Transcripts of the npm-alk fusion gene in anaplastic large cell
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Transcripts of the npm-alk fusion gene in anaplastic large cell
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For personal use only. 1995 86: 3517-3521 Transcripts of the npm-alk fusion gene in anaplastic large cell lymphoma, Hodgkin's disease, and reactive lymphoid lesions PG Elmberger, MD Lozano, DD Weisenburger, W Sanger and WC Chan Updated information and services can be found at: http://www.bloodjournal.org/content/86/9/3517.full.html Articles on similar topics can be found in the following Blood collections Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved. From www.bloodjournal.org by guest on November 20, 2014. For personal use only. Transcripts of the npm-alk Fusion Gene in Anaplastic Large Cell Lymphoma, Hodgkin’s Disease, and Reactive Lymphoid Lesions By P. Goran Elmberger, Maria D. Lozano, Dennis D. Weisenburger, Warren Sanger, and Wing C. Chan tradictory information in the literature on the occurrence Anaplastic large cell lymphoma (ALCL) and Hodgkin’s disease (HD) have some pathologic and immunohistochemical of the npm-a/& rearrangement in HD.We detected npm-elk hybrid mRNA in 8 of 22 cases of ALCL (36%). but none of similarities, and a histogenetic relationship between them the 11 cases with reactivelesions the 21 casesofHDor has been suggested by some investigators.By cytogenetic contained amplifiable template. All positive ALCL had the T study, the t(2;5)(p23;q35) translocation appears to be unique or indeterminate phenotype and occurred in young adults of the t(2;5)(p23;q35) have reforALCL.Thebreakpoints was very good correlation between a cytocently been cloned and are reported to involve a novel tyro- or children. There RT-PCR. genetically detectable t(2;5) and a positive signal by sine kinase gene, anaplastic lymphoma kinase (alk), on chroOur results indicate a selective but relatively infrequentasmosome and 2 the nucleophosmin gene (npm) on chromosome 5. Therefore,we studied the frequency of npm- sociation between the t(2;5) and ALCL ofT or indeterminate elktranslocation in ALCL using a reverse transcriptase-poly- phenotype, not shared with HD or reactive hyperplasia. 0 1995 by The American Society of Hematology. merase chain reaction (RT-PCR) assay. We also studied HD there is conand a varietyof reactive lymphoid lesions since A NAPLASTIC LARGE-CELL lymphoma (ALCL) is a recently recognized category of non-Hodgkin’s lymphoma (NHL).14 Histologically, this lymphoma in its classical form consists of large anaplastic cells that preferentially occupy the sinuses and T-cell areas of lymph nodes. The tumor cells often exhibit a cohesive pattern of growth and strongly express CD30 (Ki-l), which is an activationassociated marker belonging to the nerve growth factorhumor necrosis factor receptor family and expressed by subsets of activated T and B cells, as well as by Reed-Stemberg cells in Hodgkin’s disease (HD). The histologic diagnosis of ALCL can be difficult and many cases have previously been classified as lymphocyte depleted HD, malignant histiocytosis, melanoma, or anaplastic carcinoma. Today, most misdiagnoses canbe avoided with the application of modem analytical techniques including immunohistochemistry, electron microscopy, and molecular analysis of T- and B-cell antigen receptor gene rearrangements. However, ALCL can still be confused with HD due to the presence of cells resembling Reed-Stemberg cells and an overlapping immunohistochemical and genotypic pr~file.