摘要:

AbstractPretreatment bone marrow biopsies and aspirations from 85 consecutive patients with non‐Hodgkin lymphoma were reviewed. All patients had at least one adequate biopsy. Criteria for involvement with lymphoma were clearly defined. The frequencies and morphologic patterns of involvement correlated with the lymph node diagnoses assigned according to Rappaport's classification. Diffuse, well‐differentiated lymphocytic and diffuse mixed lymphocytic‐histiocytic lymphoma were most frequently involved (100%), followed by diffuse, poorly differentiated lymphocytic (56%), nodular, poorly differentiated lymphocytic (39%), diffuse undifferentiated (33%), diffuse histiocytic (25%), and nodular mixed lymphocytic‐histiocytic lymphoma (23%). Each of the histologic subtypes tended to have an identifiable pattern of bone marrow involvement. Most striking was a predominance of paratrabecular localization of lymphoma in patients with nodular, poorly differentiated lymphocytic lymphoma. Biopsies were superior to both clot sections and aspirate smears in making the diagnosis of lymphoma in all subtypes, but discrepancies were more common in the nodular than in the diffuse lymphomas. A total of 52 pretreatment bilateral bone marrow biopsies from patients with non‐Hodgkin lymphoma were reviewed for concordance of diagnoses. In five patients, one biopsy was positive for lymphoma while the other was negative. Four of the five patients had histiocytic lymphoma, and the other had nodular mixed lymphoma. In two of these patients the bone marrow examination obviated the need for more invasive procedures to establish stage IV disease. We concluded that bone marrow biopsies are necessary for staging non‐Hodgkin lymphomas and that bilateral biopsies are most useful in the histiocyt

ISSN:0361-8609    

DOI:10.1002/ajh.2830030201

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractComparison of the chromosome findings obtained on routine examination (10‐50 cells) of the marrows from patients with Ph1‐positive CML with those based on a large number (110‐500 cells) of metaphases in six of these patients, in whom appropriate material was available, revealed the presence of small percentages of aneuploid cells in the marrow during the chronic phase of the disease and not seen with the routine procedure. These aneuploid cells may ultimately constitute the dominant clone during the blastic phase of the chronic myelocytic leukemia (CML). Furthermore, karyotypically abnormal cells, in addition those observed on routine study, were detected in the blastic phase when a large number of cells was examined. The value and implications of these observations are disc

ISSN:0361-8609    

DOI:10.1002/ajh.2830030202

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractA computer program has been developed to assist medical personnel in the diagnosis of hematologic disorders. The program requests information such as the patient's hematocrit, white blood‐cell count, platelet count, and selected physical findings. Major problems are identified, and the program then requests further information as needed to determine whether the patient has 1 or more of 174 hematologic disorders. An evaluation note is then printed that summarizes the most important hematologic data and includes a list of selected hematologic diagnoses, a discussion of why each diagnosis is listed, a description of its pathophysiology and information concerning etiology and treatment. The printout concludes with pertinent references to the medical literature.When the program was tested with 135 patients referred for hematologic consultation, diagnoses produced by the program were in complete agreement with the hematologist in 87 cases, in partial agreement in 23 cases and not in agreement in 25 cases. The program was also tested with 34 hematologic cases from the New England Journal of Medicine's Clinical‐Pathological Conferences. In 24 patients, the computer and anatomic diagnoses were in complete or partial agreement, and in 10 they disagreed. Anecdotal evidence suggests that explanations of pathophysiology contained in the evaluation notes may be useful to students. It is concluded that the program could be useful as a memory aid for the practitioner and as a teaching aid for the stud

ISSN:0361-8609    

DOI:10.1002/ajh.2830030203

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractA phenotypically normal donor for bone marrow transplantation was found to have a previously unreported karyotype, 46, XY, t(18q+; 22q‐), resulting in a Ph′‐like chromosome. Identification of the Ph′‐like chromosome in cultures of skin fibroblasts, phytohemaglutinin‐stimulated peripheral blood cells, and bone marrow cells from the marrow donor, but not in cell cultures from siblings or parents, indicated that it represented an acquired somatic mutation. Demonstration of the Ph′‐like chromosome in the marrow graft recipient's blood and bone marrow cells after transplantation provided a unique and definitive marker of engraftment. Hematopoiesis appeared normal in both the donor and recipient after transplantation. This study indicates that a mutation creating a Ph′‐like chromosome in hematopoietic cells need not produce hematologic abnormality. Presence of this translocation did not appear to interfere with normal hematopoietic or lymphoid differentiation and replication in the

ISSN:0361-8609    

DOI:10.1002/ajh.2830030204

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractDyskeratosis conagenita is a rare genodermatosis whose hematologic complications include pancytopenia of variable time of onset, a propensity for opportunistic infections, and neoplasia. A family in which the disorder segregated in 3 generations and involved 9 members is reported, and the hematologic data of the 46 previously reported cases are reviewed.

