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Ureteral Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue, Chronic Inflammation, and Renal Artery Atherosclerosis.

Lee H, Joo JE, Hong YO, Lee WM, Kim EK, Woo JJ, Gong SJ, Huh J - J Pathol Transl Med (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.

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Malignant lymphoma of the upper urinary tract including the renal pelvis and ureter is extremely rare... MALT lymphoma arising in the stomach, skin, thyroid, and salivary gland is associated with chronic inflammation caused by pathogenic microorganisms or autoimmune disorder ; however, the pathogenesis of MALT lymphoma in the upper urinary tract is unknown... Infiltrating lymphocytes were mainly CD4+ T cells, and CD20+ B cells were rare... Neither IgG4-positive plasma cells nor anaplastic lymphoma kinase–stained cells were noted, excluding the possibility of IgG4-associated disease or an inflammatory myofibroblastic tumor... In contrast, lymphoma of the upper urinary tract is extremely rare... While MALT lymphoma of the urinary bladder is frequently associated with chronic cystitis and female predominance, MALT lymphoma of the upper urinary tract typically affects middle-aged or elderly males with unknown preceding conditions... Despite its widespread extent, the primary origin in the urinary system of this case was supported by the growth pattern within the renal pelvis and ureter walls... Thus, the chronic inflammatory infiltrates seen in the peripelvic area in the present case may have provided the appropriate conditions for growth of a malignant clone... On the other hand, atherosclerosis is defined as a chronic inflammatory response of the arterial wall to endothelial injury triggered by a variety of insults including lipid accumulation... Many inflammatory cells, mostly monocytes and CD4+T cells, are recruited into the arterial intima, forming atheromatous plaques and accompanied by high blood levels of acute phase reactants such as CRP, as in the present case... Renal artery atherosclerosis in our patient may be a coincidental lesion considering his old age... However, the patient’s laboratory and pathologic findings indicated that the inflammatory process was concurrently ongoing within the renal artery and peripelvic adipose tissue.

No MeSH data available.


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Microscopic features of mucosa-associated lymphoid tissue lymphoma and adjacent chronic inflammation. (A) Tumor cells infiltrating the perimuscular layer of the ureter form lymphoid follicles with follicular colonization. Immunohistochemically, tumor cells are diffusely positive for CD20 (B) and accompanying T cells are mostly CD4 positive (C). (D) Peripelvic adipose tissue shows a mixed infiltrate of lymphoplasma cells, eosinophils, and histiocytes with fibroblastic proliferation.
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f3-jptm-49-4-339: Microscopic features of mucosa-associated lymphoid tissue lymphoma and adjacent chronic inflammation. (A) Tumor cells infiltrating the perimuscular layer of the ureter form lymphoid follicles with follicular colonization. Immunohistochemically, tumor cells are diffusely positive for CD20 (B) and accompanying T cells are mostly CD4 positive (C). (D) Peripelvic adipose tissue shows a mixed infiltrate of lymphoplasma cells, eosinophils, and histiocytes with fibroblastic proliferation.

Mentions: Histologic examination revealed peri-ureteropelvic nodular lymphoid infiltrates encroaching upon the ureter wall (Fig. 3A). The perimuscular layer of the ureter was heavily infiltrated with tumor cells. There were centrocyte-like cells with slightly irregular nuclear contours and clear cytoplasm, occasional larger activated cells, monocytoid cells, and plasma cells forming numerous lymphoid follicles. Immunohistochemically, the neoplastic cells were positive for CD20 (Fig. 3B) but negative for CD3, CD5, CD10, Bcl-2, Bcl-6, and cyclin D1. Tumor-infiltrating T cells were mostly CD4+ cells (Fig. 3C). Monotypic expression of λ light chain was demonstrated in the plasma cells. This case was diagnosed as a MALT lymphoma. Adjacent peripelvic adipose tissue showed a dense inflammatory infiltrate composed of lymphoplasma cells, eosinophils, and histiocytes with fibroblastic proliferation (Fig. 3D). Infiltrating lymphocytes were mainly CD4+ T cells, and CD20+ B cells were rare. Neither IgG4-positive plasma cells nor anaplastic lymphoma kinase–stained cells were noted, excluding the possibility of IgG4-associated disease or an inflammatory myofibroblastic tumor.


