Initial and advanced endoscopic findings of monomorphic epitheliotropic intestinal T-cell lymphoma in the duodenum: A case report.

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is an aggressive malignant digestive system lymphoma. We report the case of a 68-year-old Asian woman who was diagnosed with MEITL of the duodenum and small intestine due to intestinal obstruction. MEITL is mainly located in the small intestine, and duodenal lesions are rare. Therefore, the endoscopic appearance of MEITL in the duodenum has been reported in only a few cases. In this case, we observed the initial and advanced endoscopic findings of MEITL in the duodenum. The initial findings were only slight mucosal changes; therefore, careful observation is required to detect early-stage MEITL.

[Microgranular-type acute promyelocytic leukemia with weak myeloperoxidase staining: difficulty of morphological diagnosis].

The 2017 World Health Organization (WHO) classification states that acute promyelocytic leukemia (APL) always presents with strong myeloperoxidase staining. However, we herein report of a 40-year-old woman with the microgranular variant of acute promyelocytic leukemia presenting with weak myeloperoxidase (MPO) staining. The leukemic cells were morphologically similar to monocytic cells, showing distorted-shaped nuclei and weak MPO staining. However, flow cytometry revealed positivity of CD2, CD34, and human leucocyte antigen-DR (HLA-DR) and pointed toward a diagnosis of APL. PML-RARA mRNA detection finally led the patient to a definitive diagnosis. The patient achieved complete remission by induction chemotherapy including tretinoin, cytarabine and idarubicin, and no differentiation syndrome was observed.

Automated Optical-Tweezers Assembly of Engineered Microgranular Crystals.

In this work, a scalable automated approach for fabricating 3D microgranular crystals consisting of desired arrangements of microspheres using holographic optical tweezers and two-photon polymerization is introduced. The ability to position microspheres as desired within lattices of any configuration allows designers to engineer the behavior of new metamaterials that enable advanced applications (e.g., armor that mitigates or redirects shock waves, acoustic lens for underwater imaging, damage detection, and noninvasive surgery, acoustic cloaking, and photonic crystals). Currently, no self-assembly or automated approaches exist with the flexibility necessary to place specific microspheres at specific locations within a crystal. Moreover, most pick-and-place approaches require the manual assembly of spheres one by one and thus do not achieve the speed and precision required to repeatably fabricate practical volumes of engineered crystals. In this paper, the rapid assembly of 4.86 µm diameter silica spheres within differently packed 3D crystal-lattice examples of unprecedented size using fully automated optical tweezers is demonstrated. The optical tweezers independently and simultaneously assemble batches of spheres that are dispensed to the build site via an automated syringe pump where the spheres are then joined together within previously unattainable patterns by curing regions of photocurable prepolymer between each sphere using two-photon polymerization.

Efficient phosphorus removal from MBR effluent with heated aluminum oxide particles (HAOPs).

Biological processes and chemical precipitation in combination with polishing by granular media or membrane filtration can remove 90-95% of the phosphorus (P) from wastewater. However, reducing the concentration to levels near those in high-quality receiving waters requires additional advanced treatment, typically including adsorption onto specialty media. These processes are often costly, they can be hard to control when the P loading varies, and their effectiveness can be compromised by the presence of competing adsorbates in the water. In this work, a novel process that might mitigate or overcome some of these challenges was explored. In the process, water is treated by passage through micron-sized adsorbent particles (Heated Aluminum Oxide Particles, HAOPs) packed in a layer that is  < 1 mm thick, thus combining the attractive features of very small particles with those of flow through packed media. In laboratory tests using both synthetic feed and the effluent from an MBR at a full-scale wastewater treatment plant, the process removed P very efficiently until the HAOPs' capacity was nearly exhausted, at which point rapid breakthrough of P occurred. The removal capacity was proportional to the thickness of the HAOPs layer and declined by only ∼20% when SO42-, Cl-, and NO3- were all added to the MBR effluent at concentrations of 30 mM (2880, 1065, and 1860 mg/L, respectively). Increasing the solution pH from 7.0 to 8.5 had a similar effect, and increasing the flux of water through the adsorbent layer from 200 to 600 LMH had an even smaller effect (∼10% reduction in removal capacity). In 18 days of continuous pilot-scale operation at the treatment plant, the process performed well, achieving 99.5% P removal steadily during the final seven days of testing, during which the P concentration in the feed ranged from 4 to 9 mg/L. The process also removed 52% of the organic matter in the MBR effluent, as represented by UV254. The sludge generated by the process was extremely easy to dewater and dry.

Early mortality in acute promyelocytic leukemia: Potential predictors.