ISSN:0361-8609    

DOI:10.1002/ajh.2830030205

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractThe development of lymphocytic leukemia with a rapidly fatal clinical course is reported in a patient with kappa light‐chain multiple myeloma treated with alkeran. The leukemic cells lacked the ultrastructural features of plasma cells but bore readily detectable B‐cell markers and resembled lymphocytes under the light, transmission, and scanning electron microscopes. The leukemic phase is perhaps best defined as lymphocytic and probably represents a variant of plasma cell leukemia, in which the cells showed a degree of dedifferentiation from plasma cells to B lymphocytes. The possible relation between these 2 proliferative processes is discussed and the nature of leukemias developing in cases of plasma cell myeloma is briefly revie

ISSN:0361-8609    

DOI:10.1002/ajh.2830030206

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractA patient with classical polycythemia vera (PV) was found to have an inappropriately elevated serum erythropoietin (Ep) level. Investigations did not reveal any lesion or blood abnormality known to be associated with excessive Ep production and erythrocytosis. Sudden withdrawal of blood to reduce the Hb and Hct from 18.5 gm% and 56% to 13.6 gm% and 41.5%, respectively, resulted in an increment of serum Ep to abnormal level. With iron treatment there was a brisk return of Hb and Hct to prebleeding levels which was associated with reduction in the serum Ep. The inverse relationship between the EP and Hb or Hct is inconsistent with the presence of excessive Ep‐producing lesion. These results suggested that the threshold for Ep secretion from normal Ep‐secreting tissue to Hb and Hct levels is set at an abnormal level.This patient's marrow cells when cultured in vitro in the absence of Ep, unlike other PV patients' (except one) marrow cells, did not grow erythroid colonies. In the presence of Ep, however, the colonies comparable to those formed from normal marrow cultures were obtained. These results suggested that his marrow erythropoietic cells were neither Ep independent nor Ep‐hyperresponsive, as has been suggested by some investigators for erythropoiesis in PV. This patient presents phenomena that hitherto have not been rep

ISSN:0361-8609    

DOI:10.1002/ajh.2830030207

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractA case of chronic myelogenous leukemia (CML) with complex chromosomal abnormalities is reported. Conventional staining techniques indicated incorrectly that the Ph1chromosome was not present. These studies showed a 46, XY,‐1,+C karyotype in all bone marrow cells. Employing RFA (R bands by fluorescence using acridine orange) technique it was clear that the part of the long arm of chromosome 1 (lq23→qter) was missing and the tip of the long arm chromosome 22 (band q22) was translocated to it. The missing long arm of chromosome 1 was translocated to the long arm of chromosome 9. Furthermore, there was a break at band 9q22 and the whole terminal part was lost. The value of RFA technique is discus

ISSN:0361-8609    

DOI:10.1002/ajh.2830030208

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractFollowing extensive bowel resection, a young woman experienced severe malnutrition; subsequent administration of parenteral nutrition precipitated the copper deficiency syndrome. This consisted of hypocupremia, subnormal ceruloplasmin levels, anemia, and severe neutropenia. The bone marrow was megaloblastic, vacuolated, and sideroblastic; granulocytic maturation was not observed beyond the myelocyte stage. Copper sulfate therapy was followed by a marked reticulocytosis, increase in hematocrit, and recovery of neutrophils.Additional studies indicated that both serum and urinary erythropoietin values were low; serum activity increased after copper supplementation. Abnormal granulopoiesis was demonstrated using the in vitro granulocyte colony assay. The patient's granulocytic stem cells were normal on two occasions; however, mixing studies showed that culture of the patient's copper‐deficient marrow with her copper‐deficient serum yielded significantly reduced numbers of granulocyte colonies. Thus, copper appears to be a necessary element for normal hematopoiesis; lack of this trace element may result in ineffective erythropoiesis and granulopoie

ISSN:0361-8609    

DOI:10.1002/ajh.2830030209

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY

摘要:

AbstractA patient is described in whom morphologic features of well‐differentiated lymphocytic lymphoma (WDL) or chronic lymphocytic leukemia (CLL) and immunologic features of multiple myeloma were present. Studies of isolated peripheral blood lymphocytes demonstrated de novo synthesis of IgA k, the same paraprotein that was identified in the serum. Predominant IgA synthesis by peripheral lymphocytes has not been previously shown in either WDL or CL

ISSN:0361-8609    

DOI:10.1002/ajh.2830030210

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1977

数据来源: WILEY