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Previous Volume 340:1239-1247 April 22, 1999 Number 16 Next

Abstract PDF Editorial by Manis, J. P Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Hodgkin's disease and non-Hodgkin's B-cell lymphoma occasionally occur in the same patient. The identification of a common precursor of the two types of lymphoma would show definitively that Reed–Sternberg cells originate from B cells.

Methods We studied lymphomas from two patients, one with a composite lymphoma (classic Hodgkin's disease and a follicular lymphoma in the same lymph node) and the other with a T-cell–rich B-cell lymphoma that was followed by classic Hodgkin's disease. Single Reed–Sternberg cells and non-Hodgkin's lymphoma cells from frozen sections were micromanipulated. The rearranged immunoglobulin variable-region genes (V genes) of the heavy and light chains were amplified by the polymerase chain reaction from genomic DNA and sequenced.

Results In both patients, the Reed–Sternberg cells were related clonally to the non-Hodgkin's lymphoma B cells. The V genes carried somatic mutations (a hallmark of germinal-center B cells and their descendants). In both patients, some somatic mutations were shared by the Reed–Sternberg and non-Hodgkin's lymphoma cells, whereas other somatic mutations were found exclusively in one or the other cell type.

Conclusions In two patients with classic Hodgkin's disease and non-Hodgkin's B-cell lymphoma, we identified a common B-cell precursor, probably a germinal-center B cell, for both lymphomas. This finding suggests that the two types of lymphoma underwent both shared and distinct transforming events and provides proof of the B-cell derivation of Reed–Sternberg cells in classic Hodgkin's disease.

In rare cases, Hodgkin's disease and a non-Hodgkin's B-cell lymphoma occur in the same patient, either simultaneously or sequentially.^15,16,17 Definitive proof of the origin of Reed–Sternberg cells from B cells could be obtained by demonstrating that in such cases the B-cell lymphoma and the Reed–Sternberg cells are members of the same B-cell clone. In the current study, we used micromanipulation of single Reed–Sternberg cells and non-Hodgkin's B-cell lymphoma cells from two patients with such cases, and we amplified rearranged immunoglobulin V genes from genomic DNA of the single cells. Because rearrangements of immunoglobulin genes are highly diverse among B cells, they represent ideal clonal markers for these cells. In both patients in our study, the Reed–Sternberg cells and the non-Hodgkin's B-cell lymphoma cells shared a common germinal-center B-cell precursor.

Case Reports

Patient 1 was a 75-year-old woman who presented with retroperitoneal lymphadenopathy in June 1990. A biopsy of retroperitoneal nodes showed a composite follicular small-cleaved-cell lymphoma and, in the same lymph node, mixed-cellularity Hodgkin's disease with abundant Reed–Sternberg cells. The Reed–Sternberg cells were CD30- and CD15-positive, whereas the tumor cells of the follicular lymphoma were negative for both markers. On a section of paraffin-embedded material, some Reed–Sternberg cells were CD20-positive. The patient was considered to have stage IVB disease on the basis of the presence of follicular lymphoma in the bone marrow and liver. She was treated with eight cycles of cyclophosphamide, vinblastine, procarbazine, and prednisone but the disease recurred (recurrence was not confirmed by biopsy) in December 1991.

Patient 2 was a 50-year-old man who presented with a T-cell–rich B-cell lymphoma of the skin in January 1994. The lymphoma was surgically removed, and no additional therapy was given. In January 1997, classic Hodgkin's disease was diagnosed in an axillary lymph node. The Reed–Sternberg cells were CD30- and CD15-positive. The patient also had Gardner's syndrome, and he underwent colectomy in 1992.

Methods

Immunostaining and Micromanipulation

We stained frozen tissue sections, 5 to 10 µm thick, with anti-CD20 (L26; Dako, Hamburg, Germany) or anti-CD30 (BerH2; Dako) monoclonal antibodies.^18,19 We visualized bound alkaline phosphatase with fast red. We overlaid stained sections with TRIS-buffered saline, and we isolated single cells using two hydraulic micromanipulators.^18,19 Isolated cells were stored at –20°C in 20-µl Expand high-fidelity polymerase-chain-reaction (PCR) buffer (Boehringer Mannheim, Mannheim, Germany). From each section used for micromanipulation, we aspirated aliquots of the buffer covering the section and used them as negative controls in parallel with the analysis of the cell samples.

