1/95. Chronic urticaria as a presenting sign of hairy cell leukemia.Chronic urticaria is a common clinical disorder that is idiopathic in over 75% of cases. Less commonly, urticaria may be the presenting manifestation of an allergic or infectious disease, endocrinopathy, inherited syndrome, or autoimmune disorder. Rarely, urticaria may be a sign of underlying malignancy, including leukemia. C.C. is a 48-year-old white female who was referred for evaluation of recurrent urticaria for 3 years. The pruritic, erythematous wheals were pinpoint, and appeared to be precipitated by heat, stress, and effort. Prick tests were negative except to D. pteronyssinus. CBCs over the past 5 years revealed WBCs of 2,300-5,000 cells/mm3. skin biopsy revealed interstitial edema with infiltration of eosinophils and mast cells consistent with urticaria. The impression was probable cholinergic urticaria, for which hydroxyzine was prescribed with fair symptomatic control. One year later, she presented with bright red blood per rectum. Repeat physical examination revealed lymphadenopathy and splenomegaly. Subsequent laboratory studies showed pancytopenia. endoscopy was normal except for small, nonbleeding hemorrhoids. bone marrow biopsy revealed histologic evidence of hair, cell leukemia that was treated with 2-chlorodeoxyadenosine. Upon initiation of chemotherapy her pruritus and urticaria subsided. Recent CBC revealed Hgb 9.2 g/dL, platelets 290,000 cells/mm3, and WBC 4,100 cells/mm3. Peripheral blood smear showed no hairy cells.- - - - - - - - - - ranking = 1keywords = infiltration (Clic here for more details about this article) |
2/95. Cryocrystalglobulinemia in hairy cell leukemia.A patient with hairy cell leukemia (leukemic reticuloendotheliosis) was noted to have a spurious leukocytosis caused by a spontaneously crystallizing cryoglobulin. The cryoprotein was identified as IgG lambda. An intracytoplasmic immunoglobulin demonstrable within the hairy cell was also IgG lambda. The cryoglobulin spontaneously disappeared over a four day period. A reliable automated count on the Coulter Model S could be obtained by prewarming the blood specimen to 37 C.- - - - - - - - - - ranking = 61.968134919169keywords = leukemic (Clic here for more details about this article) |
3/95. Induction of apoptosis in vivo and in vitro in hairy cell leukemia treated by deoxycoformycin.The leukemic cells of a patient with hairy cell leukemia were treated in vitro with 2'-deoxycoformycin (dCF), an inhibitor of adenosine deaminase, and deoxyadenosine (dAdo). Following this treatment, viability of the hairy cells progressively declined, and dna fragmentation was observed. When the patient was treated with 4 mg/m2 dCF intravenously, hairy cells in his peripheral blood rapidly decreased, and a large number of TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP- biotin nick end-labeling)-positive cells were detected in a bone marrow biopsy specimen. These findings indicate that dCF induced apoptosis of hairy cells both in vivo and in vitro. Furthermore, bcl-2 mRNA was down-regulated by dCF and dAdo in the hairy cells in vitro. Our results suggest the importance of bcl-2 mRNA regulation in apoptotic cell death mediated by dCF in hairy cell leukemia.- - - - - - - - - - ranking = 61.968134919169keywords = leukemic (Clic here for more details about this article) |
4/95. Relapse in hairy cell leukemia due to isolated nodular skin infiltration.Leukemic skin infiltration is quite uncommon in certain types of leukemia. Here, a child with hairy cell leukemia who developed isolated skin infiltration during remission is reported. The failure to diagnose the leukemic infiltration until the nodule reached a diameter of 2 cm is emphasized.- - - - - - - - - - ranking = 68.968134919169keywords = leukemic, infiltration (Clic here for more details about this article) |
5/95. Nucleolated variant of mantle cell lymphoma with leukemic manifestations mimicking prolymphocytic leukemia.Chronic lymphoproliferative disorders sometimes can be difficult to classify. We report 4 cases characterized by large cells with distinct central nucleoli, reminiscent of prolymphocytic leukemia, but shown on further workup to represent mantle cell lymphoma. At initial examination, the patients had generalized lymphadenopathy, splenomegaly, and a leukemic blood picture. The peripheral blood showed many large cells with round to slightly irregular nuclei, single central nucleoli, and a fair amount of pale cytoplasm. The picture was not typical of prolymphocytic leukemia because of the presence of generalized lymphadenopathy and the large size of the circulating abnormal cells. Immunophenotypic study showed that the large lymphoid cells were CD5 CD23- mature B cells with overexpression of cyclin d1, and cytogenetic study demonstrated the translocation t(11;14)(q13;q32) in 3 patients. Lymph node biopsy confirmed a diagnosis of mantle cell lymphoma, pleomorphic variant, in all 4 patients. This study documents the existence of an unusual leukemic form of mantle cell lymphoma with prominent nucleoli; the clinicopathologic features that distinguish it from other chronic lymphoproliferative disorders are discussed.- - - - - - - - - - ranking = 371.80880951502keywords = leukemic (Clic here for more details about this article) |
