RESUMO
Eosinophilia can be a manifestation of a variety of causes such as infections, allergic reactions and autoimmune processes. Also, it is described in various solid malignancies in the presence of tumour eosinophilic infiltration. We report a patient of high-grade urinary bladder cancer with eosinophilic leukemoid reaction and tumour histopathology demonstrated diffuse infiltration of eosinophils. Though the entity is described to carry a good prognosis in literature, our experience is totally different as the patient deteriorated rapidly in a matter of days, was deemed inoperable in view of worsening performance status and was referred for palliative management.
Assuntos
Eosinofilia/patologia , Eosinófilos/patologia , Reação Leucemoide/patologia , Neoplasias da Bexiga Urinária/patologia , Eosinofilia/complicações , Eosinofilia/imunologia , Eosinófilos/imunologia , Evolução Fatal , Humanos , Reação Leucemoide/imunologia , Masculino , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/imunologiaAssuntos
Injúria Renal Aguda/diagnóstico , Rejeição de Enxerto/diagnóstico , Falência Renal Crônica/cirurgia , Transplante de Rim , Reação Leucemoide/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Microangiopatias Trombóticas/diagnóstico , Injúria Renal Aguda/imunologia , Anticorpos/imunologia , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/imunologia , Humanos , Imunossupressores/uso terapêutico , Reação Leucemoide/imunologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/imunologia , Microangiopatias Trombóticas/imunologiaRESUMO
Extremely immature preterm infants rarely present with a leukocytosis exceeding 30,000/microL. The pathogenetic sequence leading to leukemoid reactions in non-malignant diseases remains to be elucidated. Potential triggers for leukemoid reactions in premature infants include prenatal corticosteroids, chorioamnionitis and funisitis or systemic infection. In the two-year period from 2006 to 2007 all infants with a gestational age of less than 26 weeks were screened for leukocytosis. Among our cases, one preterm infant presented with a leukocyte count of 229,300/microL at the age of 48 hours, lasting throughout the first three weeks of life. Impairment of microcirculation and resulting organ dysfunction were not observed. Thus, invasive therapeutic procedures, which are routinely initiated in hyperleukocytosis in accompanying malignant diseases, may not have the same significance in extremely immature preterm infants and should be executed in these patients on an individual basis and with extreme caution.
Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer/imunologia , Doenças do Prematuro/imunologia , Reação Leucemoide/imunologia , Candidíase/imunologia , Corioamnionite/imunologia , Enterocolite Necrosante/imunologia , Evolução Fatal , Feminino , Granulócitos/imunologia , Humanos , Recém-Nascido , Contagem de Leucócitos , Masculino , Microcirculação/fisiologia , Mycoplasma hominis/isolamento & purificação , Neutrófilos/imunologia , Doenças Placentárias/imunologia , Gravidez , Fatores de Risco , Trombose/imunologia , Ureaplasma urealyticum/isolamento & purificação , Vasculite/imunologiaRESUMO
Life-threatening Clostridium sordellii infections have recently been reported in women undergoing therapeutic abortion, during natural childbirth, and in injection drug users. Shock, diffuse capillary leak, and a leukemoid reaction (LR) are cardinal features of these infections. The magnitude of the LR is highly correlated with mortality. We have isolated a 42-kDa extractable protein from C. sordellii culture supernatant that stimulates proliferation of promyelocytic HL-60 cells in vitro. Using mass spectrometry, we have identified this protein as the C. sordellii neuraminidase, NanS. Recombinant NanS (rNanS) dose dependently stimulated HL-60 cell proliferation. Increased proliferation was observed when HL-60 cells were cocultured with both rNanS and granulocyte-macrophage colony stimulating factor. In addition, NanS also modified vascular cell adhesion molecule 1, which orchestrates the release of mature and immature granulocytes from bone marrow stromal cells. Thus, neuraminidase likely plays an important role in the characteristic LR in C. sordellii infection.