Single-Cell PCR Analysis

We amplified rearranged immunoglobulin genes from genomic DNA of single cells in a seminested PCR analysis using either family-specific V_H (variable-region heavy-chain gene) leader or framework region I primers and V or V (variable-region or light-chain) framework region I family-specific primers together with two sets of the respective joining-region (J gene)–segment primers.^1,2,19 We carried out the first round of amplification using a collection of primers for V_H (and V or V) genes together with the respective J-segment primers. In the second round of amplification, we further amplified 1.5-µl aliquots (3 percent) from the first round with the same V gene primers in separate reactions and internal J-segment primer mixes. The PCR products were gel-purified and directly sequenced on an automatic sequencer (ABI377, Applied Biosystems, Wieterstadt, Germany). We analyzed the sequences using the data bases of Immunogenetics and GenBank. Reed–Sternberg cells and non-Hodgkin's B-cell lymphoma cells were analyzed in parallel with buffer controls.

Results

PCR Analysis of Immunoglobulin Gene Rearrangements in Single Reed–Sternberg and Non-Hodgkin's Lymphoma B Cells

In both cases — the first a composite lymphoma consisting of classic Hodgkin's disease and a follicular lymphoma in the same lymph node, and the second a T-cell–rich B-cell lymphoma of the skin followed by classic Hodgkin's disease in a lymph node three years later — the Reed–Sternberg cells were CD30-positive and CD20-negative, whereas the non-Hodgkin's lymphoma cells were CD30-negative and CD20-positive (Figure 1A, Figure 1B, Figure 1C, Figure 1D, Figure 1E, and Figure 1F); in the composite lymphoma, some Reed–Sternberg cells were CD20-positive. Consequently, for the micromanipulation of single cells, Reed–Sternberg cells in frozen sections were stained with the anti-CD30 antibody, and the non-Hodgkin's lymphoma cells in frozen sections were stained with the anti-CD20 antibody.

View larger version (778K): [in this window] [in a new window]   Figure 1. Immunostaining of the Composite Lymphoma from Patient 1 and the T-Cell–Rich B-Cell Lymphoma and Hodgkin's Disease Infiltrate from Patient 2. Panel A shows the composite lymphoma from Patient 1 stained for CD20 with use of peroxidase. Positive immunostaining of the follicular lymphoma is shown at the upper right. Reed–Sternberg cells (arrows) were CD20-negative. Panel B shows the composite lymphoma stained for CD30 with use of alkaline phosphatase. Cells of the follicular lymphoma were negative, whereas Reed–Sternberg cells (arrows) were CD30-positive. Panel C shows anti-CD30 staining of a frozen section from the composite lymphoma. Panel D shows a skin-biopsy specimen of the T-cell–rich B-cell lymphoma from Patient 2. It shows numerous large CD20-positive blast cells in the corium (alkaline phosphatase). Panel E shows the T-cell–rich B-cell lymphoma with large CD20-positive B blasts surrounded by T lymphocytes. CD20 staining was visualized with alkaline phosphatase and fast red. Panel F shows Hodgkin's disease infiltrate in a lymph-node–biopsy specimen from Patient 2. Three CD30-positive Reed–Sternberg cells can be seen. CD30 staining was visualized with alkaline phosphatase and fast red.

 
In the case of Patient 1, we analyzed 22 Reed–Sternberg cells for immunoglobulin gene rearrangements (Table 1) (not all cells generated a PCR product). The same V_H gene rearrangement was amplified from 12 of the 22 Reed–Sternberg cells, and the same V (light chain) gene was amplified from 4 of the 12 cells analyzed for V gene rearrangements. We obtained a clonal V rearrangement from four of five cells analyzed for V (light chain) gene rearrangements. The same three clonal V_H, V, and V gene rearrangements were also obtained from cells of the follicular lymphoma: the V_H gene from 26 of 35 samples (each containing two cells), the V gene from 5 of 12 samples, and the V gene from 4 of 5 samples (Table 1). From 1 of 11 buffer controls, we amplified a V_H gene rearrangement, which was most likely due to cellular contamination. One V_H gene that differed from the clonal rearrangement was amplified from a CD20-positive cell; it may have represented a rare normal B cell present in the follicular lymphoma.

View this table: [in this window] [in a new window]   Table 1. PCR and Sequence Analysis of V Gene Rearrangements of Single Reed–Sternberg and Non-Hodgkin's Lymphoma Cells.

 
In the case of Patient 2, we amplified clonal V_H and clonal V gene rearrangements from 18 and 21 of 60 Reed–Sternberg cells, respectively (Table 1). The same rearrangements were also amplified from T-cell–rich B-cell lymphoma cells, the V_H gene from 23 of 60 cells and the V gene from 9 of 60 cells. We amplified three different V gene rearrangements from 1 Reed–Sternberg cell and 2 of 48 buffer controls. We amplified one clonal V_H gene from another buffer control (Table 1). We assumed that these PCR products represented cellular contamination.