6/95. Aggressive growth of epithelial carcinomas following treatment with nucleoside analogues.Two patients, one with B-cell chronic lymphocytic leukemia (CLL) and one with hairy-cell leukemia (HCL), were treated with immunosuppressive chemotherapy. The patient with CLL was a 54-year-old female, who had had a squamous cell carcinoma (SCC) excised from her forehead 5 months before receiving the first course of fludarabine. During the fludarabine treatment, the patient developed a local SCC relapse and metastases in the neck. The carcinoma was treated by excision and radiotherapy, and further fludarabine treatment was withheld. Nevertheless, the SCC metastasized aggressively and the patient died 3 months after the start of fludarabine treatment, primarily due to respiratory failure. The autopsy revealed heavy SCC infiltrations involving the lungs, pleura, mediastinum, pericardium, and liver. The patient with HCL was a 69-year-old male. At the time of diagnosis of HCL, the patient had two solid tumors in the liver containing poorly differentiated epithelial carcinoma cells of unknown origin. During treatment with 2-chlorodeoxyadenosine (2CdA), the tumors in the liver rapidly spread in multiple intrahepatic metastases, followed by liver failure and death within 1 month. Fludarabine and 2CdA cause a substantial suppression of all lymphocyte subsets, in particular the T-cell line. t-lymphocytes are believed to be responsible for the usually slow growth and the low metastatic rate of the SCC skin lesions. It is therefore assumed that fludarabine and 2CdA in these two cases triggered an exacerbation of both tumors due to the T-cell depletion.- - - - - - - - - - ranking = 1keywords = infiltration (Clic here for more details about this article) |
7/95. Rituximab: a useful drug for a repeatedly relapsed hairy cell leukemia patient.We describe a case of complete response in a patient with hairy cell leukemia, relapsed after treatment with interferon-alpha, 2'-deoxycoformicin, and 2-chlorodeoxyadenosine, and then successfully treated with rituximab. A fourfold reduction of leukemic cells was observed concomitantly with restoration of normal blood count and differential.- - - - - - - - - - ranking = 61.968134919169keywords = leukemic (Clic here for more details about this article) |
8/95. Hairy cell leukemia variant developing in a background of polycythemia vera.We report a case of hairy cell leukemia variant developing in a background of polycythemia vera in a 77-year-old man who presented with lymphocytosis and splenomegaly. Classic hairy cell leukemia in a patient with polycythemia vera has been reported previously, but hairy cell leukemia variant arising in a patient with polycythemia vera has never been described to the best of our knowledge. Initial testing of the peripheral blood showed circulating medium to large leukemic cells with large, centrally placed nuclei, each containing a prominent nucleolus, and some cells showed cytoplasmic projections. A bone marrow biopsy had marked myeloid and erythroid hyperplasia and interstitially distributed cells with a fried-egg appearance. We verified a monoclonal B-cell population by flow cytometric analysis, which revealed expression of bright CD11c, CD22, and CD103 expression, and a lack of CD25 expression. The patient received a 5-day course of cladribine and subsequently had a complete remission. Approximately 2 months later, he had a relapse and was treated with pentostatin; however, he had no clinical response and died.- - - - - - - - - - ranking = 61.968134919169keywords = leukemic (Clic here for more details about this article) |
9/95. A case of primary plasma cell leukemia with hairy-cell morphology and lambda-type Bence-Jones protein. Immunohistochemical and molecular analysis.A case of primary plasma cell leukemia with hairy-cell morphology and lambda-type Bence-Jones protein is reported. Most of the atypical cells in the peripheral blood of this case were small lymphoid cells or lymphoplasmacytoid lymphocytes with numerous cytoplasmic hairy projections. Plasmablastic cells and 'tadpole'-like cells were also present in the bone marrow. Immunohistochemically, these atypical cells expressed the cytoplasmic lambda light chain and surface CD38 proteins but were negative for B-cell markers such as CD19, CD20 and CD79a. VLA-5 (CD49e), which is supposed to be expressed in mature populations of plasma cells, was negative. A sequence analysis of the variable region gene in the light-chain (V(L)) and heavy-chain (V(H)) loci of immunoglobulin demonstrated significant somatic hypermutation and intraclonal nucleic acid sequence variations. To our knowledge, the intraclonal diversity of these loci has been previously reported in some cases of monoclonal gammopathy of undetermined significance (MGUS), but never in a case of multiple myeloma. The immunohistochemical and molecular characteristics of this case allowed us to delineate the origin of the leukemic cells with hairy cell-morphology as germinal center B-cells, which would be at a more immature stage than the presumable origin of multiple myeloma.- - - - - - - - - - ranking = 61.968134919169keywords = leukemic (Clic here for more details about this article) |
10/95. Malignant histiocytosis with chronic course. Ultrastructural and ultrastructural cytochemical studies.Four cases of malignant histiocytosis with leukemic manifestations and chronic course were reported. light microscopic, ultrastructural and ultrastructural cytochemical details of these atypical cells were demonstrated. Ultrastructurally these cells resembled hairy cells most closely among the known varieties of leukemic cells. However, ribosome-lamella complexes were not found and some atypical cells had a few short cytoplasmic projections. In addition, tartrate-resistant acid phosphatase was absent from these cells. We speculate that this leukemic reticuloendotheliosis with a chronic course seen in japan seems to be analogous to malignant histiocytosis with massive splenomegaly reported by Vardiman et al.- - - - - - - - - - ranking = 185.90440475751keywords = leukemic (Clic here for more details about this article) |
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