RESUMEN
The case is described of a 62-year-old man with a 10-year history of hairy cell leukemia (HCL) who subsequently had a large-cell anaplastic or so-called Ki-1-positive lymphoma. Immunocytochemical staining of the lymphomatous node revealed positivity for Ki-1 (CD30) and epithelial membrane antigen in the tumor cells, and flow cytometric analysis showed simultaneous expression of Leu M5 (CD11c) and Leu 14 (CD22). Although HCL has been reported to coexist with both Hodgkin's disease and non-Hodgkin's lymphoma, the authors believe this is the first case in which a Ki-1-positive lymphoma developed in a patient with HCL. The clinicopathologic and immunologic features of both entities are discussed, as is the association of HCL with other neoplasms.
Asunto(s)
Leucemia de Células Pilosas/patología , Linfoma de Células B Grandes Difuso/patología , Neoplasias Primarias Múltiples/patología , Anaplasia , Antígenos CD/análisis , Antígenos de Diferenciación/análisis , Antígenos de Neoplasias/análisis , Citometría de Flujo , Humanos , Antígeno Ki-1 , Linfoma de Células B Grandes Difuso/química , Linfoma de Células B Grandes Difuso/ultraestructura , Masculino , Glicoproteínas de Membrana/análisis , Persona de Mediana Edad , Mucina-1 , Neoplasias Primarias Múltiples/química , Neoplasias Primarias Múltiples/ultraestructuraRESUMEN
Six patients with Hodgkin's disease (HD) and demonstrable serum antibodies to human immunodeficiency virus (HIV) and two additional patients with HD belonging to HIV-associated high-risk groups but with negative HIV serology were studied. All patients were men and ranged in age from 21 to 45 years. The HIV risk factors included homosexuality (6), intravenous drug abuse (2), and hemophilia A (1). All patients had high pathologically determined stage (one Stage III and seven Stage IV), and bone marrow involvement was observed in five patients with the initial diagnosis of HD based on marrow biopsy in two cases. Four cases were histologically subclassified as mixed cellularity (MC) and three as nodular sclerosis (NS); one patient underwent only bone marrow biopsy and was not subclassified. Histologically all cases were characterized by numerous Reed-Sternberg cells and variants, and with the exception of one case, all had a distinctive decrease in the proportion of reactive background lymphocytes compared with what is usually expected in MC or NS Hodgkin's disease (relative lymphocyte depletion). Flow-cytometric immunophenotypic studies done on cell suspensions from diagnostic lymph node biopsies in four cases showed decreased CD4:CD8 ratios (mean = 1.4) compared with expected values of 4 to 6. The relative lymphocyte depletion observed histologically is probably a reflection of the decreased tissue CD4:CD8 ratios, and this impairment of host immune response may be related to the observed high stage in all eight cases. Patients with high stage HD and the described histologic and immunologic features should be evaluated for the presence of HIV infection.
Asunto(s)
Infecciones por VIH/complicaciones , Enfermedad de Hodgkin/etiología , Adulto , Antígenos de Diferenciación/análisis , Médula Ósea/patología , Citometría de Flujo , Infecciones por VIH/diagnóstico , Seropositividad para VIH , Enfermedad de Hodgkin/inmunología , Enfermedad de Hodgkin/patología , Humanos , Técnicas para Inmunoenzimas , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
Leukemias are characterized by an idiopathic proliferation of a progenitor cell that is committed to a single cell lineage. However, leukemias with dual-lineage differentiation are being described, especially within the pediatric age group. The authors reviewed 118 cases of adult acute leukemia phenotyped by immunofluorescent flow cytometry; 7 cases demonstrated mixed cell lineage. Immunophenotypically these cases were defined by early B-lymphocyte differentiation (TdT, HLA-DR, and CD19) coexpressed with a myeloid receptor (CD13, CD15, or CD33) on the same leukemic cell. Routine cytochemical evaluation demonstrated punctate positivity of the blasts with naphthol AS-D chloroacetate esterase stain in five of seven cases. Cytogenetic analysis revealed structural abnormalities of chromosome 11 in four of the seven cases. Three of these studies showed a break at 11q23-24, the location of the human proto-oncogene ets-1. Clinically, two of these leukemias represented chronic myelogenous leukemia in blast crisis, and all cases behaved aggressively. The authors' data suggest that mixed lineage leukemias are an identifiable subset of adult acute leukemias and are associated with a poor prognosis.
Asunto(s)
Leucemia/genética , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Leucemia/inmunología , Leucemia/patología , Masculino , Persona de Mediana Edad , Fenotipo , Pronóstico , Proto-Oncogenes Mas , Coloración y EtiquetadoRESUMEN
A case with persistent hypercalcemia following complete resection of a primary parathyroid carcinoma is presented. An occult bone metastasis was diagnosed by fine needle aspiration (FNA) cytology of a lytic bone lesion clinically presumed to be a "brown tumor" of hyperparathyroidism. The cytologic features of the metastatic lesion were similar to those of the resected primary lesion and of a previously identified metastasis. The potential usefulness of FNA cytology in this clinical setting is discussed.
Asunto(s)
Neoplasias Óseas/diagnóstico , Carcinoma/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de las Paratiroides/diagnóstico , Biopsia con Aguja , Neoplasias Óseas/secundario , Carcinoma/patología , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/patología , Tomografía Computarizada por Rayos XRESUMEN
Although the phenomenon of the "vanished twin" has been noted repeatedly through the use of ultrasound, no confirmatory histologic evidence has been presented previously. This has raised questions concerning the validity of the vanishing twin syndrome. In the following case, a triplet intrauterine pregnancy was diagnosed ultrasonographically four weeks after in vitro fertilization, but only a single fetus and placenta were delivered at term. Careful examination of the placenta revealed histologic evidence of the vanished twin. This evidence consisted of a chorion-lined sac containing amorphous material, surrounded by degenerated chorionic villi juxtaposed against a normal amniochorionic membrane.