AML with unusual chromosomal changes. Translocation (15;21) and 5q- in the presence of two normal chromosomes 5.

We performed serial cytogenetic studies of the bone marrow (BM) of a patient with acute myeloblastic leukemia (AML) and noted abnormal karyotypes 47,XY,+del(5)(q12q34),t(15;21)(q21;q22)/47,XY,+del(5)(q12q34 ) during the second relapse. Although a case of this t(15;21) was recently observed in a female patient with acute nonlymphocytic leukemia (ANLL) of subtype M4 of the French-American-British (FAB) classification, the present article constitutes the first report of its occurrence in association with ANLL of subtype M1-M2. Furthermore, the presence of the 5q- accompanied by two chromosomes 5 of normal appearance is very rare and of great interest.

Evaluation of marrow cellularity in alcoholism and hepatic cirrhosis, by aspiration, biopsy and histomorphometric.

A study of bone marrow cell content was carried out in 23 non-cirrhotic alcoholics, 20 cirrhotic alcoholics and 19 cirrhotic non-alcoholics compared with a control group of 12 healthy subjects, by means of sternal aspiration and bone marrow biopsy with histomorphometric quantification of fat in the latter. Although in the three pathological groups the mean values of fat area were superior to those of the control group, the only statistical differences found were between non-alcoholic cirrhotic and control subjects. The differences disappeared under covariance analysis with age as the correcting factor, showing a correlation between age and bone marrow fat content. To conclude from the biopsy the bone marrow of the cirrhotic is not hypercellular, contrary to the so far accepted findings obtained through sternal aspiration. Moreover, between the subjective global cellularity evaluation by biopsy and aspiration there was an important disagreement in 23.8% and an absolute agreement only 28.6% of cases. The non-existence of a linear correlation between fat content in bone marrow and liver, suggests that the two phenomena do not develop simultaneously.

[The beneficial effect of 1,25-dihydroxycholecalciferol on the excess of blasts and the myelofibrosis in 2 cases of chronic myeloproliferative syndrome]. / Efecto beneficioso del 1,25-dihidroxicolecalciferol sobre el exceso de blastos y la mielofibrosis en 2 casos de síndrome mieloproliferativo crónico.

The active metabolite of vitamin D3 1.25 dehydroxycholecalciferol (1.25DHCC) is a potent inducer of monocytic differentiation of the myeloid blasts "in vitro". Likewise the inhibiting role of vitamin D3 on bone marrow fibrosis by, among others, a stimulating effect of macrophagic activity is known. However, these actions have seldom been clinically demonstrated. Two cases of chronic myeloproliferative syndromes in which treatment with 1.25DHCC was effective are presented. In the first case, one patient with polycythemia vera with myelofibrosis and focal blastosis in the bone marrow achieved disappearance of the excess of blasts and a reduction in the fibrosis (grade III to grade I) upon treatment. In the second case, idiopathic myelofibrosis, also with focal blastosis in the bone marrow biopsy, there was no regression of the fibrosis but the blastosis did disappear. It was concluded that 1.25DHCC may constitute an interesting treatment in this group of diseases through the following two mechanisms: limitation of the fibrosis and delay of blast transformation.

[Neutrophil mobilization test with intravenous hydrocortisone in the study of chronic idiopathic neutropenias. Experience with 19 cases and usefulness of a new diagnostic index]. / Prueba de movilización de los neutrófilos con hidrocortisona intravenosa en el estudio de las neutropenias crónicas idiopáticas. Experiencia en 19 casos y utilidad de un nuevo índice diagnóstico.

BACKGROUND: Some patients with chronic benign neutropenia present granulocytes distribution disorders within their different physiologic pools, and this situation can be exposed by granulocyte mobilization tests. Stimulation with hydrocortisone is the best known test, but its performance and interpretation are not well standardized. Granulocyte mobilization test with hydrocortisone was performed in 19 patients with chronic peripheral idiopathic granulocytopenia, by applying homogeneous criteria. PATIENTS AND METHOD: The test included an injection of intravenous hydrocortisone 200 mg after a first basal blood neutrophil determination, and a second neutrophil count four hours after steroid administration. Following data were registered: basal blood neutrophil count (BNC), final blood neutrophil count (FNC), difference between both counts or increment (INCR), and the ratio = 60% of INCR/2.0 (109/1) BNC, which we name demargination index (DI). RESULTS: Three response patterns (three patient groups) were observed: pattern I, with FNC > 2.0 109/1 and DI >/= 1 (false neutropenia with hypermargination component); pattern II, with FNC > 2.0 (109/1) and DI < 1 (false neutropenia with pathogenic mechanisms others than hypermargination), and pattern III, with FNC < 2.0 (109/1) and DI < 1 (true neutropenia). There were no significant differences in BNC or INCR when groups I and II were compared, but we found differences in FNC (p = 0.026) and DI (p = 0.026). Comparison between groups I and III showed differences in all four parameters (BNC P = 0.07, FNC p < 0.001, INCR p = 0.02, and DI p < 0.001). No differences were found between groups II and III. CONCLUSIONS: Granulocyte mobilization test with intravenous hydrocortisone 200 mg and a four-hours interval between basal and final neutrophil counts, allows differentiation between false neutropenia with hypermargination component and true neutropenia.

