The role of circulating cells in the healing of vascular prostheses.

PURPOSE: Cells covering the flow surface of vascular prostheses are derived in part from endothelium of adjacent native artery and from capillaries that extend through the pores of the graft. This study is designed to determine whether these endothelial-like cells can also originate from circulating blood cells and if so to identify them with protein markers. METHODS: Pledgets of vascular graft material were suspended within the aortas of dogs with metal stents that isolated the pledgets from the aortic wall. Explanted pledgets were examined for cells containing factor VIII-related antigen and other markers identified with monoclonal antibodies. RESULTS: A monolayer of cells that stained positive for factor VIII formed on pledgets after 7 days. Pledgets removed after 55 days had endothelial cells, smooth muscle cells, macrophages, monocytes, and capillary-like structures which were identified by staining for the monoclonal antibodies 43 beta E3 (vimentin), HHF35 (alpha and gamma muscle actin), CGA7 (smooth muscle actin), and HAM56 (macrophage). Woven and knitted polyester and extruded polytetrafluoroethylene pledgets healed in a similar manner. CONCLUSION: The origin of the cells identified is speculative but they appear to have been derived from circulating cells, possibly stem cells, which are capable of differentiation because the pledgets on which the cells were identified were isolated from aortic wall endothelium and perivascular capillaries.

Primary renal lymphoma. Does it exist?

Although secondary renal involvement from systemic lymphoma is common, primary lymphoma of the kidney is not well recognized. One case is reported and 27 cases purported to be primary tumors are reviewed. From these cases three conclusions have been drawn: it is reasonable to assume that renal lymphoma can be a primary lesion; almost all patients with primary renal lymphoma will develop extrarenal lymphomatous disease shortly after diagnosis of their renal tumor; and survival for more than 1 year after diagnosis is rare.

Multiple myeloma. The diagnostic role and prognostic significance of exfoliative cytology.

The clinical significance and diverse cytomorphologic spectrum of exfoliative cytology in multiple myeloma are presented from our 20-year retrospective and continuing prospective studies and from an extensive review of the literature. Of 370 myeloma patients studied retrospectively, 126 had at least one exfoliative cytologic specimen but only 6 had one or more specimens positive for myeloma. These included six pleural and two ascitic fluids and one sputum. In Papanicolaou-stained smears, myeoloma cells varied from essentially normal-appearing plasma cells to dispersed large malignant cells with little or no plasmacytoid features. Whereas all 203 cervical or vaginal, cerebrospinal, urine and bronchial specimens were negative for myeloma, 40% and 50% of the pleural and ascitic fluids, respectively, were positive. Four prospectively studied patients produced a total of seven positive serous fluid specimens. Follow-up data was available for eight patients with cytology positive for myeoloma. Six were dead within three months of the first positive specimen.

Aspiration and exfoliative cytology, including ultrastructure, of a malignant granular-cell tumor.

The cytopathologic features of a malignant granular cell tumor in both exfoliative and aspiration cytopreparations included isolated cells with low nuclear-cytoplasmic ratios and abundant, diffusely granular cytoplasm. Transmission electron microscopy revealed the diagnostic secondary lysosomes in the neoplastic cells.

Renal plasmacytoma: a case report and summary of reported cases.

Although multiple myelomas occur fairly frequently, extramedullary plasmacytomas are uncommon. To date, only 7 cases of renal plasmacytoma have been documented. We report case 8 and discuss its management.

Primary lymphoma of bone presenting as monoarthritis.

We report an unusual case of primary non-Hodgkin's lymphoma or reticulum cell sarcoma of bone presenting as monoarthritis in a middle-aged woman without previous rheumatic disease. She underwent rheumatologic evaluation of plasma and synovial fluid, synovial cytology, arthroscopy, synovial and bone biopsies. Our evaluation may be the most thorough rheumatologic one yet reported.

Adult non-Hodgkin's lymphoma. Correlation of cell surface marker phenotype with prognosis, the new working formulation, and the Rappaport and Lukes-Collins histomorphologic schemes.