The presence of the same clonal V gene rearrangements in the Reed–Sternberg cells of Hodgkin's disease and the associated non-Hodgkin's lymphoma cells indicates that a single B cell is the common precursor of both lymphomas.

Analysis of Somatic-Mutation Patterns

The V_H and V gene rearrangements amplified from the Reed–Sternberg cells of Patient 1 were potentially functional (translatable into protein RNA) and somatically mutated with mutation frequencies of 9.6 and 5.8 percent, respectively (Table 2). No intraclonal diversity was observed. Most somatic mutations in the V_H and V genes of the Reed–Sternberg cells were shared by the corresponding rearrangements of the follicular lymphoma. However, in the heavy-chain rearrangement, the Reed–Sternberg cells harbored two point mutations that were absent in the V_H gene of the follicular lymphoma, and the cells lacked one point mutation present in the V_H gene of the follicular lymphoma (Figure 2). Likewise, 15 point mutations in the V gene were shared by the Reed–Sternberg and follicular-lymphoma cells, but the former carried 2 additional point mutations. In the V_H and V genes of the follicular lymphoma, ongoing somatic mutation was observed, as is typical of follicular lymphoma.^21,22 For the heavy-chain rearrangement, we observed 23 sequence variants among the 26 V_H gene sequences (Figure 2 and Table 2). Most variants differed by one to four mutations from the sequence with the smallest number of mutations.

View this table: [in this window] [in a new window]   Table 2. V Gene Sequence and Mutation Analysis of Immunoglobulin Gene Rearrangements from Reed–Sternberg and Non-Hodgkin's Lymphoma Cells.

 

View larger version (70K): [in this window] [in a new window]   Figure 3. Scenario for the Generation of a Composite Lymphoma. The horizontal lines within the circles indicate a V gene rearrangement; vertical lines within the circles indicate somatic mutations.

 
The V gene amplified from Reed–Sternberg and follicular-lymphoma cells of the composite lymphoma was nonfunctional and unmutated. In B cells expressing immunoglobulin light chains, the nonfunctional V gene rearrangements that are often present in such cells are usually inactivated by deletion of the C gene and the enhancers; this deletion also abolishes somatic hypermutation in persisting V J joints of the rearranged variable-region genes.⁹

In Patient 2, the V_H and V gene rearrangements of the Reed–Sternberg cells were both potentially functional and somatically mutated, with mutation frequencies of 11.7 and 8.3 percent, respectively (Table 2). One V_H sequence differed from the 17 others by a single nucleotide. The V gene rearrangements of the T-cell–rich B-cell lymphoma carried a higher load of somatic mutation than did the corresponding rearrangements of the Reed–Sternberg cells: 15.8 percent for the V_H gene and 14.6 percent for the V gene. In this patient, most of the mutations were unique to either the Reed–Sternberg cells or the T-cell–rich B-cell lymphoma cells. For the heavy-chain gene rearrangement, only 7 mutations were shared between the two lymphomas; 28 of the mutations in the V_H gene of the Reed–Sternberg cells were not present in the T-cell–rich B-cell lymphoma cells, whereas the latter carried 39 mutations that were not present in the Reed–Sternberg cells (data not shown). The situation was similar for the V light-chain genes (data not shown). As in Patient 1, the non-Hodgkin's lymphoma cells showed considerable intraclonal diversity (Table 2).

The pattern of somatic mutation in the rearranged V genes of the clonally related lymphomas is evidence of the reliability of our analysis. In both patients, the patterns of somatic mutations found in the clonally related immunoglobulin gene rearrangements of the Reed–Sternberg cells differed from those of the corresponding non-Hodgkin's lymphoma cells (Figure 2). We found these distinct patterns of somatic mutation in different populations of tumor cells that were isolated and analyzed in parallel, ruling out the possibility of contamination.

Because crippling mutations rendering previously functional rearrangements nonfunctional were detected in some cases of classic Hodgkin's disease in our earlier studies,² we amplified and sequenced additional upstream and downstream fragments of the V genes of the lymphomas analyzed here (data not shown). However, no obviously crippling mutations (such as stop codons) were detected. This finding does not argue against the possibility that Reed–Sternberg cells in these cases derive from crippled germinal-center B cells, because most types of crippling mutations (such as those that disturb heavy- or light-chain folding or reduce affinity to the selecting antigen) cannot be identified easily.

