plasmic inclusions as containing lipid; however, we did not study the intracytoplasmic pseudo-inclusions as this was not the purpose of the paper. In their paper Insabato et al raised the question as to whether the presence of intranuclear cytoplasmic pseudo-inclusions may be used as an additional diagnostic feature to identify extraskeletal myxoid chondrosarcomas, and the same question may be raised with regard to the intracytoplasmic vacuoles we have described. Obviously, since neither of these cytologic features is unique to chondrosarcomas they cannot be used as absolute differentiating features to identify these tumors.
CORRESPONDENCE Guidelines
for Letters
Letters to the Editor will be published at the discretion of the editor as space permits and are subject to editing and abridgement. They should be typewritten, double-spaced, and submitted in triplicate. They should be limited to 500 words or less and to no more than five pertinent references.
PAUL KNEAFSEY, MB, FRCPC Foothills Hospital Calgary, Alberta, Canada
Chondrosarcoma With lntranuclear Cytoplasmic Vacuoles To the Editor:-In a recent issue of HUMAN PATHOLOGY Demetrick et al described a case of signet-ring chondrosarcoma.’ I am intrigued about the high-power cytologic features of a fine needle aspirate (Fig 3 in Demetrick et al’s report) because of the remarkable resemblance of some cells to the intranuclear vacuoles containing tumor cells. Do the tumor cells have intranuclear cytoplasmic vacuoles? Are there two such vacuoles within the same nucleus in the figure? It would be very interesting to compare this case with a case of extraskeletal myxoid chondrosarcoma that we recently have reported.* The tumor displayed some interesting features, such as the microtubular aggregates in the rough endoplasmic reticulum. In particular, we described and illustrated the unusual and prominent presence of intranuclear vacuoles in the tumor cells that we observed cytologically, histologically, and ultrastructurally. We stated that it was unclear whether the intranuclear vacuoles represented an addiiional cytologic feature, justifying a differential diagnosis of extraskeletal myxoid chondrosarcoma. Experience suggests that this feature is better observed in the cytologic smears than in the sections. I would like to think that the intranuclear vacuoles may be a characteristic cytologic feature of chondrosarcoma cells.
1. Demetrick DJ, Kneafsey PD, Hwang WS: Signet-ring chondrosarcoma. A new morphologic entity. HUM PATHOt. 1175-l 179. 1991 2. Insabato L, Terracciano LM, Boscaino A, et al: Extraskeletal myxoid chondrosarcoma with intranuclear vacuoles and microtubularaggregates in the rough endoplasmic reticulum. Report of a case with fine needle aspiration and electron microscopy. Acta Cytol 34:858-862, 1990
Nerve Growth Factor Receptor Expression on Dendritic Reticulum Ceils in Cutaneous B-Cell Lymphoma To the Editor:-We read with great interest the article of Strobach et al’ in a recent issue of HUMAN PATHOLOGY. The findings of these authors clearly indicate that nerve growth factor receptor (NGFR) is almost constantly expressed on dendritic reticulum cells (DRCs) in reactive follicular hyperplasia (as nicely documented by double immunohistochemical labeling with anti-NGFR-5 and anti-DRC-1 monoclonal antibodies) while, on the contrary, NGFR expression is virtually absent in follicular non-Hodgkin’s lymphomas. Dendritic reticulum cells are regularly found in primary cutaneous B-cell lymphoma (CBCL), a recently defined entity characterized by a homogeneous clinical behavior (mainly locoregional extension and a low tendency to extracutaneous spread despite frequent skin relapses), good response to nonaggressive treatment (orthovolt radiotherapy), and overall benign prognosis (very low mortality rate).2-4
LLIIGI INSABATO, MD University of Naples Naples, Italy
1. Demetrick DJ, Kneafsey PD, Hwang W-S: Signet-ringchondrosarcoma: A new morphologic entity. HUMPATHOL22: 1175-l 179, 1991 2. Insabato L, Terracciano LM. Boscaino A, et al: Extraskeletal myxoid rhondrosarcoma with intranuclear vacuoles and microtubular aggregates in the rough endoplasmic reticulum. Report of a case with fine needle aspiration and electron microscopy. Acta Cytol 34:858-862. 1990 The above letter was referred to the authors question, who offer the following reply:
of the article in
To the Editor:-Dr Insabato raises the question as to whether two different types of intracellular inclusion may be found in chondrosarcoma. In our article’ we described the presence of intracytoplasmic inclusions imparting a “signetring” appearance in a case of chondrosarcoma. We agree, however, that many of the cells that we illustrate, particularly in Figures 2 and 3, show intranuclear inclusions similar to those demonstrated by Insabato et al.’ The presence of intracytoplasmic vacuoles that impart a signet-ring appearance to the tumor cells is perhaps best appreciated in Fig 4 and in the electron microscopic photograph shown in Fig 5. We agree with Dr Insabato that one of the nuclei in Fig 3 of our article does show what appears to be two intranuclear cytoplasmic inclusions. In our case report we identified the intranuclear cyto-
1088
The histomorphologic features of CBCL have supported a follicular center cell (FCC) origin for these lymphomas.? Some immunologic and genotypic data, however, speak against this thesis: the absent expression of CD5 and CD10 antigens by neoplastic B cells,?‘s4 their Leu-8+ staining4 (suggestive of a possible mantle zone nature5), and the absence of bcl-2 gene rearrangement.3 In CBCL we have recently documented immunoarchitectural prototypical patterns related to the evolutionary modifications of lesions.4 In early lesions CD35+, DRC-l+, and CD14-DRCs are constantly associated with Leu-8+, sIg+ (monoclonal)/neoplastic B cells, either clustered in folliclelike nodules (in which DRCs are loosely arranged in ill-defined meshworks with blurred and radiating contours and skip the nodule centers in a centrifugal fashion) or scattered among infiltrating B cells without a distinct compartmentalization. The careful evaluation of serial sections stained with anti-CD35, anti-DRC-1, anti-CD14, and anti-NGFR (clone 20.4) monoclonal antibodies clearly indicates that DRCs clustered with neoplastic B cells regularly express NGFR. This finding (in light of Strobach et al’s results documenting the virtual absent expression of NGRF on DRCs in nodal B-cell lymphomas of FCC origin) provides further evidence against the proposed FCC origin of CBCL and, along with the constantly absent
CORRESPONDENCE Guidelines
for Letters
Letters to the Editor will be published at the discretion of the editor as space permits and are subject to editing and abridgement. They should be typewritten, double-spaced, and submitted in triplicate. They should be limited to 500 words or less and to no more than five pertinent references.
PAUL KNEAFSEY, MB, FRCPC Foothills Hospital Calgary, Alberta, Canada
Chondrosarcoma With lntranuclear Cytoplasmic Vacuoles To the Editor:-In a recent issue of HUMAN PATHOLOGY Demetrick et al described a case of signet-ring chondrosarcoma.’ I am intrigued about the high-power cytologic features of a fine needle aspirate (Fig 3 in Demetrick et al’s report) because of the remarkable resemblance of some cells to the intranuclear vacuoles containing tumor cells. Do the tumor cells have intranuclear cytoplasmic vacuoles? Are there two such vacuoles within the same nucleus in the figure? It would be very interesting to compare this case with a case of extraskeletal myxoid chondrosarcoma that we recently have reported.* The tumor displayed some interesting features, such as the microtubular aggregates in the rough endoplasmic reticulum. In particular, we described and illustrated the unusual and prominent presence of intranuclear vacuoles in the tumor cells that we observed cytologically, histologically, and ultrastructurally. We stated that it was unclear whether the intranuclear vacuoles represented an addiiional cytologic feature, justifying a differential diagnosis of extraskeletal myxoid chondrosarcoma. Experience suggests that this feature is better observed in the cytologic smears than in the sections. I would like to think that the intranuclear vacuoles may be a characteristic cytologic feature of chondrosarcoma cells.