~”Although the reciprocal translocation t(2;5)(p23;q35) has been associated with ALCL,8-I3 it has not been described in HD. However, cytogenetic analysis is hampered in HD by the generally small proportion of neoplastic cells that are not very active mitotically, resulting in poor yieldof tumor cell metaphases in chromosome preparations. Recently, Morris et al have shown that the t(2;5)(p23;q35) results in the fusion of the nucleophosmin gene (nprn) on chromosome 5 with the anaplastic lymphoma kinase gene (alk) on chromosome 2.14 The alk gene shows sequence similarity to the insulin receptor subfamily of tyrosine kinases. The abnormal fusion protein resulting from the translocation retains the tyrosine kinase domain and likely contributes to the malignant transformation of ALCL. Southern blot analysis using probes close to the npm-alk breakpoints or a reverse transcriptase-polymerase chain reaction (RTPCR) using nprn and alk primers have consistently detected a fusion product in cases of ALCL or cell lines with a cytogenetically detected t(2;5).I5.l6The RT-PCRassay is an extremely sensitive technique that should be able to detect the Blood, Vol 86, No 9 (November l), 1995 pp 3517-3521 presence of a small number of neoplastic cells with t(2;5), independent of cell division. As such, RT-PCR appears ideally suited to investigate the possible relationship between the t(2;5) and HD. Therefore, we have undertaken a study of the utility of a RT-PCR assay in the detection of the t(2;5) in ALCL, and compared the results with available cytogenetic data. A series of classical HD was also studied to determine whether the t(2;5) with the same breakpoints was detectable in this condition. Tissues showing reactive lymphoid hyperplasia were also examined for the presence of rare cells with the translocation. MATERIALS AND METHODS Patient samples. Cases of primary ALCL were identified in the Nebraska Lymphoma Study Group (NLSG) Registry. All the cases were reviewed and those showing the typical histopathologic features of ALCL, ie, large anaplastic cells with strong expression of CD30 on tumor cells, along with snap-frozen tissue were selected for further study. None of the morphologic variants of ALCL was included in this study. Three of the tumors occurred in extranodal sites including two skin lesions and a thigh mass, but one of the skin lesions represented a recurrent tumor after a nodal primary and the other skin tumor was associated with axillary lymphadenopathy. Human immunodeficiency virus infection was not diagnosed in any of the patients studied. Two cases without anaplastic morphology were From the Division of Clinical Cytology, the Department of Pathology and Cytology, Karolinska Institute and Hospital, Stockholm, Sweden; the Department of Pathology and Microbiology, and the Department of Pediatrics, University of Nebraska Medical Center, Omaha. Submitted May 8, 1995; accepted June 26. 1995. Supported in part by Grant No. USPHS CA36727 from the National Institutes of Health. Address reprint requests to Wing C. Chan, MD, Department of Pathology and Microbiology, University of Nebraska Medical Center, 600 42nd St, Omaha, NE 68198-3135. The publication costs of this article were defrayedin part by page charge payment. This article must therefore be herebymarked “advertisement” in accordance with 18 U.S.C. section 1734 solely to indicate this fact. 0 1995 by The American Society of Hematology. ooaS-4971/95/8609-01$3.00/0 3517 From www.bloodjournal.org by guest on November 20, 2014. For personal use only. ELMBERGER ET AL 3518 identified from our cytogenetic dat;hse because of the presence of the 1(2;5)(~23:q35). These two cases were analyzed for the correlation of cytogenetic findings with the RT-PCR assay. The most recent 21 cases of HD. including 15 cases of the nodular sclerosis and six cases of the mixed cellularity subtypes. with classical features and snap-frozen tissue were also identified in the NLSG database. In addition. I I cases of various types of reactive lymphoid hyperplasia were included in the study. Cofrrrol rissrrc. Frozen placental tissue