Discussion

The occurrence of a non-Hodgkin's B-cell lymphoma and Hodgkin's disease in the same patient is rare.^15,16 The most frequent combination of the two is a diffuse large-cell lymphoma that develops after lymphocyte-predominant Hodgkin's disease.^15,16,17 Because the B-cell origin of the Reed–Sternberg cells in the lymphocyte-predominant subtype of Hodgkin's disease has long been suspected,²³ a transformation to a high-grade lymphoma (as is well known to occur in several types of low-grade non-Hodgkin's B-cell lymphoma) would not be surprising. However, studies of the clonal relation between lymphocyte-predominant Hodgkin's disease and subsequent or concurrent non-Hodgkin's B-cell lymphoma found a clonal relation between the two lymphomas in only some cases.^24,25,26,27 In the example of classic Hodgkin's disease in which the patient also had a non-Hodgkin's lymphoma, only a single case has been analyzed with molecular techniques.²⁸ The two lymphomas were clonally unrelated. In this instance, the non-Hodgkin's lymphoma may have been related to the therapy received, because the patient underwent radiotherapy and chemotherapy before the non-Hodgkin's lymphoma developed.

Both lymphomas in each of the two patients we studied were derived from a common B-cell precursor. In Patient 2, in whom Hodgkin's disease was diagnosed three years after the T-cell–rich B-cell lymphoma, the Reed–Sternberg cells or their precursor must have been present during those three years.

In both patients, there was considerable ongoing mutation within the tumor cells of the non-Hodgkin's lymphoma, as indicated by numerous variations in the clonal sequences. This phenomenon is well known in follicular lymphoma^21,22 and also typical of T-cell–rich B-cell lymphoma.²⁹ Because the process of somatic hypermutation is thought to be restricted to germinal-center B cells, these findings — together with other morphologic, histologic, and immunohistochemical features of the two types of lymphomas^30,31 — indicate that the non-Hodgkin's lymphomas in both patients were cancers derived from germinal-center B cells.

In the composite lymphoma, most of the somatic mutations were the same in the Reed–Sternberg cells as in the follicular-lymphoma cells. This finding indicates that a germinal-center B cell that had already acquired a high load of somatic mutation gave rise to two daughter cells, one of which was the origin of the Reed–Sternberg cell clone, and the other of the follicular lymphoma. In the other patient, the number of shared mutations was lower (only 7 of a total of 74 mutations in the heavy chain). Nevertheless, in this case the pattern of V gene mutations also indicates that the tumor clones originated from a common germinal-center B-cell progenitor.

In our previous work, the interpretation that the Reed–Sternberg cells in classic Hodgkin's disease derive from germinal-center B cells was based on the argument that transformed B cells with crippled V genes reside within the germinal center and must have been rescued from apoptosis in this microenvironment by some transforming event.^2,10 The two cases presented here address the issue of the cellular origin of Reed–Sternberg cells in classic Hodgkin's disease independently and more directly. The finding of a clonal relation and the pattern of V gene mutations of the Reed–Sternberg and non-Hodgkin's lymphoma cells in the same patient unequivocally demonstrate the derivation of Reed–Sternberg cells from mature B cells and are further evidence of their germinal-center B-cell derivation.

Because Reed–Sternberg cells express a number of genes typical of dendritic cells, monocytic cells, or both,^11,12,13,14 it has been argued that Reed–Sternberg cells derive from dendritic cells in which immunoglobulin gene rearrangements accidentally occurred. The results presented here rule out this possibility. Rather, the Reed–Sternberg cells are B cells that in the course of malignant transformation can acquire features of dendritic cells, an event that may be of key importance for the pathogenesis of Hodgkin's disease.

The finding of a shared precursor of the lymphomas in each patient has implications for the pathogenesis of lymphomas. Because it is unlikely that two B cells belonging to the same germinal-center B-cell clone give rise to two lymphomas independently, we assume that both lymphomas in each patient shared one or more transforming events. These transforming events could have taken place before the tumor precursor entered the germinal center or in the course of the germinal-center reaction. Additional transforming events that are specific for the Reed–Sternberg or the non-Hodgkin's lymphoma precursor cell presumably occurred later, probably within the germinal center, thus explaining the development of two distinct diseases from the same B-cell precursor (Figure 3).

View larger version (31K): [in this window] [in a new window]   Figure 2. VH Gene Sequences Amplified from Follicular-Lymphoma (FL) Cells and Reed–Sternberg (RS) Cells of a Composite Lymphoma. Only part of the sequences from codons 75 to 102 is shown. The sequences are compared with the VH 4 germ-line gene VH 4-59 and the JH 6 gene. Dashes indicate sequence identity. Complementarity-determining region (CDR) III is indicated. Because the samples of the follicular lymphoma contained two cells (sequences 36–53) or represent DNA dilutions containing on average DNA of two cells (sequences 56.1–56.18), mixed sequences were obtained when two sequence variants were amplified from one sample. The International Union of Pure and Applied Chemistry code was used for these mixed sequences. Codons are numbered according to the system of Kabat et al.20 The mutations present in the Reed–Sternberg cells in codons 77 and 100D were absent from the follicular-lymphoma cells, and the mutation in codon 100E was present only in the follicular-lymphoma cells.