Assuntos
Infecções por Clostridium/fisiopatologia , Clostridium sordellii/enzimologia , Células Precursoras de Granulócitos/efeitos dos fármacos , Reação Leucemoide/enzimologia , Neuraminidase/farmacologia , Sequência de Aminoácidos , Proliferação de Células/efeitos dos fármacos , Clonagem Molecular , Infecções por Clostridium/microbiologia , Clostridium sordellii/genética , Primers do DNA/química , Relação Dose-Resposta a Droga , Exotoxinas/farmacologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/farmacologia , Células HL-60 , Humanos , Reação Leucemoide/imunologia , Reação Leucemoide/microbiologia , Dados de Sequência Molecular , Neuraminidase/biossíntese , Neuraminidase/genética , Neuraminidase/isolamento & purificação , Proteínas Recombinantes/farmacologia , Fatores de Tempo , Molécula 1 de Adesão de Célula Vascular/efeitos dos fármacosRESUMO
Antibody responses to the lipopolysaccharide (LPS) of shigellae were compared between children with uncomplicated and complicated Shigella dysenteriae 1 infection. One hundred fifteen children between 12 and 60 months of age with S. dysenteriae 1 infection were studied. Of these children, 42 had complications (leukemoid reaction and/or hemolytic-uremic syndrome [complicated shigellosis] and 73 had no complications (uncomplicated shigellosis). Antibodies to the LPS of S. dysenteriae 1 and Shigella flexneri Y were measured in plasma and stools, as were total immunoglobulin A (IgA) and IgG concentrations in plasma and the total IgA concentration in stool, on enrollment and 3 to 5 days later. In the plasma, the concentrations of homologous (IgG) and heterologous (IgA) LPS antibodies on enrollment were higher in children with complicated shigellosis than in those with uncomplicated shigellosis. In stool, the concentrations on enrollment were similar between the two groups of children. There was a rise in antibody concentrations in the plasma (homologous and heterologous) and stool (homologous) between the day of enrollment and 3 to 5 days later in children with uncomplicated shigellosis but not in those with complicated shigellosis. These findings suggest that systemic stimulation is more marked in children with complications, so that a subsequent rise in plasma antibody concentrations does not occur in these children. In contrast, the lack of a rise in stool antibody concentrations in children with complicated shigellosis is suggestive of a lower-level mucosal response. Because the duration of diarrhea before enrollment influenced the homologous antibody concentrations, children were further divided into three subgroups (short [3 to 5 days], medium [6 to 9 days], and long [> 9 days] diarrhea durations before enrollment). Comparisons of homologous antibody concentrations between the two groups of children following such subdivisions showed that in children with complicated shigellosis, antibody concentrations were higher in the plasma of children in the short diarrhea duration subgroup but lower in the stool children in the medium diarrhea duration subgroup. No differences in antibody concentrations were observed in children in the other diarrhea duration subgroups. Thus, complications in shigellosis are associated with an early and strong systemic stimulation without a concomitant stimulation of the mucosal antibody response.
Assuntos
Anticorpos Antibacterianos/sangue , Especificidade de Anticorpos/imunologia , Disenteria Bacilar/imunologia , Fezes/microbiologia , Síndrome Hemolítico-Urêmica/etiologia , Reação Leucemoide/etiologia , Lipopolissacarídeos/imunologia , Shigella dysenteriae/patogenicidade , Pré-Escolar , Feminino , Síndrome Hemolítico-Urêmica/imunologia , Humanos , Lactente , Reação Leucemoide/imunologia , MasculinoRESUMO
The paper presents clinical, hematological, morphological and immunological characteristics of B-cell lymphosarcoma with prolymphocytic-lymphocytic type of leukemization in 50 adult patients (9 females and 41 males aged 29-86 years). In B-cell immunological subvariant of prolymphocytic-lymphocytic leukemization changes in the primary tumor always corresponded to prolymphocytic variant of lymphosarcoma. This distinguishes B-cell lymphosarcomas from previously described T-cellular ones in which the type of eventual leukemic changes did not always correspond to the kind of initial tumor. The presence or absence of prolymphocytes with split nuclei in bone marrow puncture samples was neither of clinical nor of prognostic significance. In leukemization of B-cell prolymphocytic lymphosarcoma from the cells with split nuclei or cells with different configuration of the nuclei, immunological phenotype typical for B-cell chronic lymphoid leukemia did not occur. In prolymphocytic lymphosarcoma from cells with round nuclei one-third of patients had immunological phenotype more typical for B-cell chronic lymphoid leukemia. However, among them were patients with aggressive course with predominant extranodal location of tumor and prolymphocytic type of leukemization. Tumor nodes in B-cell prolymphocytic lymphosarcomas, irrespective of leukemization morphological variant, proved rather resistant to therapy. A complete clinicohematological remission according to the international criteria occurred in 2 of 50 patients, only.
