Blast crisis of chronic myelogenous leukemia.
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Child, Preschool↗
Biomedical subjects
J R Krause
Publications and source records attributed to J R Krause.
Bone marrow examination: for metastatic tumor: aspirate and biopsy.
A 6-year experience with bone marrow aspirates and biopsies (96 cases) positive for metastatic carcinoma is reviewed. Marrow examination detected secondary carcinoma in 58 cases (60%) despite negative roentgenographic and/or bone scan examinations. Breast carcinoma was the most frequent primary site. The bone marrow biopsy was superior to the aspirate in finding carcinoma (97% vs. 72%). However, in an occasional case, tumor was found only in aspirate preparations. Both procedures should be considered complementary and are recommended in the marrow evaluation of patients with carcinoma.
Biopsy, Needle↗
Initial complications and late results in dismembered pyeloplasty.
A total of 109 dismembered pyeloplasties has been reviewed and examples of initial complications and their management are discussed. These early complications do not preclude excellent long-term results. Over-all followup studies show resolution of pain, hematuria and infection in the vast majority of patients. X-ray results have since, in general, improved or stabilized. No nephrectomies have been done subsequent to the repair of the hydronephrosis.
Adolescent↗
Acquired factor X deficiency and amyloidosis.
A selective acquired Factor X deficiency is an unusual occurrence. Six cases of an acquired Factor X deficiency in association with amyloidosis have been reported. This paper describes two additional cases, suggesting that this relationship may be more than coincidental. The mechanism by which amyloid may affect Factor X levels remains unknown, but suggestions include consumption, inactivation or decreased synthesis of Factor X. Factor II, VII, IX, and X concentrate transiently increased the Factor X level to normal in one of the patients. In an adult patient who has an isolated Factor X deficiency, amyloidosis should be actively sought.
Amyloidosis↗
Use of the bone marrow imprint in the diagnosis of leukemic reticuloendotheliosis ("hairy cell leukemia").
Leukemic reticuloendotheliosis is a distinct entity, often misdiagnosed as chronic lymphocytic leukemia or lymphoma. The neoplastic cells have a specific tartrate-resistant acid phosphatase isoenzyme by which the diagnosis may be secured. Most individuals are leukopenic, and when, as in our case, rare or no circulating cells with tartrate-resistant acid phosphatase activity are found in the peripheral blood, an alternate site must be sought. Bone marrow aspirations often result in "dry taps," however, and cryostat sections of the bone marrow biopsy necessary to demonstrate tartrate-resistant acid phosphatase activity are involved and impractical to obtain for most laboratories. This report illustrates and recommends the simple technic of imprinting the core biopsy, which yields a satisfactory sample with which the specific cytochemical activity can be demonstrated.
Acid Phosphatase↗
Kaposi's sarcoma after long-term alkylating agent therapy for multiple myeloma.
Described is a patient with multiple myeloma who, during long-term treatment with alkylating agents, developed cutaneous Kaposi's sarcoma. Patients with multiple myeloma, unlike those with malignant lymphoma, do not usually develop Kaposi's sarcoma during the natural course of the disease. It is suggested that the immunosuppression resulting from the long-term alkylating agent therapy for multiple myeloma may have prediposed this individual to the development of Kaposi's sarcoma.
Aged↗
Value of bone marrow biopsy in the diagnosis of amyloidosis.
Amyloid involvement of the bone marrow is not commonly diagnosed before necropsy. Paraffin sections of the trephine bone biopsy specimen are superior to marrow aspiration cell smears for the antemortem diagnosis. Thirteen cases of amyloidosis were diagnosed from the bone biopsy specimen during a ten-year period. Amyloid was detected in only two of the corresponding aspirates. Three morphologic patterns of marrow involvement were found: vascular, focal extravascular/perivascular, and diffuse. Five (38%) of the cases were associated with multiple myeloma. An abnormal immunoglobulin was detected in the serum or urine or both in ten of 11 cases when determined. Although the bone marrow may not be the best site for the diagnosis of amyloidosis, it should not be neglected and marrow biopsies taken for other diagnostic reasons may "incidentally" reveal amyloid. Amyloidosis should be included in the list of non-primary hematologic conditions of the bone marrow in which the trephine biopsy may prove useful for diagnosis.