The interrelationships between histomorphologic classification, cell surface marker phenotype and prognosis were prospectively studied in 130 adults with non-Hodgkin's lymphomas. Within each of the classification schemes used there were certain histologic variants that exhibited heterogeneity of cell lineage as well as those that were extremely uniform. Diffuse lymphomas with cell populations consisting of large cells, or mixtures of large and small cells were the most heterogeneous phenotypically and were most resistant to precise definition of immunologic cell lineage. The new Working Formulation for Clinical Usage likewise exhibited considerable heterogeneity of phenotype even within well defined histomorphologic categories. Two immunologic phenotypic variables that conferred a significant favorable prognosis were the expression of surface membrane immunoglobulin (B derivation) and the simultaneous expression of a membrane mu and delta immunoglobulin heavy chain. The results of this study suggest that cell surface marker phenotypic determinations have well defined and potentially useful correlations with histomorphologic classification schemes, and are useful in predicting biologic behavior and prognosis. It is suggested that a knowledge of both immunologic phenotype and histomorphologic characteristics is necessary in formulating therapeutic decisions.

Probable herpes simplex pneumonia after aortic valve replacement.

Herpesvirus pneumonia developed in a 68-year-old man after aortic valve replacement and two-vessel aortocoronary bypass. The complication was fatal, and the diagnosis was made only after death. The source of the herpesvirus could not be determined.

Surface marker identification of small cleaved follicular center cell lymphomas with a highly favorable prognosis.

Between 1976 and 1980, 143 cases of non-Hodgkin's lymphoma have been prospectively analyzed for correlations between surface marker phenotype, histomorphology, and prognosis. This study analyzed 44 adults with tumors classified by Lukes-Collins criteria as small cleaved follicular center cell lymphomas. Two surface marker phenotypic subsets were membrane immunoglobulin, immunoglobulin D (IgD), or a receptor for the third component of the complement system (C'3) (Group I = IgD+ and/or C'3+, group II = IgD-C'3-). Eleven of the 44 patients have died with a projected median survival of 58 months. Four patients in Group I have died with a median survival of 58 months while seven patients in Group II have died with a median survival of 30 months. The difference in the survival curves for the two subgroups is statistically significant (p = 0.01). An analysis of variables such as stage, age, sex, and sites of involvement revealed no differences between the two groups. When classified histologically, the two groups were morphologically indistinguishable and had similar distributions of nodular (follicular) and diffuse variants. Of interest, five patients in Group I were judged to require no initial therapy whereas none in Group II remained untreated initially. The expression of the second heavy chain delta and/or a receptor for C'3 appears to define a subgroup of small cleaved follicular center cell lymphomas with an indolent course and an excellent prognosis.

Surface marker and histopathologic correlation with long-term survival in advanced large-cell non-Hodgkin's lymphoma.

Since 1974, a group of consecutive adult patients with non-Hodgkin's lymphoma have been prospectively analyzed for tumor-surface membrane-marker phenotype and histopathologic correlation with response to treatment and survival. The results are reported in a subset of 35 patients with advanced (Stages III-IV) large-cell variants, most of whom would be classified by Rappaport criteria as histiocytic. An attempt has been made to define those marker characteristics that will identify long-term survivors in this diverse group who remain in continuous disease-free remission. There were ten patients with complete remissions with intensive treatment. The most common subgroup within the complete responders were patients with cells that were nonexpressive (null) and were classified by Lukes-Collins criteria as the large, noncleaved follicular center cell variant. Currently there are seven patients remaining in complete remission, five of whom have been in continuous disease-free remission for more than two years (total survival 34+-42+ months) following cessation of all treatment. Of those five, four were in the null group and four were classified as large non-cleaved. The actuarial survival curve for all null patients is characterized by a rapid initial decline and a subsequent plateau, which contains four of the long survivors. In contrast, the B-derived group has a more graded decline in survival with time; this curve currently contains the remaining long survivor. Although the overall prognosis of B-derived tumors appears to be superior to that of the null subset, the subgroup with the potential for cure at this point in our study includes patients with both null and B-derived tumors, particularly those classified by Lukes-Collins criteria as the large noncleaved follicular center cell variant.