HIV-associated primary body-cavity-based lymphoma: clinico-biologic features in three patients diagnosed at the same institution.

Primary effusion lymphoma (PEL) is a recently individualized form of non-Hodgkin lymphoma (WHO classification) that mainly develops in HIV infected males, more frequently in homosexuals and advanced stages of the disease (total CD4+ lymphocyte count below 100-200/mL). Occasionally, it appears in others immunodepressive states (such as solid organs postransplant period) and even, although very rarelly, in immunocompetents patients. From a pathogenetic point of view, PEL has been related to Kaposi's sarcoma-associated herpes virus (also named human herpesvirus 8) and to the clinical antecedent of Kaposís sarcoma. Relative unfrequency of this disease, the absence of wide casuistics allowing a better characterization, and its unfavorable outcome, support the need of a deeper knowledge. We present here the clinical-biological findings of three patients that were diagnosed of pleural PEL in our institution in the last two years.

[Indurated erythema as the presenting form of a case of chronic myelomonocytic leukemia]. / Eritema indurado como forma de presentación de un caso de leucemia mielomonocítica crónica.

Chronic myelomonocytic leukemia (CMML) is an oncohematologic disease with a mixed nature, myeloproliferative and myelodysplastic, and presenting features are usually the consequence of peripheral blood cytopenias (anemic syndrome, infections or bleeding). Specific or non-specific cutaneous involvement in patients with myelodysplastic syndromes or chronic leukemias is exceptional, and it takes place often in advanced stages of the disease, as a preample of a transformation from chronic illness to acute leukemia. Recognition and early diagnosis of the skin lesion by cutaneous biopsy, in every patient with myelodysplastic or myeloproliferative disease, have therapeutic and prognostic significance. We describe a patient who presented with a non-especific cutaneous lesion, Bazin's erhythema induratum, as initial manifestation of chronic myelomonocytic leukemia; we also comment diagnostic, therapeutic and clinical evolution aspects.

Bone marrow trephine biopsy: anterior superior iliac spine versus posterior superior iliac spine.

Bone marrow biopsy (BMB) is generally performed either on the anterior superior iliac spine (ASIS) or the posterior superior iliac spine (PSIS), the choice between these two sites depending largely upon practice at individual centres. No previous study has attempted to ascertain which of these two sites is preferable for needle BMB. We studied 72 biopsies, of which 36 were of the PSIS and 36 of the ASIS, measuring the length of the cylinder and the area of the histologic section. We asked those patients who had undergone BMB at both sites which had been the less painful. The cylinders obtained from the PSIS were found to have a significantly greater length and area than those obtained from the ASIS (P < 0.00001). Of the 13 patients who underwent BMB at both sites, 11 reported the PSIS biopsy to have been distinctly less painful (P = 0.012). We conclude that needle BMB of the PSIS provides samples of greater length and area, and is less painful, than that of the ASIS.

Bone marrow fibrosis: histomorphometric analysis and interobserver reproducibility of a simple optical method of assessing its intensity.

A histomorphometric analysis of the length of reticulin fibres per area of haemopoietic bone marrow was performed on 59 trephine iliac crest biopsies. The values obtained were found to correlate with the degree of fibrosis as determined by a simple optical method based on the degree of microscopic magnification required for recognition of the presence of reticulin fibres. The mean length of fibre (microns/10,000 micron2) for the three degrees of fibrosis defined by the optical method were: 241.8 +/- 16.6 for grade I, 713 +/- 85.6 for grade II, and 1827.9 +/- 230.4 for grade III (P < 0.001). In a series of 67 biopsies, the overall interobserver agreement of the optical method was found to be good (Spearman's r = 0.99; P < 0.001) and there was good individual agreement for each of the three degrees of fibrosis (improved kappa test). There was a small amount of overlap between the extreme values of adjacent optical degrees. These results suggest that the optical method described here can be recommended as a practical technique for the routine evaluation of myelofibrosis.

A case of chronic lymphocytic leukemia overwhelmed by rapidly progressive idiopathic myelofibrosis.