and K562 cells, an erythroleukemia cell line, were used as negative controls for the npm-crlk rearrangement assay. The JB6 cell line (kindly provided by Dr M. Kadin. Beth Israel Hospital. Harvard Medical School. Boston. MA) derived from a case of ALCL and carrying a t(2:S) was used as a positive control. RNA isokrrion m t d cDNA prqwrorion. Tissue samples thathad been either directly snap-frozen or embedded in OCT medium and snap-frozen were used. Intact tissue (3 mm’) was minced with a fresh razor blade. transferred to a prelabeled Eppendorf tube with I mL TRlzol (GIBCO BRL, Gaithersburg. MD) containing 5 pg glycogen carrier (BoehringerMannheim. Indianapolis. I N ) and immediately vortexed. The OCT-embedded tissue was sectioned on a cryostat with disposable knife blades, and three 20-pm sections with approximately I cm‘ area were collected in I mL TRIzol. Every step was taken to avoid the possibility of cross contamination. Tissue was minced in ;I laminar flow hood with new towels over the cutting area and U V irradiation between each sample. An extensive cleaning procedure was applied between the cutting of each sample in the cryostat, including dismantling of the cutting knife holder and five cleansing cycles with ethanol and 0. I mollL HCI. A new blade was used for each sample. Gloves were changed between each step in the procedure. To monitor the efficacy of the contamination prevention procedures. negative control placental tissue was introduced as every fifth sample. Total R N A extraction. precipitation. and washings were performed according to the TRlzol protocol. Total RNA was quantitated using spectrophotometric absorbance at 260/280 nm. diluted to 0.2 pglpL, and stored in 10 pL fractions at -70°C for further analysis. Contaminating DNA was removed by DNAase treatment (GlBCO BRL). cDNA was prepared using random hexamer primers and reverse transcriptase (GIBCO BRL) according to the manufacturer‘s instruction. RT-PCR. The presence of amplifiable cDNA was confirmed by performing PCR for glyceraldehyde 3 phosphate dehydrogenase (G3PDH) mRNA with a PCR product of 497 bp.” The S’ r r p n and 3’ d k primers and the junction oligonucleotide used for probing have been previously described.”’ and their sequences are S’-CCCTTCCGGGCTTTGAAATAACACC-3‘. 5”GAGGTGCGGAGCTTGCTCAGC-3’. and 5’-AGCACITAGTAGTGTACCGCCGGA3’. respectively. Amplification was performed with addition of 10 pmol of each primer, I U of Taq polymerase, 125 nmol MgCI?. 10 nmol deoxynucleotide triphosphates in I X PCR buffer (50 mmollL KCI. 10 mmollL Tris HCI at pH 8.3. 0.1 m g h L gelatin. 0.45% Nonidet-P40. and 0.45% Tween 20) in a total volume of 45 pL. Hot start technique was used and the reaction started with the addition of 5 pL of cDNA when the reaction mixture reached 94°C. The cycling parameters were 40 cycles at 94°C for 30 seconds. 62°C for I minute, and 72°C for 30 seconds, followed by a final extension at 72°C for I O minutes. The RT-PCR products were electrophoresed on 1.5% NuSieve agarose gels and visualized with ethidium bromide staining. The PCR products were then blotted by capillary transfer onto nylon membranes, which were hybridized with end-labeled /rprn-olk junctional oligonucleotide. washed at the appropriate stringency, and then autoradiograph was performed. /nttnrrtto/o,~ic srrrdies. lmmunophenotyping was performed on Fig1. Sensitivity of the RT-PCR assay.Serial dilutions ofcDNA from JB6 cell line were amplified and the products electrophoresed as follows: lanes 1 through 6 at 10.’