 
Because the Epstein–Barr virus is thought to participate in the pathogenesis of classic Hodgkin's disease in some cases,³² the presence of Epstein–Barr virus was sought in the Reed–Sternberg and non-Hodgkin's lymphoma cells in both cases, but the results were negative (data not shown). Moreover, although most follicular lymphomas carry translocations of the bcl-2 oncogene into the immunoglobulin heavy-chain locus,³³ we failed to detect such a translocation in the Reed–Sternberg and follicular-lymphoma cells of the composite lymphoma using a PCR-based method (data not shown). For these reasons, the shared and unique transforming events involved in the development of these lymphomas remain to be identified.

In summary, the two combinations of Hodgkin's disease and non-Hodgkin's lymphoma that we studied exemplify the close relation between these diseases and provide definitive evidence of the origin of Reed–Sternberg cells from B cells in classic Hodgkin's disease. Moreover, the development of two lymphomas from members of a single germinal-center B-cell clone supports the emerging concept that molecular processes in germinal-center B cells play a decisive part in the malignant transformation of B lymphocytes and further supports the concept that Reed–Sternberg cells derive from B cells residing within the germinal center.⁹

Supported by grants from the Deutsche Forschungsgemeinschaft (SFB502) and the Deutsche Krebshilfe.

We are indebted to Michaela Fahrig, Julia Jesdinsky, Christiane Gerhard, and Tanja Schaffer for excellent technical assistance.

Source Information

From the Department of Pathology, University of Frankfurt, Frankfurt am Main, Germany (A.B., M.-L.H.); the Department of Pathology, Mayo Clinic, Rochester, Minn. (J.G.S.); the Department of Dermatology, Universitätsspital Zürich, Zurich, Switzerland (R.D., G.B.); and the Institute for Genetics, University of Cologne, Cologne, Germany (K.R., R.K.).

Address reprint requests to Dr. Küppers at the University of Cologne, University Hospital, LFI E4 R706, Joseph-Stelzmannstr. 9, 50931 Cologne, Germany, or at rkuppers{at}mac.genetik.uni-koeln.de.

