Denis Wright
University of Southampton, Southampton
Our understanding of malignant lymphomas has traveled a long journey in the
past half century. For me the journey started in Africa in 1960 when I began
working with Denis Burkitt in Uganda. Denis was not the first to describe the
remarkable clinical features of what is now known as endemic Burkitt lymphoma
(eBL), but he was the first to systematically study the disease. He subsequently
delineated the distribution of the disease in Africa and was the first to use
chemotherapy for its treatment. It was my privilege to work alongside Denis
recording the pathology of his cases. In those early days our understanding
of the immune system and the biology of lymphocytes was primitive and the nature
of BL was uncertain. An international meeting of pathologists convened by the
UICC and WHO in 1968 concluded that BL should be defined on the basis of its
morphology (cytology and histology). Using this definition, cases of sporadic
BL were identified throughout the world. The majority of these cases of sBL
differed in their clinical features and relationship to EBV from eBL. Later,
AIDS-related BL was recognized; it differs from eBL in its clinical features
and relationship to EBV. The common morphology of all types of BL relates to
the fact that all show translocations of one of the immunoglobulin genes with
the c-myc gene. Consequent c-myc deregulation keeps all BL cells in cycle, resulting
in a monomorphic blastic tumor. Our understanding of the immune system underwent
a renaissance in the second half of the 20th century and shed new light on the
semantic and conceptual confusion that characterized the study of lymphomas.
Technical developments in immunohistochemistry, cytogenetics and gene profiling
are providing new insights into the biology of malignant lymphomas. Ideally,
this will be matched to more specific therapies for these tumors. Some of these
technical advances, such as gene profiling, will not be readily available in
the developing world. However they may reveal the expression of genes, the products
of which can then be identified by immunohistochemistry - a relatively simple
and inexpensive technique. Thus the unexpected ZAP-70 gene expression in poor-prognosis
CLL can be detected using immunohistochemistry. Immunohistochemistry, together
with modern imaging techniques, has also made it possible to arrive at a precise
diagnosis on many needle biopsy specimens. This technique is particularly valuable
in the investigation of deep-seated lesions, avoiding the morbidity of invasive
surgery.
Mulago
Hospital Kampala,
where Professor Wright worked in Uganda.
Our understanding of malignant lymphomas has traveled a long journey in the
past half century. For me the journey started in Africa in 1960 when I began
working with Denis Burkitt in Uganda. Denis was not the first to describe the
remarkable clinical features of what is now known as endemic Burkitt lymphoma
(eBL), but he was the first to systematically study the disease. He subsequently
delineated the distribution of the disease in Africa and was the first to use
chemotherapy for its treatment. It was my privilege to work alongside Denis
recording the pathology of his cases. In those early days our understanding
of the immune system and the biology of lymphocytes was primitive and the nature
of BL was uncertain. An international meeting of pathologists convened by the
UICC and WHO in 1968 concluded that BL should be defined on the basis of its
morphology (cytology and histology). Using this definition, cases of sporadic
BL were identified throughout the world. The majority of these cases of sBL
differed in their clinical features and relationship to EBV from eBL. Later,
AIDS-related BL was recognized; it differs from eBL in its clinical features
and relationship to EBV. The common morphology of all types of BL relates to
the fact that all show translocations of one of the immunoglobulin genes with
the c-myc gene. Consequent c-myc deregulation keeps all BL cells in cycle, resulting
in a monomorphic blastic tumor. Our understanding of the immune system underwent
a renaissance in the second half of the 20th century and shed new light on the
semantic and conceptual confusion that characterized the study of lymphomas.
Technical developments in immunohistochemistry, cytogenetics and gene profiling
are providing new insights into the biology of malignant lymphomas. Ideally,
this will be matched to more specific therapies for these tumors. Some of these
technical advances, such as gene profiling, will not be readily available in
the developing world. However they may reveal the expression of genes, the products
of which can then be identified by immunohistochemistry - a relatively simple
and inexpensive technique. Thus the unexpected ZAP-70 gene expression in poor-prognosis
CLL can be detected using immunohistochemistry. Immunohistochemistry, together
with modern imaging techniques, has also made it possible to arrive at a precise
diagnosis on many needle biopsy specimens. This technique is particularly valuable
in the investigation of deep-seated lesions, avoiding the morbidity of invasive
surgery.