1. Demetrick DJ, Kneafsey PD, Hwang WS: Signet-ring chondrosarcoma. A new morphologic entity. HUM PATHOt. 1175-l 179. 1991 2. Insabato L, Terracciano LM, Boscaino A, et al: Extraskeletal myxoid chondrosarcoma with intranuclear vacuoles and microtubularaggregates in the rough endoplasmic reticulum. Report of a case with fine needle aspiration and electron microscopy. Acta Cytol 34:858-862, 1990
Nerve Growth Factor Receptor Expression on Dendritic Reticulum Ceils in Cutaneous B-Cell Lymphoma To the Editor:-We read with great interest the article of Strobach et al’ in a recent issue of HUMAN PATHOLOGY. The findings of these authors clearly indicate that nerve growth factor receptor (NGFR) is almost constantly expressed on dendritic reticulum cells (DRCs) in reactive follicular hyperplasia (as nicely documented by double immunohistochemical labeling with anti-NGFR-5 and anti-DRC-1 monoclonal antibodies) while, on the contrary, NGFR expression is virtually absent in follicular non-Hodgkin’s lymphomas. Dendritic reticulum cells are regularly found in primary cutaneous B-cell lymphoma (CBCL), a recently defined entity characterized by a homogeneous clinical behavior (mainly locoregional extension and a low tendency to extracutaneous spread despite frequent skin relapses), good response to nonaggressive treatment (orthovolt radiotherapy), and overall benign prognosis (very low mortality rate).2-4
LLIIGI INSABATO, MD University of Naples Naples, Italy
1. Demetrick DJ, Kneafsey PD, Hwang W-S: Signet-ringchondrosarcoma: A new morphologic entity. HUMPATHOL22: 1175-l 179, 1991 2. Insabato L, Terracciano LM. Boscaino A, et al: Extraskeletal myxoid rhondrosarcoma with intranuclear vacuoles and microtubular aggregates in the rough endoplasmic reticulum. Report of a case with fine needle aspiration and electron microscopy. Acta Cytol 34:858-862. 1990 The above letter was referred to the authors question, who offer the following reply:
of the article in
To the Editor:-Dr Insabato raises the question as to whether two different types of intracellular inclusion may be found in chondrosarcoma. In our article’ we described the presence of intracytoplasmic inclusions imparting a “signetring” appearance in a case of chondrosarcoma. We agree, however, that many of the cells that we illustrate, particularly in Figures 2 and 3, show intranuclear inclusions similar to those demonstrated by Insabato et al.’ The presence of intracytoplasmic vacuoles that impart a signet-ring appearance to the tumor cells is perhaps best appreciated in Fig 4 and in the electron microscopic photograph shown in Fig 5. We agree with Dr Insabato that one of the nuclei in Fig 3 of our article does show what appears to be two intranuclear cytoplasmic inclusions. In our case report we identified the intranuclear cyto-
1088
The histomorphologic features of CBCL have supported a follicular center cell (FCC) origin for these lymphomas.? Some immunologic and genotypic data, however, speak against this thesis: the absent expression of CD5 and CD10 antigens by neoplastic B cells,?‘s4 their Leu-8+ staining4 (suggestive of a possible mantle zone nature5), and the absence of bcl-2 gene rearrangement.3 In CBCL we have recently documented immunoarchitectural prototypical patterns related to the evolutionary modifications of lesions.4 In early lesions CD35+, DRC-l+, and CD14-DRCs are constantly associated with Leu-8+, sIg+ (monoclonal)/neoplastic B cells, either clustered in folliclelike nodules (in which DRCs are loosely arranged in ill-defined meshworks with blurred and radiating contours and skip the nodule centers in a centrifugal fashion) or scattered among infiltrating B cells without a distinct compartmentalization. The careful evaluation of serial sections stained with anti-CD35, anti-DRC-1, anti-CD14, and anti-NGFR (clone 20.4) monoclonal antibodies clearly indicates that DRCs clustered with neoplastic B cells regularly express NGFR. This finding (in light of Strobach et al’s results documenting the virtual absent expression of NGRF on DRCs in nodal B-cell lymphomas of FCC origin) provides further evidence against the proposed FCC origin of CBCL and, along with the constantly absent