Assuntos
Linfócitos B/imunologia , Leucemia Linfoide/imunologia , Leucemia Prolinfocítica/imunologia , Reação Leucemoide/imunologia , Linfoma não Hodgkin/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Medula Óssea/imunologia , Medula Óssea/patologia , Feminino , Humanos , Imunofenotipagem , Leucemia Linfoide/tratamento farmacológico , Leucemia Linfoide/patologia , Leucemia Prolinfocítica/tratamento farmacológico , Leucemia Prolinfocítica/patologia , Reação Leucemoide/tratamento farmacológico , Reação Leucemoide/patologia , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
The paper presents a detailed clinical, hematological, morphological, ultrastructural and immunological characterisation of T-cell lymphosarcoma with prolymphocytic-lymphocytic leukemic transformation (PLLT). In PLLT the proportion of T-cell immunological subvariant of lymphosarcoma came to 15% being detected only in 8 out of 52 examinees. The patients (6 males and 2 females) varied in age from 24 to 76 years (median 49 years) and had the following histological forms of primary tumor tissue: lymphoblastic lymphosarcoma (n = 3), pleiomorphic small cell lymphosarcoma (n = 1), large-cell anaplastic lymphosarcoma (n = 1), prolymphocytic lymphosarcoma. Immunological characteristics of these 8 cases were heterogeneous: in lymphoblastic variant there was immature T-immunological phenotype. In pleomorphic small-cell lymphosarcoma there were also signs of T-cell activation. In large-cell anaplastic lymphosarcoma an immunological phenotype of lymphoid cells from the primary tumor tissue and bone marrow differed in more advanced immunological differentiation of bone marrow tumor cells. In prolymphocytic variant tumor cells had features of T-helpers or T-suppressors. Most of the patients received polychemotherapy according to the schemes for high-grade lymphosarcomas despite PLLT though the latter is not a universal indicator of late tumor progression, more aggressive course of the disease and poor prognosis.
Assuntos
Reação Leucemoide/patologia , Linfoma de Células T/patologia , Linfócitos T/ultraestrutura , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Asparaginase/administração & dosagem , Medula Óssea/imunologia , Medula Óssea/ultraestrutura , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Imunofenotipagem , Reação Leucemoide/sangue , Reação Leucemoide/tratamento farmacológico , Reação Leucemoide/imunologia , Linfoma de Células T/sangue , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/imunologia , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Linfócitos T/imunologia , Fatores de Tempo , Vincristina/administração & dosagemRESUMO
Early chronic myeloid leukemia (CML) and leukemoid reaction (LR) sometimes show similar histological pictures. In order to assess the efficacy of immunohistochemistry in the discrimination of the two forms, twenty bone marrow (BM) trephines of patient with CML and twenty with LR were immunostained and studied. A wide spectrum of antibodies effective on paraffin-embedded tissues (NP 57 anti-neutrophil elastase, Leu M1, MAC 387, KP1, Y2/51, LCA, UCHL1, L26, BerH2 and Glycophorin A) and directed against granulopoietic, erythropoietic, megakaryocytic, monocytic and lymphoid cells was tested by means of the alkaline phosphatase anti-alkaline phosphatase (APAAP) method. Expression of neutrophil elastase in CML and LR showed a different pattern of reactivity in normal and neoplastic granulocytic cells and Y2/51 put in evidence significant discrepancies of megakaryocytes in the two groups. Moreover, a greater number of histiocytic, lymphoid and erythropoietic cells were detected in LR after immunostaining with KP1, LCA, UCHL1, L26 and Glycophorin A. The different immunophenotypical pictures observed, suggest the value of immunohistochemistry as a supplementary diagnostic tool for the differential diagnosis between early CML and LR.