References

1. Braeuninger A, Küppers R, Strickler JG, Wacker HH, Rajewsky K, Hansmann ML. Hodgkin and Reed-Sternberg cells in lymphocyte predominant Hodgkin disease represent clonal populations of germinal center-derived tumor B cells. Proc Natl Acad Sci U S A 1997;94:9337-9342. [Erratum, Proc Natl Acad Sci U S A 1997;94:14211.] [Free Full Text]
2. Kanzler H, Küppers R, Hansmann ML, Rajewsky K. Hodgkin and Reed-Sternberg cells in Hodgkin's disease represent the outgrowth of a dominant tumor clone derived from (crippled) germinal center B cells.J Exp Med 1996;184:1495-505.
3. Kanzler H, Hansmann ML, Kapp U, et al. Molecular single cell analysis demonstrates the derivation of a peripheral blood-derived cell line (L1236) from the Hodgkin/Reed-Sternberg cells of a Hodgkin's lymphoma patient. Blood 1996;87:3429-3436. [Free Full Text]
4. Küppers R, Rajewsky K, Zhao M, et al. Hodgkin disease: Hodgkin and Reed-Sternberg cells picked from histological sections show clonal immunoglobulin gene rearrangements and appear to be derived from B cells at various stages of development. Proc Natl Acad Sci U S A 1994;91:10962-10966. [Free Full Text]
5. Marafioti T, Hummel M, Anagnostopoulos I, et al. Origin of nodular lymphocyte-predominant Hodgkin's disease from a clonal expansion of highly mutated germinal-center B cells. N Engl J Med 1997;337:453-458. [Free Full Text]
6. Ohno T, Stribley JA, Wu G, Hinrichs SH, Weisenburger DD, Chan WC. Clonality in nodular lymphocyte-predominant Hodgkin's disease.N Engl J Med 1997;337:459-65.
7. Vockerodt M, Soares M, Kanzler H, et al. Detection of clonal Hodgkin and Reed-Sternberg cells with identical somatically mutated and rearranged VH genes in different biopsies in relapsed Hodgkin's disease. Blood 1998;92:2899-2907. [Free Full Text]
8. Irsch J, Nitsch S, Hansmann M-L, et al. Isolation of viable Hodgkin and Reed-Sternberg cells from Hodgkin disease tissues. Proc Natl Acad Sci U S A 1998;95:10117-10122. [Free Full Text]
9. Klein U, Goossens T, Fischer M, et al. Somatic hypermutation in normal and transformed human B cells. Immunol Rev 1998;162:261-280. [CrossRef][Medline]
10. Küppers R, Rajewsky K. The origin of Hodgkin and Reed/Sternberg cells in Hodgkin's disease. Annu Rev Immunol 1998;16:471-493. [CrossRef][Medline]
11. Sorg UR, Morse TM, Patton WN, et al. Hodgkin's cells express CD83, a dendritic cell lineage associated antigen. Pathology 1997;29:294-299. [CrossRef][Medline]
12. Pinkus GS, Pinkus JL, Langhoff E, et al. Fascin, a sensitive new marker for Reed-Sternberg cells of Hodgkin's disease: evidence for a dendritic or B cell derivation? Am J Pathol 1997;150:543-562. [Abstract]
13. Brown RE. Histogenesis of Reed-Sternberg and dendritic interdigitating cells in nodular sclerosing Hodgkin's disease: immunohistochemical evidence for monocytoid precursors. Ann Clin Lab Sci 1997;27:329-337. [Abstract]
14. Söderström KO, Rinne R, Hopsu-Havu VK, Järvinen M, Rinne A. Hodgkin's disease: a malignancy of follicular dendritic cells? Lancet 1994;343:422-423. 
15. Kim H. Composite lymphoma and related disorders. Am J Clin Pathol 1993;99:445-451. [Medline]
16. Jaffe ES, Zarate-Osorno A, Kingma DW, Raffeld M, Medeiros LJ. The interrelationship between Hodgkin's disease and non-Hodgkin's lymphomas. Ann Oncol 1994;5:Suppl 1:7-11. [Free Full Text]
17. Hansmann ML, Stein H, Fellbaum C, Hui PK, Parwaresch MR, Lennert K. Nodular paragranuloma can transform into high-grade malignant lymphoma of B type. Hum Pathol 1989;20:1169-1175. [Medline]
18. Küppers R, Zhao M, Hansmann ML, Rajewsky K. Tracing B cell development in human germinal centres by molecular analysis of single cells picked from histological sections. EMBO J 1993;12:4955-4967. [Medline]
19. Küppers R, Hansmann ML, Rajewsky K. Micromanipulation and PCR analysis of single cells from tissue sections. In: Herzenberg LA, Herzenberg LA, Weir DM, Blackwell C, eds. Weir's handbook of experimental immunology. 5th ed. Malden, Mass.: Blackwell Science, 1997:206.1-206.4.
20. Kabat EA, Wu TT, Reid-Miller M, Perry HM, Gottesman KS. Sequences of proteins of immunological interest. Washington, D.C.: Government Printing Office, 1987.
21. Cleary ML, Meeker TC, Levy S, et al. Clustering of extensive somatic mutations in the variable region of an immunoglobulin heavy chain gene from a human B cell lymphoma. Cell 1986;44:97-106. [CrossRef][Medline]
22. Bahler DW, Levy R. Clonal evolution of a follicular lymphoma: evidence for antigen selection. Proc Natl Acad Sci U S A 1992;89:6770-6774. [Free Full Text]
23. Mason DY, Banks PM, Chan J, et al. Nodular lymphocyte predominance Hodgkin's disease: a distinct clinicopathological entity. Am J Surg Pathol 1994;18:526-530. [Medline]
24. Greiner TC, Gascoyne RD, Anderson ME, et al. Nodular lymphocyte-predominant Hodgkin's disease associated with large-cell lymphoma: analysis of Ig gene rearrangements by V-J polymerase chain reaction. Blood 1996;88:657-666. [Free Full Text]
25. Pan LX, Diss TC, Peng HZ, Norton AJ, Isaacson PG. Nodular lymphocyte predominance Hodgkin's disease: a monoclonal or polyclonal B-cell disorder? Blood 1996;87:2428-2434. [Free Full Text]
26. Wickert RS, Weisenburger DD, Tierens A, Greiner TC, Chan WC. Clonal relationship between lymphocytic predominance Hodgkin's disease and concurrent or subsequent large-cell lymphoma of B lineage. Blood 1995;86:2312-2320. [Free Full Text]
27. Yoshinaga H, Ohashi K, Yamamoto K, et al. Clonal identification of Burkitt's lymphoma arising from lymphocyte-predominant Hodgkin's disease. Br J Haematol 1996;95:380-382. [CrossRef][Medline]
28. Ohno T, Trenn G, Wu G, Abou-Elella A, Reis HE, Chan WC. The clonal relationship between nodular sclerosis Hodgkin's disease with a clonal Reed-Sternberg cell population and a subsequent B-cell small noncleaved cell lymphoma. Mod Pathol 1998;11:485-490. [Medline]
29. Bräuninger A, Küppers R, Spieker T, et al. Molecular analysis of single B cells from T cell-rich B cell lymphoma reveals the derivation of the tumor cells from mutating germinal center B cells and exemplifies means by which immunoglobulin genes are modified in germinal center B cells. Blood (in press).
30. De Jong D, Van Gorp J, Sie-Go D, Van Heerde P. T-cell rich B-cell non-Hodgkin's lymphoma: a progressed form of follicle centre cell lymphoma and lymphocyte predominance Hodgkin's disease. Histopathology 1996;28:15-24. [CrossRef][Medline]
31. Harris NL, Jaffe ES, Stein H, et al. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 1994;84:1361-1392. [Free Full Text]
32. Oudejans JJ, Jiwa NM, Meijer CJLM. Epstein-Barr virus in Hodgkin's disease: more than just an innocent bystander. J Pathol 1997;181:353-356. [CrossRef][Medline]
33. Cotter FE. The role of the bcl-2 gene in lymphoma. Br J Haematol 1990;75:449-453. [Medline]