Acute promyelocytic leukemia (APL) is a rare leukemia characterized by the balanced reciprocal translocation between the promyelocytic leukemia gene on chromosome 15 and the retinoic acid receptor α (RARα) gene on chromosome 17, and accounts for 10-15% of newly diagnosed acute myeloid leukemia each year. The combined use of all-trans retinoic acid and arsenic trioxide (ATO) as primary therapy has markedly improved the survival rate of patients with APL. Mortality in the first 30 days following therapy remains a major contribution to treatment failure. In the present study, published data was reviewed with a focus on the factors associated with early mortality. When treated with ATO as a primary treatment, the fms-like tyrosine kinase-internal tandem deletion has no impact on early mortality. Low lymphoid enhancer binding factor-1 expression may be a reliable marker for early mortality and the target of therapy if it could be proven by further studies. Cluster of differentiation (CD)56+ and CD34+/CD2+ may be candidates to select high-risk patients. The risk of early mortality in APL still cannot be predicted via the cell surface makers, despite multiple studies on their prognostic significance. Typically, a complex translocation did not alter the survival rate in patients with APL; however, if an abnormal karyotype [e.g., Ide(17), ZBTB16/RARα and STAT5B/RARα] appeared singularly or as part of a complex mutation, there is a high possibility of early mortality if clinicians are unable to identify or monitor it.

Microgranular acute promyelocytic leukemia presenting with leukopenia and an unusual immunophenotype.

The microgranular variant (M3v) of acute promyelocytic leukemia (APL) is rare, and the diagnosis can be delayed due to variability in how this condition presents. M3v blasts often have folded nuclei, but unlike traditional APL blasts, they often possess faint granules without Auer rods. In addition, microgranular APL often presents with an elevated or normal white blood cell count in contrast with the leukopenia seen in traditional APL. In APL, delayed diagnosis can lead to early death from disseminated intravascular coagulation (DIC), which is the main cause of mortality in an otherwise treatable, and often curable, leukemia. We describe a 19-year-old male with microgranular APL who presented with leukopenia and many blasts resembling non-APL AML blasts with an unexpected immunophenotypic pattern. He was treated for DIC and initiated on all-trans-retinoic acid and arsenic trioxide; he achieved complete molecular remission after induction therapy. Suspicion for APL should always remain high in the presence of clinical manifestations of the disease in order that appropriate treatment can be initiated rapidly to prevent early death.

Microgranular variant of acute promyelocytic leukemia with der(17) ins(17;15): A case report and review of the literature.

Acute promyelocytic leukemia (APL) with variant translocations is rare. The patient of the present case report, a 2-year-old male with a microgranular variant of APL carrying der(17) ins(17;15) translocation, exhibited fever and epistaxis. The complete blood count showed marked leukocytosis with 72% atypical promyelocytes, anemia and thrombocytopenia. Conventional cytogenetic analysis of the bone marrow cells revealed a karyotype of 47, XY, add(3)(q29), -7, ins(17;15)(q12;q14q22),+21,+mar. The promyelocytic leukemia/retinoic acid receptor α (PML/RARα) rearrangement and insertion were confirmed by fluorescence in situ hybridization. The PML/RARα transcripts were not detected by the reverse transcription polymerase chain reaction, and the patient was diagnosed with microgranular variant M3 APL. The patient achieved remission after a 30-day treatment and was still in remission during a recent follow-up. The present findings suggest that the ins(17;15) variant in APL may not be associated with an unfavorable prognosis. In summary, we reported an extremely rare case of APL with der(17) ins(17;15) abnormality in a pediatric patient and reviewed the literature.

Clinicopathological features of acute promyelocytic leukemia: an experience in one institute emphasizing the morphological and immunophenotypic changes at the time of relapse.

Acute promyelocytic leukemia (APL) has two morphological variants, namely macrogranular (M3) and microgranular (M3v). M3v, characterized by the presence of neoplastic promyelocytes with only sparse fine azurophilic granules, accounts for 10-25% of all APL and has unique biological characteristics. Relapse occurs in approximately 20% of patients with APL. The morphological type of the leukemic cells at relapse is usually identical with the primary disease, and only one case of morphological change at relapse has been reported. Here, we analyzed the clinicopathological features of APL, including 4 relapsed cases emphasizing morphological changes at the time of relapse. The unique finding of the present study is that 2 of 4 relapsed cases changed from M3 to M3v at relapse. The morphological features of these were different in each case (one had blastic features and the other resembled monocytoid leukemic cells). Cytogenetic analyses revealed the continued presence of t(15;17)(q22;q12) at the time of relapse and morphological change. Moreover, the immune phenotype of the leukemic cells changed from CD2(-)/CD34(-) to CD2(+)/CD34(+) at that time. These findings suggest that morphological change at relapse in APL may not be a rare event, and that the leukemic cells can show variable morphological features at the time of relapse, which could result in misdiagnosis as a different type of acute myeloid leukemia. Therefore, a comprehensive approach with emphasis on combined morphological, immunophenotypic, and cytogenetic analyses is important for diagnosis and appropriate treatment of relapsed APL.