Assuntos
Imunofenotipagem , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Reação Leucemoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antineoplásicos/imunologia , Biomarcadores Tumorais/análise , Medula Óssea/patologia , Diagnóstico Diferencial , Feminino , Células-Tronco Hematopoéticas/imunologia , Células-Tronco Hematopoéticas/patologia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/imunologia , Reação Leucemoide/diagnóstico , Reação Leucemoide/etiologia , Reação Leucemoide/imunologia , Linfoma/complicações , Masculino , Megacariócitos/imunologia , Megacariócitos/patologia , Pessoa de Meia-Idade , Células-Tronco Neoplásicas/imunologia , Células-Tronco Neoplásicas/patologiaRESUMO
The authors studied a blast cell immunological phenotype in 50 adults with lymphosarcoma undergoing leukemization following the pattern of acute leukemia. Among the patients there were 12 females and 38 males aged 14-61. Immunological phenotyping of tumor cells was performed using a panel of monoclonal antibodies to T- and B-lymphocyte antigens, to myelomonocytic cells, some nonlinear and activation antigens. T, B and zero variants of blast cells were identified. Occasionally, blast cells carried nonlymphoid antigens and those corresponding to the common lymphosarcoma subvariant. Leukemization in the direction of lymphoblastic leukemia is associated with greater frequency of lymphosarcoma T subvariant (46%). B-cell and zero subvariants occurred in 28% and 20% of the patients, respectively. The number of complete remissions in the group of patients with T-cell subvariant was greater than in the group with B-cell subvariant. The survival in these two groups, however, was almost similar (median up to 8-12 months). Further studies into lymphoblastic leukemization immunophenotyping can help design programs of differentiated polychemotherapy.
Assuntos
Ativação Linfocitária/imunologia , Linfoma não Hodgkin/imunologia , Adolescente , Adulto , Linfócitos B/imunologia , Medula Óssea/imunologia , Medula Óssea/patologia , Doença Crônica , Feminino , Humanos , Imunofenotipagem , Reação Leucemoide/imunologia , Reação Leucemoide/mortalidade , Linfócitos Nulos/imunologia , Linfoma não Hodgkin/mortalidade , Masculino , Pessoa de Meia-Idade , Linfócitos T/imunologiaRESUMO
Increasing evidence suggests that paraneoplastic syndromes may be mediated by tumour-related cytokine release, although the specific factor(s) involved remain poorly defined. Colony-stimulating factors (CSF) and interleukins (IL) promote colony growth in semi-solid media and, when administered in recombinant form, increase blood counts in patients. However, normal serum CSF levels in individuals with physiologic blood counts and the relationship between specific serum CSF levels and paraneoplastic leukaemoid reaction are not well established. In this study, we found that normal serum levels of granulocyte-macrophage CSF (GM-CSF), as measured by ELISA, were generally < 55 pg ml-1; IL-3, < 30 pg ml-1; and granulocyte CSF (G-CSF), < 50 pg ml-1. In contrast, high levels of GM-CSF (132 pg ml-1), but not G-CSF or IL-3, were found in a patient with a transitional cell carcinoma of the renal pelvis and increased leukocytosis correlating with the tumour burden. The GM-CSF was biologically active, as demonstrated by its ability to stimulate colony growth in vitro. Based on these results it appears that autonomous production of GM-CSF is one possible pathophysiologic mechanism underlying leukaemoid reaction in cancer patients.
Assuntos
Carcinoma de Células de Transição/imunologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/fisiologia , Neoplasias Renais/imunologia , Reação Leucemoide/imunologia , Síndromes Paraneoplásicas/imunologia , Idoso , Feminino , Fator Estimulador de Colônias de Granulócitos/fisiologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/sangue , Humanos , Interleucina-3/fisiologiaRESUMO
Although mononuclear cell surface markers are primarily used to determine the lineage and stage of differentiation of leukemias and lymphomas, they can also be helpful in discriminating between some cases of neoplastic and reactive conditions. Peripheral blood lymphocytosis secondary to infection most often shows increased numbers of activated T cells of the suppressor/cytotoxic subset. A few exceptions, such as in pertussis, show predominantly T-helper cells. Although persistent B-cell lymphocytosis is most often associated with neoplastic conditions, B-cell predominant reactive conditions may also occur. Lack of light chain restrictions on B-cell membranes suggests non-neoplastic disorders. Reactive lymphadenopathy most often shows a predominance of T cells with normal to increased T-helper/T-suppressor cell ratios. In addition, normal ratios of kappa/lambda light chain surface immunoglobulin usually occur on B cells of reactive lymph nodes. Benign lymphocytic infiltrates in skin most often show a predominance of activated T-helper cells. Distinguishing reactive from neoplastic dermal infiltrates by mononuclear cell markers can be extremely difficult and may require DNA genotypic analysis. Mononuclear cell markers applied to bone marrow in patients treated for leukemia and other disorders must also be interpreted with caution. The presence of CD10 antigen (CALLA) may herald recurrence of leukemia; however, this determinant is not leukemia-specific and may be found on normal cells. Similarly, lymphoid cells bearing TdT often represent recurrent leukemia, and they must be differentiated from immature nonmalignant TdT-positive cells. Immunologic surface markers must be interpreted together with a careful review of the morphology of the tissues.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Antígenos de Superfície/imunologia , Reação Leucemoide/imunologia , Doenças Linfáticas/imunologia , Linfócitos/imunologia , Antígenos de Diferenciação de Linfócitos B/imunologia , Antígenos de Diferenciação de Linfócitos T/imunologia , Humanos , Doenças Linfáticas/diagnóstico , Linfocitose/diagnóstico , Linfocitose/imunologiaRESUMO
Plasma cells are occasionally encountered in peripheral blood during fibrinolytic treatment with streptokinase. Leukaemoid plasmocytosis and increase of immunoglobulins were observed in a 44-year-old patient in connection with streptokinase treatment. Mature stages of plasma cells could be demonstrated in peripheral blood. The observed phenomena are considered as exaggerated immune response to foreign protein. They are of no disease value as they are only concomitant reactions to streptokinase treatment. Spontaneous regression occurred.
