Giant cell tumour of the skull base: MRI appearances. Case report.
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Biomedical subjects
Publications and source records attributed to J A Britton.
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Blast cell morphology was assessed at diagnosis and subsequent bone marrow relapse in 33 unselected patients with lymphoblastic leukemia (ALL). Each marrow was classified 'blind' according to the French-American-British (FAB) criteria, and it was found that 19 of 24 (79%) patients initially typed as FAB L1 changed to FAB L2 during the course of their disease, but no patient made the reverse morphological change (p is less than 0.001). Five patients retained FAB L1 appearances; these included three of the four who had T-cell markers. One patient typed as FAB L3 did so consistently. This study indicates that FAB L2 ALL frequently emerges as a treatment-resistant offshoot of FAB L1 and provides further evidence that this marks a more aggressive form of the disease.
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A semiquantitative assessment of blast cell acid phosphatase activity, expressed as a score, was made in 41 unselected children with newly diagnosed and untreated non-T acute lymphoblastic leukaemia (ALL). Despite a wide range of enzyme activity in both sexes boys had significantly higher scores than girls, and, in view of the known association between males and T ALL on the one hand, and between acid phosphatase and T ALL on the other, these findings raise the possibility that boys may have a predisposition to a type of pre-T ALL which could contribute to the as yet unexplained difference in prognosis between the sexes.
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Bone marrow smears taken at diagnosis and subsequent haematological relapse from 41 patients with lymphoblastic leukaemia (ALL) were compared to assess the proportion of blast cells showing a positive periodic acid-Schiff (PAS) reaction at different stages of the same disease. 20 patients never displayed more than 10% PAS positive blasts at any stage, and of these 8 never had any PAS positivity at all. 7 patients maintained a proportion of PAS positive cells over 10% of the total but with no loss or gain in the numbers of such cells. 14 patients showed a significant change in the PAS reaction during the course of their disease, 7 showing a marked reduction in PAS positive cells, and 7 showing an equally marked increase. From these results it seems that the PAS reaction does not identify a sub-type of ALL or mark the degree of differentiation of a given case. It could be indicative of a specific stage of the lymphoblast mitotic cycle.
Diagnostic bone marrow smears from 132 patients with acute lymphoblastic leukaemia, (ALL) were stained simultaneously by the periodic acid-Schiff (PAS) reaction, and the blast cell positivity was assessed quantitatively. The patients fell naturally into two unequal groups: those with more than 20% PAS-positive blast cells (44 patients) and those with less (88 patients). There was no relation between the degree of positivity and age, sex, or presenting leucocyte count. Actuarial survival studies showed that the group with more than 20% PAS-positive blast cells survived longer, but that this difference assumed statistical significance only after the exclusion of patients over 14 years old and those with high white cell counts at the time of diagnosis. It appears that the PAS reaction can identify long survivors among patients with ALL, but not in the absence of features strongly associated with a poor prognosis.