Adult↗
Hairy cell leukaemia: seven cases with probable B-lymphocytic origin.
Mononuclear cells from seven patients with hairy cells leukaemia were examined for features suggestive of either a lymphocytic or monocytic origin. Immunofluorescent staining of both methanol fixed and incubated cells, using monospecific antisera, revealed a predominant cell-associated immunoglobulin in each case. Three were positive for mu and kappa chains, two for gamma and kappa chains, one for delta and kappa chain determinants and one reacted only with antigamma chain serum. Formation of EAC rosettes, a feature of both B lymphocytes and monocytes, was variable. T cells, as judged by E rosettes, were not elevated in any patient. Phytohaemagglutinin reactivity was normal in six and depressed in one case. With the exception of minimal activity in assays for glass adherence and latex particle phagocytosis, none of the cells showed features typical of monocytes. Hairy cells were negative by peroxidase stain and lacked the electron microscopic characteristics of monocytes. They did not react in either rosette or phagocytic assays with anti-A or anti-D coated erythrocytes nor did they elaborate granulocyte colony stimulating factor, a monocyte-derived in vitro granulopoietin. Although unequivocal classification of these abnormal cells is not possible, the data storngly suggests that this represents a variant of a B lymphocytic neoplasm.
Adult↗
Massive intraperitoneal hemorrhage from ruptured corpus luteum during anticoagulant therapy.
The unpredictability of hemorrhagic complications during anticoagulant therapy is well known. An unusual case of massive intraperitoneal hemorrhage from a ruptured corpus luteum during such therapy is presented. That this complication is uncommon may be because relatively few premenopausal women are placed on anticoagulant therapy. In addition, the most likely condition for which premenopausal women are given anticoagulants is thrombophlebitis associated with pregnancy and childbirth when ovulation is inhibited.
Corpus Luteum↗
Hyaline globules in human neoplasms. A report of three autopsy cases.
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Adenocarcinoma↗
Generalized lymphangioma in infancy with chylothorax.
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Bone Marrow Examination↗
Basaloid squamous cell carcinoma of the head and neck: a clinicopathologic and flow cytometric study of 10 new cases with review of the English literature.
INTRODUCTION: We describe the clinicopathologic and flow cytometric features of 10 cases of basaloid squamous cell carcinoma (BSCC) of the head and neck to determine if DNA ploidy is a useful prognostic indicator. We also provide a review of 80 cases previously reported in the English language literature. MATERIALS AND METHODS: The 10 cases were obtained from the surgical pathology files of Presbyterian University Hospital and The Eye and Ear Institute, Pittsburgh, PA (1987-1991). In all 10 cases, the microscopic slides and clinical data were reviewed. Flow cytometry was performed using the Hedley technique and formalin-fixed, paraffin-embedded tissue. RESULTS: The mean age of patients with BSCC was 64 years (range, 49 to 75 years). Tumor involved the base of tongue (n = 5), hypopharynx-epiglottis (n = 3), and tonsil (n = 1). One case presented with cervical lymph node metastasis from an unknown primary site. Histologically, BSCC showed a biphasic pattern with basaloid-squamous elements, comedonecrosis, stromal hyalinization, surface dysplasia, and an in situ and/or invasive squamous cell carcinoma component. Flow cytometry revealed six diploid and four aneuploid tumors. Five of six patients with diploid and all four patients with aneuploid tumors developed early regional and/or distant metastases. Of the two patients who died of disease, one had a diploid and the other an aneuploid tumor. CONCLUSION: Our study reaffirms the predilection of BSCC for the base of tongue, pyriform sinus, and supraglottic larynx, and its aggressive biologic behavior with a high incidence of cervical lymph node metastasis (64%), distant spread (44%), and death from disease (38% mortality at 17 months median follow-up). However, in contrast to previous reports, tumor ploidy by flow cytometry provided no additional prognostic information beyond that supplied by routine histologic evaluation.
Aged↗
Molecular pathology in the diagnosis and treatment of non-Hodgkin's lymphomas.
