[Immunophenotyping and gene rearrangement analysis in lymphoid/lymphoproliferative disorders of the lungs].
OBJECTIVE
To determine the usefulness, in routine practice, of using polymerase chain reaction to analyze B and T lymphocyte clonality in pulmonary tissue as a tool for the diagnosis of pulmonary lymphoproliferative disorders.


METHODS
Immunohistochemistry and molecular gene rearrangement analysis were performed in order to assess 8 cases of lymphoid interstitial pneumonia (LIP) and 7 cases of pulmonary lymphoproliferative disorders.


RESULTS
All 8 cases of LIP presented moderate to strong immunostaining for CD3, compared with only 2 cases of lymphoma and 1 case of pseudolymphoma (p = 0.02). Gene rearrangement was detected in 4 of the 8 cases, which changed the diagnosis from LIP to lymphoma, showing the importance of gene rearrangement detection in cases of LIP. In this situation, gene rearrangement using the VH/JH and Vgamma11/Jgamma12 primer pairs was detected in 3 cases and 1 case, respectively, and no gene abnormalities were found using the Dbeta1/Jbeta2 and Vgamma101/Jgamma12 primer pairs in any of the cases. A significant positive association was found between the intensity of CD20 and CD68 expression and gene rearrangement using the VH/JH primer pair. Prior to the gene rearrangement, 4 patients with LIP died quickly, whereas only one patient with LIP died after the gene rearrangement.


CONCLUSIONS
Detection of monoclonal B and T cells by immunophenotyping and polymerase chain reaction had an impact on the diagnosis of pulmonary lymphomas in patients previously diagnosed with LIP. Therefore, immunophenotyping and polymerase chain reaction should be used as 'gold standard' techniques in routine practice.
Ishikawa
Camila Cristina
CC
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Ab'Saber
Alexandre Muxfeldt
AM
Parra
Edwin Roger
ER
Lin
Chin Jia
CJ
Barbas
Carmen Silvia Valente
CS
Capelozzi
Vera Luiza
VL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000032:analysis; D016022:Case-Control Studies; D002675:Child, Preschool; D017931:DNA Primers; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D015321:Gene Rearrangement; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain / Q000235:genetics / Q000276:immunology; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor / Q000235:genetics / Q000276:immunology; D006801:Humans; D016130:Immunophenotyping; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000235:genetics / Q000276:immunology*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000276:immunology*; D008221:Lymphoid Tissue / Q000473:pathology; D008223:Lymphoma / Q000175:diagnosis / Q000235:genetics / Q000276:immunology*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000235:genetics / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D019310:Pseudolymphoma / Q000175:diagnosis / Q000235:genetics / Q000276:immunology; D012189:Retrospective Studies
D015703:Antigens, CD; D017931:DNA Primers