pulp becomes hypertrophic. The lesions enlarge, extend into the red pulp, and compress the sinuses and the cords of Billroth. T h e derivations of various "histiocytes" contained with the lesions are differentiated by using cytochemical stains for lysosomal enzymes and for granulocytes. T h e epithelioid cells in the granulomas are rich in those lysosomal enzymes typically seen in- phagocytic histiocytes, suggesting that they are indeed true histiocytes. T h e malignant "histiocytes," including the mononuclear Hodgkin cells, the binucleated Sternberg-Reed cells, and the multinucleated giant cells, do not contain significant amounts of lysosomal enzymes and more closely resemble stimulated lymphocytes. The splenic lesions in Hodgkin's disease may be the result of a lymphocytic and histiocytic cellular response to an unknown agent, which reaches the spleen through the central artery in the white pulp. (Key words: Histogenesis; Histochemistry; Splenic lesions; Hodgkin's disease.)
December 1976
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SPLENIC LESIONS IN HODGKINS DISEASE
Table 1. Chemical Markers for Cellular and Structural Elements of Spleen Cells and Structures
Results
Chemical Markers
Sinus lining cells
Blue Dark brown
Cordal macrophages
Nonspecific esterase Fluoride-resistant esterase
Dark red Dark red
Vascular endothelium
Alkaline phosphatase
Blue or bright red
Neutrophilic granulocytes
Chloroacetate esterase
Red or blue
Eosinophilic granulocytes
Cyanide-resistant peroxidase Chlorazol Fast Pink
Brown Pink-red
Basophilic granulocytes
Toluidine blue
Metachromatic
Erythroblasts and erythrocytes
Pseudoperoxidase
Dark brown
Lymphatic reticulum cells (germinal center cells)
Methyl green-pyronin
Bright red
Lymphocytes
None
Slernbcrg-Reed cells and related "histiocytes"
Methyl green-pyronin Tartrate-resistant acid phosphatase Fluoride-resistant esterase
Reticulin framework
Epithelioid cells
Bright red Red Dark red
Table 2. Cytochemical Characteristics of the Mononuclear Cells in the Spleen
Acid phosphatase Tartrate-resistant acid phosphatase Nonspecific esterase Fluoride-resistant esterase /3-glucuronidase N-acelyl-glucosaminidase Methyl greenpyronin Chloroacetate esterase Peroxidase Alkaline phosphatase
Lymphoid Cellst
PHAstimulalcd Lymphocytes (Control)
Granulocytes (Neutrophilic)
Epithelioid Cells
Phagocytic Histiocytes
Monocytes (Blood, Spleen)
"Histiocytes" (S-R and Related Cells)*
+ + +*
+++++
+++++
++++
0- +
0- + +
0- + +
0- + 0
+ + + + 0- + + + +++++ +++++
0 + +++
0- + 0- +
0- + 0- +
0- + 0- +
0 ++
++++ ++ + + +++++ +++++
0- + ++++
0-± 0- +
0-± 0- + +
0-± 0- + +
++
+++++ +++++
++++
0- +
0- +
0- + +
0- +
0- +
0- +
++++ ++++
0 0
0 0
()- + + + +
0
0
0- +
++ + +
0- + + + +
++++
0 0- + +
0 0
0 0
0 0
0
0
0
0
Including llodgkin cells. Steinberg-Reed (S-R) tells, and multinucleated gianl cells. v Including lymphatic tetit ulum cells, lymphoblasts. and lymplic.c vtes. :j: Inlensilv ol cylotlieinital marker staining: 0 - no staining; ± c|ueslicmal)le staining: + + + + - \ery slicing staining.
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Naphthol AS acetate esterase Reticulin slain
fin ,'J*
66 A.J.C.P.—Vol. YAM AND LI 978
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December 1976
SPLENIC LESIONS IN HODGKIN'S DISEASE
979
Materials and Methods
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