IS NON-TRAUMATIC NAIL DYSTRPOPHY ONLY DUE TO CHRONIC ONYCHOMYCOSIS? THE ONYCHOMATRICOMA. CASE REPORT.

B cell lymphoma develops in the pleural cavity of patients affected by long-standing pyothorax resulting from lung tuberculosis, thus termed pyothorax-associated lymphoma (PAL). PAL usually shows a diffuse large cell morphology, and constantly contains Epstein-Barr virus (EBV) genome. To investigate whether PAL cells proliferate in response to specific antigenic stimuli and its stage in B cell differentiation, immunoglobulin heavy chain gene in 7 cases and 2 cell lines from PAL, all confirmed by histological studies to be EBV-positive diffuse large B cell lymphoma, were examined by using polymerase chain reaction (PCR) method. Clonal rearrangement of the gene was detected in 4 cases of PAL tissues and one cell line. As for the usage of the V region gene (V(H)), the V(H)3 family gene was used in 3 of these 5 cases with different homologous germlines, suggesting that the origin of PAL cells from a repertoire of B lymphocytes responsive to specific antigenic epitope was unlikely. Compared to the homologous germline, the mutation frequency of PAL was 9% on average. Only one case might have more replacement mutations in the complementarity-determining regions than expected by chance, thus antigen-selected maturation might not take place in PAL. Intraclonal sequence heterogeneity in the V(H) gene was found in another case. From these findings, it is concluded that PAL is composed of B lymphocytes at the differentiation stage of the postgerminal center. Antigen-selected maturation might not take place in PAL, which is distinct from the majority of B cell lymphomas.