Chronic lymphocytic leukemia (CLL) is sometimes associated with solid tumors but rarely coexists with other hematologic neoplasias in the same patient. There are isolated case reports in the literature of an association between CLL and idiopathic myelofibrosis, a representative disease of the group of the myeloproliferative syndromes. We describe the case of a 70-years old female diagnosed as having CLL and idiopathic myelofibrosis in a prefibrotic phase with an indolent course, managed only with observation. Twenty-eight months after diagnosis, the patient developed hepato-splenomegaly and progressivly rising of serum lactic dehydrogenase (LDH) levels; immature granulocytic cells and tear drop red cells appeared in the blood. A bone marrow trephine biopsy (after a "dry tap" external aspiration) was consistent with the diagnosis of overt idiopathic myelofibrosis and only residual foci of CLL cells were present. Three months later, the blood diagnostic features of CLL remained but a progressive fall in the numbers of CD5+/CD19+ cells was noted. Other observations related to this association in several chronological sequences, their possible pathogenesis possibilities, and the diagnostic value of the rise in serum LDH levels, are discussed. The case reported here constitutes an extremely rare situation of CLL overwhelmed by rapidly progressing idiopathic myelofibrosis.

[Acute monocytic leukemia as secondary neoplasia in a girl with acute lymphocytic leukemia]. / Leucemia monocítica aguda (LMA-M5) como segunda neoplasia en una niña con LLA-L1.

The presence of second malignancies in children suffering from acute lymphoblastic leukemia (ALL) is becoming increasingly frequent. Nevertheless, the appearance of M5 type acute myeloid leukemia (AML) in patients being treated for ALL is very rare. We report the presence of AML-M5 as a second malignancy in a girl diagnosed of ALL-L1 56 months before. The clinical course of this rare association is discussed.

[Low grade non-Hodgkin's lymphoma after combined therapy for Hodgkin's disease]. / Linfoma no Hodgkin de bajo grado tras terapéutica combinada por enfermedad de Hodgkin.

The most serious complication of curative therapy for Hodgkin's disease is the development of a second malignancy. A patient who developed a low grade non-Hodgkin's lymphoma three years and a half after combined-modality therapy for Hodgkin's disease, is described. It is exceptional this type of non-Hodgkin's lymphoma as a second neoplasm after cytotoxic treatment for Hodgkin's disease. Pathogenic relationships between both processes are discussed.

[Prevalence of ferropenia and iron deficiency anemia in a rural school population, 4 to 16 years of age]. / Prevalencia de ferropenia y anemia ferropénica en una población escolar rural, entre cuatro y dieciséis años.

The ferropenic, is an important disturbance in the childhood due to its frequency, and the necessity of a permanent increase of iron at this age, other factors can be added, such as the iron demand and hemorrhagic loss in puberty. We studied 214 rural school children, between 4 and 16 years in Tenerife, among who two girls, 13 and 14 years old, and one boy 11 years old showed clear ferropenic (1.4%). Another four (1.8%) 3 girls with 14.14 and 9 years, and one boy with 7 years showed latent ferropenic. Overall the ferropenic incidence was 3.2%. There was not ferropenic anemia in any case. These results are similar to those found in another study in urban school children of the same ages, in the same island.

[Bone marrow biopsy in non-Hodgkin's lymphoma: experience with 259 samples]. / Biopsia medular en los linfomas no Hodgkin: experiencia sobre 259 muestras.

A study performed on 259 cases of bone-marrow biopsy specimens from 121 patients with non-Hodgkin's lymphoma (NHL) is presented after an introduction dealing with several well-known facts. Specific involvement of the initial samples was present in 53.45% of the cases. Such involvement was more frequent in stages III and IV, although no difference was found between the clinical forms, A or B. Stage progression due to positive bone-marrow biopsy occurred in 26% of the patients, and in 25% of these it was from stages 0 to II onto stage IV. Low-grade lymphomas showed higher bone-marrow involvement than high-grade ones (p = 0.025); specific involvement significantly influenced survival in only high-grade lymphomas, not in the low-grade ones, when the series was considered as a whole. Absolute compatibility between lymph-node and bone-marrow cellularity was found in 71% of the cases, and in 85% was taken into account. Six possible histological lesions are described herein, while for practical purposes, the use of 5 patterns of involvement is recommended, namely, interstitial, nodular, patchy, mixed nodular-patchy, and diffuse. Patchy pattern associated to low-grade and skin-involvement lymphomas. Although those patterns had non-significant influence on survival, this last was found when comparing diffuse pattern with the remainders; similarly, the diffuse pattern correlated with significantly lower haemoglobin rates. Finally, fibrosis was present in 58% of the positive biopsies and in 94% of the lesions, it being thus considered as a marker of bone-marrow involvement.