[Hemolysis and valvular prosthesis. Study of 136 cases].
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Biomedical subjects
Publications and source records attributed to A Bernadou.
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A laparotomy performed for an occlusive syndrome, disclosed the presence of an ileal lymphoma in a renal graft recipient, 17 years after a first renal transplant. Mesenteric lymph node and spleen involvement were associated. The morphology of the large cells, the type of infiltration of the lymph node simulating metastatic carcinoma or malignant histiocytosis were highly suggestive of a new type of high grade malignancy lymphoma recently described which is called 'large cell anaplastic ML'. The immunolabelling study confirmed this diagnosis, demonstrating the following phenotype CD4, CD25 (TAC), CD30 (Ki-1), OKT 9 (transferrin receptor), EMA and HLA DR positivity. The tumour cells were negative for the other T, B and histiomonocytic markers. This case, of a large cell anaplastic Ki-1 positive lymphoma, expressing CD4, in a renal graft recipient shows that high grade ML in such patients are not all of the B cell type.
Forty-five bone marrow (BM) biopsies have been studied in 30 T-cell malignant lymphoma (ML). According to the updated Kiel classification, these ML comprised 12 low grade ML and 18 high grade ML. BM involvement was not significantly more frequent in low grade ML (41.6 per cent) than in high grade (33.3 per cent). This involvement was discovered in 85 per cent of the cases at the time of diagnosis. A correlation was found between BM and other visceral localizations for histological type in all cases. Infiltrates principally showed a nodular pattern in low grade and a diffuse pattern in high grade ML. Hematopoietic hyperplastic reaction was frequent (66.6 per cent) not correlated to involvement. Clinical staging showed extensive spreading. Our patients had an overall median survival of 40 months, worse in high grade ML (median: 19 months) than in low grade ML (41 months) but not statistically different (p = 0.25). Extranodal localizations are a significant criteria for poor prognosis (p = 0.018). Among them, BM involvement appears to be the most significant criteria (Cox model, p = 0.006). Patients with BM localization had a median survival of 9 months contrasting with 40 months in patients without BM localization (p = 0.007). Thus, BM biopsy is useful for the diagnosis of patients with T-ML and essential to establish the prognosis.
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