Ureteral Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue, Chronic Inflammation, and Renal Artery Atherosclerosis.

Lee H, Joo JE, Hong YO, Lee WM, Kim EK, Woo JJ, Gong SJ, Huh J - J Pathol Transl Med (2015)

Microscopic features of mucosa-associated lymphoid tissue lymphoma and adjacent chronic inflammation. (A) Tumor cells infiltrating the perimuscular layer of the ureter form lymphoid follicles with follicular colonization. Immunohistochemically, tumor cells are diffusely positive for CD20 (B) and accompanying T cells are mostly CD4 positive (C). (D) Peripelvic adipose tissue shows a mixed infiltrate of lymphoplasma cells, eosinophils, and histiocytes with fibroblastic proliferation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508573&req=5

f3-jptm-49-4-339: Microscopic features of mucosa-associated lymphoid tissue lymphoma and adjacent chronic inflammation. (A) Tumor cells infiltrating the perimuscular layer of the ureter form lymphoid follicles with follicular colonization. Immunohistochemically, tumor cells are diffusely positive for CD20 (B) and accompanying T cells are mostly CD4 positive (C). (D) Peripelvic adipose tissue shows a mixed infiltrate of lymphoplasma cells, eosinophils, and histiocytes with fibroblastic proliferation.
Mentions: Histologic examination revealed peri-ureteropelvic nodular lymphoid infiltrates encroaching upon the ureter wall (Fig. 3A). The perimuscular layer of the ureter was heavily infiltrated with tumor cells. There were centrocyte-like cells with slightly irregular nuclear contours and clear cytoplasm, occasional larger activated cells, monocytoid cells, and plasma cells forming numerous lymphoid follicles. Immunohistochemically, the neoplastic cells were positive for CD20 (Fig. 3B) but negative for CD3, CD5, CD10, Bcl-2, Bcl-6, and cyclin D1. Tumor-infiltrating T cells were mostly CD4+ cells (Fig. 3C). Monotypic expression of λ light chain was demonstrated in the plasma cells. This case was diagnosed as a MALT lymphoma. Adjacent peripelvic adipose tissue showed a dense inflammatory infiltrate composed of lymphoplasma cells, eosinophils, and histiocytes with fibroblastic proliferation (Fig. 3D). Infiltrating lymphocytes were mainly CD4+ T cells, and CD20+ B cells were rare. Neither IgG4-positive plasma cells nor anaplastic lymphoma kinase–stained cells were noted, excluding the possibility of IgG4-associated disease or an inflammatory myofibroblastic tumor.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Malignant lymphoma of the upper urinary tract including the renal pelvis and ureter is extremely rare... MALT lymphoma arising in the stomach, skin, thyroid, and salivary gland is associated with chronic inflammation caused by pathogenic microorganisms or autoimmune disorder ; however, the pathogenesis of MALT lymphoma in the upper urinary tract is unknown... Infiltrating lymphocytes were mainly CD4+ T cells, and CD20+ B cells were rare... Neither IgG4-positive plasma cells nor anaplastic lymphoma kinase–stained cells were noted, excluding the possibility of IgG4-associated disease or an inflammatory myofibroblastic tumor... In contrast, lymphoma of the upper urinary tract is extremely rare... While MALT lymphoma of the urinary bladder is frequently associated with chronic cystitis and female predominance, MALT lymphoma of the upper urinary tract typically affects middle-aged or elderly males with unknown preceding conditions... Despite its widespread extent, the primary origin in the urinary system of this case was supported by the growth pattern within the renal pelvis and ureter walls... Thus, the chronic inflammatory infiltrates seen in the peripelvic area in the present case may have provided the appropriate conditions for growth of a malignant clone... On the other hand, atherosclerosis is defined as a chronic inflammatory response of the arterial wall to endothelial injury triggered by a variety of insults including lipid accumulation... Many inflammatory cells, mostly monocytes and CD4+T cells, are recruited into the arterial intima, forming atheromatous plaques and accompanied by high blood levels of acute phase reactants such as CRP, as in the present case... Renal artery atherosclerosis in our patient may be a coincidental lesion considering his old age... However, the patient’s laboratory and pathologic findings indicated that the inflammatory process was concurrently ongoing within the renal artery and peripelvic adipose tissue.

No MeSH data available.


Related in: MedlinePlus