. l 0 10 ‘, and lo” dilutions, respectively. Lane 7. reaction performed with no template DNA. M, molecular-weight markers at 100-bp interval. A signal is detectable down to 10 dilution. ’, paraffin and/or frozen sections using a panelof monoclonal and polyclonal antibodies against leukocyte-associated antigens. The cases were classified as being of T-cell typc when theneoplastic cells in frozen sections were positive with one or more of the antibodies to CD2. CD3. or CD5 and negative for CDIY, CD20. and CD22 and/ or paraffin sections were positive withatleast two antibodies to CD45RO. CD43. or CD3 in the absence of CD20 positivity. The cases were classified :IS being of B-cell type when frozen sections were positive with one or more antibodies to CD19. CD20, or CD22 in the absence of CD2. CD3. and CDS. and/or when paraffin sections showed CD20 positivity with no more than one of either CD43 or above CD45RO being positive. When a case did not tit any of the criteria. it was considered to have an indeterminate phenotype. RESULTS Perfonnonce of RT-PCR for npm-alk. Using the control cell line JB6, the sensitivity of the optimized ntpm-dk RTPCR assay was determined. cDNA was prepared from I pg of RNA (equivalent to approximately IO5 cells) andserial IO-fold dilutions of the RT-reaction product from JB6 were made in the RT-reaction product from 1 pg of K562 RNA to simulate a progressively decreasing amount of tumor cells with npnt-alk transcripts in irrelevant cells. Theexpected 175-bp rtpnt-alk product was clearly visible on agarose gels when a dilution of IO-‘ JB6 cDNAwasused as template (Fig l ) . RT-PCR in ALCL. HI),crrtd reactive conditions. RNA samples from 22 cases of CD30-positive ALCL. 21 cases of classical HD, and 1 1 cases of reactive lymphoid hyperplasia were suitable for analysis. Only cases with amplifiable products after the RT reaction using G3PDH primers were subjected to the rtprn-alk RT-PCR assay. All results were confirmedby probing themembranesforthedesired175-bp From www.bloodjournal.org by guest on November 20, 2014. For personal use only. npm-alk FUSION GENE IN LYMPHOMA 3519 Table 1. npm-alk RT-PCR Analysis in CDBO-Positive ALCL, Hodgkin's Disease, and Reactive Lymphoid Hyperplasia the four cytogenetically negative ALCL cases showedthe n p m - d k product with RT-PCR. RT-PCR for t12;5) DISCUSSION Samples (n) + ALCL (22) HD Nodular sclerosis (15) Mixed cellularity (6) Reactive hyperplasia (11) 8 14 0 0 0 15 6 11 hybrid product using the breakpoint specific probe. Of the 22 ALCLcases. 8 (36%) were positive by the RT-PCR assay (Fig 2). Noneofthe 21 cases ofHD or the I I cases of reactive hyperplasia showedthe expected 175 bp product (Table I ) . All HD and reactive cases remained negative following transfer and probing with the labeled npnt-dk junction oligonucleotide. Noneof IO placental negative control samples interspersed among thetest samples, the negative control cell line RNA and cDNA, or the reaction mixtures without DNA template added to the assay procedure was positive. Clirticcrl jecrtlrres. The cases of ALCLwiththe t(2;S) differed fromthe negative cases withrespect to age and tumor cell phenotype. The positive cases were younger and were only of T-cell or indeterminant phenotype (Table 2). Corre1crtiort.s with cytogenetic clatcr. Of the 22 cases of ALCL, I O hadbeen previously analyzed cytogenetically. Among these. the classical t(2;S)(p23,q3S) was found in six cases, and in one additional case, the origin of a der 5q3S was uncertain. The six cases with the classical t(2;S) were all positive in the RT-PCR analysis. Two additional cases ofNHLwiththe t(2;S), butnot included in our analysis of ALCL because of atypical morphologic features or the absence of CD30, were also studied. These tissue samples weretestedwiththeRT-PCRassay and a non-anaplastic, CD30'peripheral T-cell lymphoma from a 7-year-old boy was found to be positive, whereas a B-large-celllymphoma with monoclonalkappa expression from a 73-year-old man was negative. Thus, of the eight cases with a t(2;5)(p23,q3S) demonstrated cytogenetically, seven (88%) were positive with the RT-PCR assay. None of the positive