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• Savage, K. J., Monti, S., Kutok, J. L., Cattoretti, G., Neuberg, D., de Leval, L., Kurtin, P., Cin, P. D., Ladd, C., Feuerhake, F., Aguiar, R. C. T., Li, S., Salles, G., Berger, F., Jing, W., Pinkus, G. S., Habermann, T., Dalla-Favera, R., Harris, N. L., Aster, J. C., Golub, T. R., Shipp, M. A. (2003). The molecular signature of mediastinal large B-cell lymphoma differs from that of other diffuse large B-cell lymphomas and shares features with classical Hodgkin lymphoma. Blood 102: 3871-3879 [Abstract] [Full Text]  
• Wlodarska, I., Nooyen, P., Maes, B., Martin-Subero, J. I., Siebert, R., Pauwels, P., De Wolf-Peeters, C., Hagemeijer, A. (2003). Frequent occurrence of BCL6 rearrangements in nodular lymphocyte predominance Hodgkin lymphoma but not in classical Hodgkin lymphoma. Blood 101: 706-710 [Abstract] [Full Text]  
• Franke, S., Wlodarska, I., Maes, B., Vandenberghe, P., Achten, R., Hagemeijer, A., De Wolf-Peeters, C. (2002). Comparative Genomic Hybridization Pattern Distinguishes T-Cell/Histiocyte-Rich B-Cell Lymphoma from Nodular Lymphocyte Predominance Hodgkin's Lymphoma. Am. J. Pathol. 161: 1861-1867 [Abstract] [Full Text]  
• Bosshart, H., Ansell, S. M., Jelinek, D. F., Wettstein, P. J., Witzig, T. E. (2002). T Helper Cell Activation in B-Cell Lymphomas. JCO 20: 2904-2905 [Full Text]  
• Jundt, F., Anagnostopoulos, I., Forster, R., Mathas, S., Stein, H., Dorken, B. (2002). Activated Notch1 signaling promotes tumor cell proliferation and survival in Hodgkin and anaplastic large cell lymphoma. Blood 99: 3398-3403 [Abstract] [Full Text]  
• Pileri, S A, Ascani, S, Leoncini, L, Sabattini, E, Zinzani, P L, Piccaluga, P P, Pileri, A Jr, Giunti, M, Falini, B, Bolis, G B, Stein, H (2002). Hodgkin's lymphoma: the pathologist's viewpoint. J. Clin. Pathol. 55: 162-176 [Abstract] [Full Text]  
• Xu, Y, Wiernik, P H (2001). Systemic lupus erythematosus and B-cell hematologic neoplasm. Lupus 10: 841-850 [Abstract]  
• Brauninger, A., Spieker, T., Willenbrock, K., Gaulard, P., Wacker, H.-H., Rajewsky, K., Hansmann, M.-L., Kuppers, R. (2001). Survival and Clonal Expansion of Mutating "Forbidden" (Immunoglobulin Receptor-deficient) Epstein-Barr Virus-infected B Cells in Angioimmunoblastic T Cell Lymphoma. J. Exp. Med. 194: 927-940 [Abstract] [Full Text]  
• Seitz, V., Hummel, M., Anagnostopoulos, I., Stein, H. (2001). Analysis of BCL-6 mutations in classic Hodgkin disease of the B- and T-cell type. Blood 97: 2401-2405 [Abstract] [Full Text]  
• Frisch, M., Biggar, R. J., Engels, E. A., Goedert, J. J., for the AIDS-Cancer Match Registry Study Group, (2001). Association of Cancer With AIDS-Related Immunosuppression in Adults. JAMA 285: 1736-1745 [Abstract] [Full Text]  
• Franke, S., Wlodarska, I., Maes, B., Vandenberghe, P., Delabie, J., Hagemeijer, A., De Wolf-Peeters, C. (2001). Lymphocyte predominance Hodgkin disease is characterized by recurrent genomic imbalances. Blood 97: 1845-1853 [Abstract] [Full Text]  
