Prognostic value of follicular dendritic cells in nodular sclerosing Hodgkin's disease

Abstract

Aims In nodular sclerosing Hodgkin's disease (NSHD), the prognostic relevance of the histopathological grading in two subtypes NSI (low‐grade) and NSII (high‐grade) remains controversial. Analysis of follicular dendritic cells (FDC) may provide new prognostic parameters. Methods and results Tumours from 59 patients with NSHD were studied. Mean follow‐up time was 8 years. Forty‐one cases were classified as NSI and 18 as NSII. FDC were immunostained with the paraffin‐resistant monoclonal antibodies CD21 and CNA.42. We distinguished three patterns in the neoplastic tissue: FDC1, the presence of well‐defined follicle‐like structures (n = 20); FDC2, the presence of largely destroyed FDC networks (n = 25); and FDC3, no or a few isolated FDC (n = 14). The three groups differed clearly regarding the frequency of relapse and the survival. The longest survival was seen in the FDC1 group, the shortest in the FDC3 group, the FDC2 group being intermediate (P = 0.0025). FDC status was a discriminating prognostic factor for all patients, and within various age and stage categories. Combining the FDC status and the NSI–NSII grading defined the best survival group as FDC1‐NSI. Conclusions Assessment of FDC pattern, associated with histological subtyping, brings valuable data for predicting survival and outcome in NSHD.

Follicular dendritic cells: origin, function, and different disease-associated patterns

“…Earlier studies have examined the association of FDCs with the clinical outcome in patients with CHL, and an intermediate prognosis was reported in FDC-positive cases by immunohistochemistry (44% of the cases studied) compared to a guarded prognosis for the FDC-negative cases [67]. Similar results were reported in another study, although it was mainly confined to the nodular sclerosis subtype of CHL, where the authors reported the presence of FDC meshworks, whether intact or disrupted, in about 70% of their cases and that the cases with intact FDC meshworks exhibited relatively better prognosis than those with disrupted meshworks and a much better prognosis than those with absent FDC staining by immunohistochemistry [66].…”

“…phenotype of CHL (positive for CD15 and CD30, faintly positive for Pax-5, and negative for CD45 and CD20). In the authors' experience as well as in few reported studies, the FDC meshworks are usually present and are relatively intact in the nodules and sometimes may be distributed in a pattern similar to that seen in NLPHL [65,66].…”

“…The borders of these mantle cell nodules are often scalloped, and in these areas Hodgkin cells are frequently present, sometimes forming small clusters. The meshworks may be disrupted in the mixed cellularity subtype, but usually completely absent in the lymphocyte-depleted type [65,66]. The absence of the meshworks in the lymphocyte-depleted subtype is thought to be due to the loss of the ability of the Hodgkin cells to bind to the FDCs, which as discussed above, are needed for antigen presentation and for B-and T-cell survival, and as a result, progressive break-up of the FDC meshworks may partly be responsible for the lymphocytic depletion [66].…”

“…The meshworks may be disrupted in the mixed cellularity subtype, but usually completely absent in the lymphocyte-depleted type [65,66]. The absence of the meshworks in the lymphocyte-depleted subtype is thought to be due to the loss of the ability of the Hodgkin cells to bind to the FDCs, which as discussed above, are needed for antigen presentation and for B-and T-cell survival, and as a result, progressive break-up of the FDC meshworks may partly be responsible for the lymphocytic depletion [66]. Earlier studies have examined the association of FDCs with the clinical outcome in patients with CHL, and an intermediate prognosis was reported in FDC-positive cases by immunohistochemistry (44% of the cases studied) compared to a guarded prognosis for the FDC-negative cases [67].…”

Tumor-Infiltrated Immune Response Correlates with Alterations in the Apoptotic and Cell Cycle Pathways in Hodgkin and Reed-Sternberg Cells

“…The abnormal cytokine pattern in HL may contribute not only to the proliferation of H/RS cells but also to the maintenance of an inappropriate environment in which an effective host immune response to H/RS cells cannot be achieved. The role of the reactive microenvironment was found to be associated with the number, subset type, and activation state of the reactive immune cells (15,16), specifically the cytotoxic and regulatory T cells (17 -19). However, the full significance of infiltrating immune cells in the pathology of HL continues to be controversial (20).…”