control JB6. Lanes 2, 10, and 14 are placental samples interspersedbetween test samples.Lanes 1, 4, and 15 through 18 are samples with the characteristic band at 175 bp (upper panel), which hybridizes strongly with the 32P-labeled junctional oligonucleotide (lower panel). M, molecular-weight markers at 100-bp interval. While the majority of cases of ALCL can be recognized by a constellation of morphologic and immunohistochemical features, there is no single characteristic feature that is pathognomonic of this lymphoma. The discovery of the t(2;S)(p23;q35) in cases of ALCL was significant'"' since it wasthoughtto be a specific marker for this form of lymphoma, andtoprovide a clue as toits pathogenesis. However, the reported incidence of the t(2;S) is highly variable in ALCL,probably due tovariablemethods of case selection in the various studies. The cloning of the breakpoint in the t(2;5)(p23;q3S) was a significant step toward the understanding of the pathogenesis of ALCL, and it opened the way to the demonstration of the t(2;5) by molecular techniques." The new assays have allowed the study of a larger number of cases of ALCL since tissues with adequately preserved DNA and/or RNA can now be examined. Several such studies of ALCL have been published15.1X'?"or presented at recent the and results are summarized in Table 3. Bullrichet all5 studied 16 cases of ALCL by Southern blot analysis and found two positive cases (12.5%). A similar percentage of positives (16%) wasfound by Lopategui et allXwhen37paraffinembedded tissues werestudied by RT-PCR.while Orscheschek et all'' reported that four of five cases (80%) they examined were positive.Variable percentages of ALCL have been reported to be positive ( 13% to 43%) in abstracts by other groups."'.'' Some of the differences in these reported series may be due to case selection with regard toage, phenotype, cytogenetic findings, andthe diagnostic criteria for inclusion in the ALCL category. Our finding of 36% is close tothemedianofthereported series. We havebeenvery strict in the pathologic criteria for case selection, so our results should be representative of classic cases of ALCL. Morphologic variants, CD3O- cases, primary cutaneous ALCL, and cases associated with the acquired immunodeficiency syndrome have notbeen included. Our patients spanned the entire age spectrum, with four of the patients under I8 years of age. It is interesting that the t(2;S)-positive From www.bloodjournal.org by guest on November 20, 2014. For personal use only. 3520 ELMBERGER ET AL Table 2. Age, Sex, and Tumor Phenotype of Cases of CD30+ ALCL would give rise to some overlap in the cases assigned to the two categories. ALCL Cases Male/Female T/B/I However, this explanation cannot account forthevery high percentage of positive cases reported by Orscheschek All cases 1319 22 35 yrs a1411o et aI.l9 Theprimers used by these latter investigators encom(3-86) RT-PCR(+) a 18 414 yrs 41014 pass a larger DNA fragment than the primers usually used (3-32) by other investigators. However, because the products of 58 RT-PCR(-) 915 14 yrs 41416 all their positive cases hybridized with the same junctional (9186) oligonucleotide, it does not appear thattheir cases had breakpoints that were undetectable by the primers used by others. Although it is possible that rare Reed-Sternberg cells in HD could harbor this translocation, the techniques used cases appear more prevalent in the younger age group and all by us and other investigators are highly sensitive and yet we of the ALCLs were of the T-cell or indeterminate phenotype were unable todetect any positive cases of HD in our series. (Table 2). Whether the t(2;5) positive cases form a distinct Therefore, even if the t(2;5) is present in HD, it would have clinicopathologic subset of ALCL deserves further investigato be present