The non-Hodgkin's lymphomas encompass a wide spectrum of hematologic neoplasms that exhibit different clinical and biological features. Lymphomas classically have been initially assessed based on their cytologic and histologic features. Morphology alone is often inadequate as similar appearing neoplasms may be immunophenotypically and molecularly heterogeneous. Molecular diagnostic methods can provide an additional level of testing that not only helps refine diagnoses but can provide prognostic information. New methods are being refined that may provide information to establish precise diagnostic profiles, provide targets for therapy and provide more sensitive methods for monitoring the success of treatment. Molecular methods will be increasingly utilized and eventually required as the accepted method of diagnosis and for monitoring the disease. Understanding of the molecular abnormality and the pathogenesis of the neoplasm hopefully will lead to therapeutic intervention aimed at the specific molecular defect or its product. The molecular pathology of the non-Hodgkin's lymphomas is discussed.
Gene Expression Regulation↗
Myeloproliferative syndrome in childhood.
This report describes an atypical "myeloproliferative disorder" in a child that evolved over a 6-year period. The clinical and laboratory features resembled the adult type of chronic myelogenous leukemia, but a Philadelphia chromosome was lacking. Although the proper classification of this disorder remains uncertain, the case makes a good point for the use of diagnostic procedures such as the bone marrow core biopsy and cytogenetic studies to help unravel and define the characteristics of these unusual "myeloproliferative" disorders.
Bone Marrow Cells↗
The Tulane University Medical Center/Columbia partnership: opportunities and challenges for pathology.
A joint venture between the largest health-care corporation in the country (Columbia/HCA) and Tulane University Hospital/Clinic was established about 1 year ago. Early indications are that the partnership is successful and mutually beneficial. For Tulane University Medical Center, the joint venture provides financial stability and support for academic centers of excellence. Tulane University Hospital/Clinic will become the referral center for complicated cases from the regional Columbia hospitals. The Tulane University Hospital laboratories are positioned to become the regional referral laboratory for esoteric testing. For the pathologists of the regional Columbia hospitals, the opportunity beckons to form a group of equal partners that will contract with Columbia to provide laboratory services at Columbia hospitals and to consolidate the laboratories in the New Orleans division. Columbia has brought corporate expertise, capital, and opportunities for cost-saving economies of scale to the partnership. Quality and cost-effectiveness of patients care will be emphasized as will research on clinical outcomes. This model of corporate/academic partnership represents a new option for academic medical centers around the country as they respond to the rapid changes in the health-care environment.
Academic Medical Centers↗
Size and frequency of the DNA fragments in the rearranged immunoglobulin heavy chain joining regions in the lymphocytic leukemias.
Four distinct groups of DNA fragments produced by the rearrangement of the joining regions of the immunoglobulin heavy chain gene were found after hydrolysis of the leukemic DNA with the EcoR I restriction enzyme. Three fragments were smaller than the genomic fragment (16 kb) and their average sizes were 9.6, 11.2, and 13.7 kb. The largest fragment was 18.7 kb. The fragment groups 2 and 3 (11.2 and 13.7 kb) were found in 65 per cent of the cases. There was no correlation between the fragment groups and the acute or chronic lymphocytic leukemia or B-cell lymphoma.
Base Sequence↗
Posttransplant mediastinal Burkitt-like lymphoma. Diagnosis by cytologic and flow cytometric analysis of pleural fluid.
Cytologic and flow cytometric (FCM) analyses of pleural fluids established the diagnosis of a Burkitt-like posttransplant lymphoma with a unique mediastinal presentation. FCM analysis of pleural fluid specimens was especially helpful in determining the cell lineage.
Adult↗
Hairy cell leukemia (leukemic reticuloendotheliosis) in serous effusions.
The cytology of two cases of hairy cell leukemia (leukemic reticuloendotheliosis) involving pleural and ascitic fluids is described. With the Papanicolaou stain, the cells have a "lymphoid" appearance. The presence of these cells plus knowledge of the clinical history might help the cytologist and/or hematologist in their identification. A tartrate resistant acid phosphatase (TRAP) stain will confirm the true nature of such cells and establish the clinical diagnosis of hairy cell leukemia. Unlike the other members of the leukemia-malignant lymphoma group, the body cavities are rarely involved.
Acid Phosphatase↗