• Kuppers, R., Brauninger, A., Muschen, M., Distler, V., Hansmann, M.-L., Rajewsky, K. (2001). Evidence that Hodgkin and Reed-Sternberg cells in Hodgkin disease do not represent cell fusions. Blood 97: 818-821 [Abstract] [Full Text]  
• Stein, H., Marafioti, T., Foss, H.-D., Laumen, H., Hummel, M., Anagnostopoulos, I., Wirth, T., Demel, G., Falini, B. (2001). Down-regulation of BOB.1/OBF.1 and Oct2 in classical Hodgkin disease but not in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription. Blood 97: 496-501 [Abstract] [Full Text]  
• Spieker, T., Kurth, J., Kuppers, R., Rajewsky, K., Brauninger, A., Hansmann, M.-L. (2000). Molecular single-cell analysis of the clonal relationship of small Epstein-Barr virus-infected cells and Epstein-Barr virus-harboring Hodgkin and Reed/Sternberg cells in Hodgkin disease. Blood 96: 3133-3138 [Abstract] [Full Text]  
• Shimodaira, S., Hidaka, E., Katsuyama, T. (2000). Clonal Identity of Nodular Lymphocyte-Predominant Hodgkin's Disease and T-Cell-Rich B-Cell Lymphoma. NEJM 343: 1124-1125 [Full Text]  
• Falini, B., Fizzotti, M., Pucciarini, A., Bigerna, B., Marafioti, T., Gambacorta, M., Pacini, R., Alunni, C., Natali-Tanci, L., Ugolini, B., Sebastiani, C., Cattoretti, G., Pileri, S., Dalla-Favera, R., Stein, H. (2000). A monoclonal antibody (MUM1p) detects expression of the MUM1/IRF4 protein in a subset of germinal center B cells, plasma cells, and activated T cells. Blood 95: 2084-2092 [Abstract] [Full Text]  
• Kanzler, H., Kuppers, R., Helmes, S., Wacker, H.-H., Chott, A., Hansmann, M.-L., Rajewsky, K. (2000). Hodgkin and Reed-Sternberg-like cells in B-cell chronic lymphocytic leukemia represent the outgrowth of single germinal-center B-cell-derived clones: potential precursors of Hodgkin and Reed-Sternberg cells in Hodgkin's disease. Blood 95: 1023-1031 [Abstract] [Full Text]  
• Staudt, L. M. (2000). The Molecular and Cellular Origins of Hodgkin's Disease. J. Exp. Med. 191: 207-212 [Full Text]  
• Muschen, M., Rajewsky, K., Brauninger, A., Baur, A. S., Oudejans, J. J., Roers, A., Hansmann, M.-L., Kuppers, R. (2000). Rare Occurrence of Classical Hodgkin's Disease as a T Cell Lymphoma. J. Exp. Med. 191: 387-394 [Abstract] [Full Text]  
• Kuppers, R., Klein, U., Hansmann, M.-L., Rajewsky, K. (1999). Cellular Origin of Human B-Cell Lymphomas. NEJM 341: 1520-1529 [Full Text]  
• Gopal, A. K., Schuetze, S. M., Maloney, D. G., Weiden, P. L. (1999). Large Cell Non-Hodgkin's Lymphoma and Hodgkin's Disease Arising Synchronously in a Patient With Chronic Lymphocytic Leukemia: Importance of Immunocytochemistry. Blood 94: 2537-2537 [Full Text]  
• Kerl, K., Girardet, C., Borisch, B. (1999). A Common B-Cell Precursor in Composite Lymphomas. NEJM 341: 764-765 [Full Text]  
• Kamel, O. W. (1999). Unraveling the Mystery of the Lymphoid Follicle. Am. J. Pathol. 155: 681-682 [Full Text]  
• Montesinos-Rongen, M., Roers, A., Kuppers, R., Rajewsky, K., Hansmann, M.-L. (1999). Mutation of the p53 Gene Is Not a Typical Feature of Hodgkin and Reed-Sternberg Cells in Hodgkin's Disease. Blood 94: 1755-1760 [Abstract] [Full Text]  
• Manis, J. P (1999). Precursors of Hodgkin's Disease and B-Cell Lymphomas. NEJM 340: 1280-1282 [Full Text]