Assuntos
Hipergamaglobulinemia/imunologia , Reação Leucemoide/imunologia , Estreptoquinase/efeitos adversos , Adulto , Humanos , Masculino , Femprocumona/uso terapêutico , Plasmócitos/imunologia , Embolia Pulmonar/tratamento farmacológico , Estreptoquinase/imunologia , Estreptoquinase/uso terapêuticoRESUMO
A patient with metastatic soft tissue sarcoma presented with a leukemoid reaction. The elevated white blood cell count was due to an increase in bands and mature segmented neutrophils. The degree of granulocytosis correlated with the tumor burden. There was no evidence of superimposed infection and the degree of bone marrow involvement by metastatic tumor was minimal. A cell line derived from the sarcoma produces granulocyte-macrophage colony-stimulating activity (CSA) in vitro. Although CSA could not be detected in serum, the findings in this patient suggest that the leukemoid reaction was due to tumor production of CSA.
Assuntos
Fatores Estimuladores de Colônias/metabolismo , Reação Leucemoide/sangue , Sarcoma/metabolismo , Neoplasias de Tecidos Moles/metabolismo , Linhagem Celular , Feminino , Humanos , Reação Leucemoide/imunologia , Pessoa de Meia-IdadeAssuntos
Antígenos de Neoplasias/análise , Leucemia Linfoide/imunologia , Tecido Linfoide/imunologia , Adolescente , Adulto , Anemia Aplástica/imunologia , Antígenos de Superfície/imunologia , Medula Óssea/imunologia , Criança , Pré-Escolar , Citoplasma/imunologia , Feto/imunologia , Humanos , Imunoglobulina M/análise , Lactente , Leucemia Linfoide/tratamento farmacológico , Reação Leucemoide/imunologia , Fígado/imunologia , Receptores de Antígenos de Linfócitos B/análiseRESUMO
Human lysosomes were isolated from normal peripheral blood leukoyctes and characterized by electron microscopy, enzyme analysis, and assays for DNA and RNA. Stored sera from 37 unselected patients with systemic lupus erythematosus (SLE), including active and inactive, treated and untreated cases, were tested in complement fixation (CF) reactions with these lysosome preparations. 23 SLE sera exhibited positive CR reactions, as did sera from two patients with "lupoid" hepatitis. The seven SLE sera with strongest CF reactivity also demonstrated gel precipitin reactions with lysosomes. Neither CF nor precipitin reactions with lysosomes were observed with normal sera or with sera of patients with drug-induced lupus syndrome, rheumatoid arthritis (RA), polymyositis, or autoimmune hemolytic anemia. By several criteria the antilysosome CF and precipitin reactions of SLE sera cound not be attributed to antibody to DNA, RNA, or other intracellular organelles. The lysosomal component reactive with SLE sera in CF assays was sedimentable at high speed and is presumably membrane associated. The CF activity of two representative SLE sera was associated with IgG globulins by Sephadex filtration. A search for lysosomal antigen in SLE and related disorders was also made. By employing rabbit antiserum to human lysosomes in immunodiffusion, a soluble lysosomal component, apparently distinct from the sedimentable (membrane-associated) antigen described above, was identified in serum, synovial fluid, or pleural fluid from patients with SLE, RA, ankylosing spondylitis, and leukemoid reaction. An antigenically identical soluble component reactive with the rabbit antiserum could be released in vitro from intact lysosomes by repeated freeze-thaw cycles..