in a very small fraction of the Reed-Sternberg tion. cells. This is supported by our cytogenetic studies of 5 1 cases There was a very good correlation between the cytogenetic ofHDwith clonal or non-clonal karyotypic abnormalities, findings and the RT-PCR results when cases with a non-Bwhereinnot a single metaphase showing t(2;5)(p23;q35) cell phenotype were considered with concordance in all was detected (W.S., unpublished observations, April 1995). seven cases. However, two cytogenetically positive cases [ 1 Wedidnot detect the t(2;5) byRT-PCR in any of our with t(2;5); 1 with a der 5q35J with a B-cell phenotype were cases of reactive lymphoid hyperplasia. Similar results have not positive by the RT-PCR assay. It is interesting to note been obtained by ~ t h e r s . ’ ~Therefore, ,’~ it appears that the that the one B-cell ALCL case examined by Southern blotRT-PCR assay should be a useful assay to detect minimal ting by Bullrich et alls appeared to have a different residual disease or tostudy biopsies with questionable breakpoint from the one commonly found in ALCL. In most involvement in patients with tumors containing the translocacases of ALCL with t(2;S), the breakpoints seem to occur tion.Whenusedasan alternative to cytogenetic studies, in a common intron on npm and alk, respectively. Whether there would be a small percentage of cases that would be B-cell ALCL is associated with breakpoints that are outside missed, including t(2;5)(p23;q35) with breakpoints different of these introns requires further investigation. The B-cell fromthe classical one andvariant translocations such as ALCL with der 5q35 in our series may indeed not have the t(2;5)(p21;q35),t(3;5)(q12;q35), and t(5;6)(q35;p12).“’.” classic t(2; S ) . Some of the variant translocations may be three-way transloIn most of the reported series, HD has been found to be cations that involve nprn and alk,I5but one cannot exclude negative for the t(2;5) by molecular assays or only a low the possibility of other partners for the nprn gene. percentage of positive cases have been found.’5316,22.24.2s A In conclusion, the RT-PCR assay is a useful alternative striking exception is the report by Orscheschek et al,” to cytogenetic studies and has the advantages of high sensiwherein 11 of 13 cases of HD (85%) were found tobe tivity, lesslabor intensiveness, and does not require cell positive by RT-PCR. Because it may be difficult to differenculture. For CD30’ ALCL with classical morphology, about tiate HD from ALCL in some cases, it is conceivable that 36%ofthe cases had detectable t(2;5)(p23;q35) bythis the different diagnostic criteria used by various investigators No. Median Age (range) Phenotype Table 3. Review of the Literature: t(2;5) in ALCL, HD, and Benign Conditions ALCL No. Studies t et (14) Current study Bullrich et all5 Ladanyi et aIz5 Lopategui et all8 Orcheschek et all’ Downing McBride et alz’ Ngan et alzz Weilmann et aiz3 Yee et aiz4 Total 20 Method (36) RT-PCR Southern RT-PCR RT-PCR (80) RT-PCR RT-PCR Southern RT-PCR RT-PCR RT-PCR 148 8 blot No. No. Studied Positive 22 16 - 4 21 blot 8 37 5 49 (13) 15 24 15 (13) 22 17 (29) 198 2 Studied 113) 21 9 40 (16) 13 (43) - - 2 2 5 58 No. No. (Yo) Studied Positive (0) (22) (0) 11 0 - - - - No. (%) 6 Benign Conditions HD Positive 0 2 0 - 1 14 (36) (30) * Lymphomatoid papulosis in all six cases. t Cases classified as ALCL and imrnunoblastic included for analysis. - - 41 2 - - - 0 (85) 5 - (211 (5) 6* 0 - - - - 20 0 0 (%l (0) (0) (0) (0) (0) From www.bloodjournal.org by guest on November 20, 2014. For personal use only. npm-a/&FUSION GENE IN LYMPHOMA 3521 12. Ebrahim SA, Ladanyi M, Desai SB, OffitK, Jhanwar SC, Filippa DA, Liebeman PH, Chaganti RS: Immunohistochemical molecular cytogenetic analysis of a consecutive series of 20 peripheral T-cell lymphomas of uncertain lineage