الفهرس 
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Abstract
Lymphomas constitute a broad group of tumors of the immune system that continue to challenge oncologists. The dynamics of lymphoma entails that it must be handled through a multi-disciplinary approach. The last decade has witnessed marked change in the profile of malignant lymphoma (Holte et al., 2009).
Lymphomas are divided into Non-Hodgkin’s Lymphoma (NHL) and Hodgkin’s disease (HD). Non-Hodgkin’s Lymphoma occurs roughly three times as frequent as Hodgkin’s disease (HD) (Friedberg et al., 2008).
In Egypt, malignant lymphomas are relatively common. The exact national incidence is not precisely known due to absence of a National Cancer Registry and the only data available are from hospital registries. At Ain Shams Radiation Oncology and Nuclear Medicine Department (RONMD), the total number of cancer cases from 2004 to 2006) was 4046 cases, with 413 lymphoma cases constituting 10.2% of cases. Relative predominance of NHL over HD was at a rate of 2: 1 (Ibrahim et al., 2008).
Alpha-fetoprotein (AFP) is a cancer-associated fetal glycoprotein (62-72 kDa). It is normally produced in the fetal liver and yolk sac, and its high serum level is a useful clinical marker for hepato-cellular carcinoma (HCC) and yolk sac tumor. Uptake of AFP by certain malignant cells has been demonstrated with receptors on blast transformed lymphocytes as well as on a murine T lymphoma cell line, but not on normal resting lymphocytes (Li et al., 2002).
To our knowledge, the use of RECAF as a tumor marker in lymphoma cases has not yet been evaluated. In our opinion it might be beneficial to study it in lymphoma cases given its established use in the diagnosis and its potential as a target for therapy in solid tumors. Therefore, in theory detection of RECAF in smears of bone marrow (BM) trephine biopsies in patients with NHL may provide valuable information for diagnosis of such cases (Moro, 2005).
In this work we aim to detect the presence of RECAF in BM specimens obtained from patients having B-NHL using immunohistochemical techniques. Also, we aim to compare the detection of RECAF by immunohistochemistry to the routine histopathological examination as a tool to identify BM infiltrations in such cases.
The current study is a carried out in clinical pathology department at Ain Shams University hospitals in the period from October 2009 to October 2010, aiming to detection of the presence of RECAF in BM specimens obtained from patients having B-NHL using immunohistochemical techniques. Also, we aim to compare the detection of RECAF by immunohistochemistry to the routine histopathological examination as a tool to identify BM infiltrations in such cases.
The study included eighty archival bone marrow trephine biopsies and subdivided into two major groups; group (I); which included 20 archival BM trephine biopsies of persons free from malignant disease included as a normal control group.
Group (II); which included 9 cases (1CML case, 1 case of yolk sac tumor, 3 cases of neuroblastoma, 2 ALL cases and 2 multiple myeloma cases) included as a pathological control group
Group (III); that included 51 archival bone marrow trephine biopsies of B-NHL patients (22 DLBCL, 11 FL, 7 CLL, 5 MCL and 6 HCL cases).
All BM specimens were examined for the presence of RECAF by using immunohistochemistry (IHC) technique, and the results have been compared with the usual pathological methods for detection of BM infiltration by lymphoma cells. This group was divided into non-leukemic group formed of DLBCL cases, FL cases and MCL cases. The leukemic group included HCL and CLL cases.
All cases fulfilled the inclusion criteria, then all patients were staged according to the Ann Arbor staging system (Friedberg et al., 2008).
Samples used in such study were fixed in formalin and embedded in paraffin blocks. Deparaffinization was done then The technique used to stain the tissue sections was Avidine-Biotine Immunoperoxidase technique.
As regards the histopatological findings of the studied groups; in group I, all normal controls were free from BM infiltration. In group II, all the specimens selected as a pathological control were negative for BM infiltration by the routine histopathological examination except for the CML and ALL cases. While in group III, twenty six of 51 (51%) of B-NHL patients had BM infiltration detected by routine histopathological examination divided as follows; Six of 22 (27.3%) patients of DLBCL, 6 of 11 (54.5%) patients of FL, 1 of 5 (20%) patients of MCL had BM infiltration with lymphoma cells, and all CLL and HCL patients had BM infiltration.
As regards the immunohistochemical analysis for the expression of RECAF; in group I, five of the 20 normal controls (25%) showed positive reaction for RECAF using IHC in their BM smears with percentage of RECAF positive cells in the NC group ranged from zero to 12% with a median of 0%. In group II, percentage of cells positive for RECAF by IHC in the PC group ranged from 0 to 40% with a median of 6. Finally in group III; the non leukemic B-NHL patients showed percentage of cells positive for RECAF to range from 0 to 80% with a median of 3%in DLBCL, 0 to 90% with a median of 22% in FL and from 0 to 65% with a median of 7% in MCL. But the leukemic B-NHL patients showed percentage of cells positive for RECAF to range from 0 to 40% with a median of 10 %in CLL while all cases were negative for RECAF in HCL patients.
As regards the leukemic B-NHL group, the detection of BM infiltration was significantly higher by histopathology 13/13(100%) compared to RECAF 3/13 (23%) (p=0.001).
In the PC group 4/9 (44.4%) BM specimens were positive for RECAF by IHC while 3/9 (33.3%) was identified as having BM infiltration by routine histopathology, so RECAF by IHC was more sensitive than routine histopathology for detection of BM infiltration.
In the non leukemic group, 22 of 38 cases were identified as positive for BM infiltration by RECAF compared to 13 cases by routine histopathology so detection of RECAF by IHC was more sensitive than routine histopathology for detection of BM infiltration with lymphoma cells in this subgroup (p=0.01).