including twelve Ki-1 positive lymphomas. Genes Chromosomes Cancer 2:27, 1990 13. Mason DY, Bastard C, Rimokh R, Dastugue N, Huret JL, Kristoffersson U, Magaud JP, Nezelof C, Tilly H, Vannier JP, Hemet J, Warnke R: CD30-positive large cell lymphomas (“Ki-l lymphoma”) are associated with a chromosomal translocation inACKNOWLEDGMENT volving 5q35. Br J Hematol 74:161, 1990 14. Moms SW, Kirstein MN, Valentine MB, Dittmer KG, ShaWe thank Robert Wickert for technical assistance, Martin Bast piro DN, Saltman DL, Look A T Fusion of a kinase gene, ALK, to a for data management, George Pallas for photography, andKaren nucleolar protein gene, NPM, in non-Hodgkin’s lymphoma. Science Hansen for preparation of the manuscript. 263:1281, 1994 15. Bullrich F, Moms SW, Hummel M, Pileri S, Stein H, Croce REFERENCES C: Nucleophosmin ( N P M ) gene rearrangement in Ki-l-positive 1. Stein H, Mason DY, Gerdes J, O’Connor N, Wainscoat J, lymphomas. Cancer Res 54:2873, 1994 Pallesen G, Gatter K, Falini B, Delsol G, Lemke H: The expression 16. Moms SW, Shurtleff SA, Head D, Behm FG, Raimondi SC, of the Hodgkin’s disease associated antigen Ki-l in reactive and Weisenburger DD, Kossakowska AE, Thomer P, Zielenski M, Loneoplastic lymphoid tissue: Evidence that Reed-Stemberg cells and renzana A, Ladanyi M, Downing J R Molecular detection of the histiocytic malignancies are derived from activated lymphoid cells. t(2; 5) non-Hodgkin’s lymphoma (NHL) by reverse transcriptaseBlood 66:848, 1985 polymerase chain reaction. Blood 84:138, 1994 (abstr) 2. Kadin ME, Sako D, Berliner N, Franklin W, Woda B, Borowitz 17. Ercolani L, Florence B, Denaro M, Alexander M: Isolation M, Ireland K, Schweid A, Herzog P, Lange B: Childhood Ki-l and complete sequence of a functional human glyceraldehyde-3lymphoma presenting with skin lesions and peripheral lymphadenopphosphate dehydrogenase gene. J Biol Chem 263:15225, 1988 athy. Blood 68:1042, 1986 18. Lopategui JR, Sun L-H, Chan JKC, Gaffey MJ, Frierson HR, 3. Agnarsson BA, Kadin ME: Ki-l positive large cell lymphoma. Jr, Glackin C, Weiss LM: Low frequency association of the A morphologic and immunologic study of 19 cases. Am J Surg t(2;5)(p23;q35) chromosomal translocation with CD30+ lymphomas Pathol 12:264, 1988 from American and Asian patients: A reverse transcriptase-polymer4. Delsol G, AI Sasti T, Gatter KC, Gerdes J, Schwarting R, ase chain reaction study. Am J Pathol 146:23, 1995 Caveriviere P, Rigal-Huguet F, Robert A, Stein H, Mason DY: Coex19. 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Yee HT, Ponzoni M, MersonA, Scarpa A, Menestrina F, Germain D, Mason DY: A translocation involving a specific Chilosi M, Pittaluga S, De Wolf-Peeters C, Frizzera G, Inghirami breakpoint (q35) on chromosome 5 is characteristic of anaplastic G: Chimeric NPM-ALK transcripts of t(2;5) in anaplastic large cell large cell lymphoma (“Ki-l lymphoma”). Br J Haematol 71:31, lymphoma (ALCL) and Hodgkin’s disease (HD). Mod Pathol 1989 8:124A, 1995 (abstr) 11. LeBeau MM, Bitter MA, Larson RA, Doane LA, Ellis ED, 25. Ladanyi M, Cavalchire G. Moms SW, Downing J, Filippa Franklin WA, Rubin CM, Kadin ME, Vardiman JW: The DA: Reverse transcriptase polymerase chain reaction for the Ki-l t(2;5)(p23;q35). A recurring chromosomal abnormality in Ki-l-posianaplastic large cell lymphoma-associated t(2;S) translocation in tive anaplastic large cell lymphoma. Leukemia 3:866, 1989 Hodgkin’s disease. Am J Pathol 145:1296, 1994 assay with a higher incidence in childhood cases and cases with non-B phenotype. This translocation appears undetectable in reactive hyperplasia and also negative in the majority of HD. The positive HD cases may be due to inclusion of some overlapping ALCL cases or the presence of rare ReedStemberg cells with t(2;S) as an expression of cytogenetic instability in the tumor cell population.