Spontaneous Remission of Pernicious Anemia / 대한내과학회지

Pernicious anemia is a macrocytic anemia that is caused by vitamin B12 deficiency, itself a result of the absence of intrinsic factors due to autoimmune destruction of parietal cells. We report here the case of a 43-year-old female with spontaneous remission of pernicious anemia. The patient presented with fatigue. Her serum vitamin B12 level was low, hemoglobin level was 7.6 g/dL, and serologic tests for anti-intrinsic factor and anti-parietal cell antibodies were positive. We diagnosed her with pernicious anemia, but did not administer vitamin B12 because her hemoglobin level increased spontaneously. Since then, the patient's hemoglobin and serum vitamin B12 levels have been within the normal range.

Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum

BACKGROUND/AIMS: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. METHODS: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. RESULTS: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). CONCLUSIONS: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.

Effect of Cyclophosphamide and Prednisone as a First-line Treatment for Non-transplant Candidates with Multiple Myeloma / 대한내과학회지

BACKGROUND/AIMS: For many years, conventional treatment for multiple myeloma (MM) not ineligible for high-dose therapy has been the combination of oral melphalan and prednisone (MP). However, melphalan-based regimens are associated with numerous complications. Another alkylating agent, cyclophosphamide, has similar effects on MM and is associated with fewer reports of complications. Therefore, cyclophosphamide-based regimens have usually been used as salvage therapy in patients with refractory or relapsed MM, despite the development of newer drugs. The purpose of this report was to evaluate the efficacy and tolerability of cyclophosphamide and prednisone as a first-line therapy for MM. METHODS: For the period January 2002 to June 2012, we retrospectively analyzed 29 patients newly diagnosed with MM who underwent a treatment regimen consisting of intravenous cyclophosphamide (1,000 mg/kg) for 1 day and prednisone (100 mg) for 4 days. RESULTS: The rate of response to this regimen was 31.1 percent. The median progression-free survival (PFS) was 5.5 months and the median overall survival (OS) was 47.3 months. The regimen was well tolerated. Adverse effects of grades above III were as follows: anemia in seven patients (24.1%), neutropenia in five patients (17.2%), and thrombocytopenia in two patients (6.8%). These adverse effects were easily adjusted. No one developed a secondary malignancy or hemorrhagic cystitis. CONCLUSIONS: Although PFS was less than for the MP regimen, median OS was better than for the MP regimen. Furthermore, the cyclophosphamide-prednisone regimen was well tolerated, and the adverse effects that did occur were easily adjusted. The cyclophosphamide-prednisone combination regimen may represent an effective and well tolerated first-line therapy for non-transplant candidates with MM.

Successful Treatment of Small-Cell Lung Cancer With Irinotecan in a Hemodialysis Patient With End-Stage Renal Disease

The prognosis of patients with end-stage renal disease has improved with advances in hemodialysis techniques. However, many patients who undergo hemodialysis suffer from various types of cancer. Limited data is available to guide clinical management of these patients who may have impaired renal function. Here, we report our experience with the use of irinotecan for the treatment of a hemodialysis patient with small-cell lung cancer and end-stage renal disease.

Lupus anticoagulant-hypoprothrombinemia in healthy adult

The presence of lupus anticoagulant is associated with an elevated risk of venous and arterial thrombosis, and recurrent miscarriages as well. For some cases, this disease can present with bleeding as a consequence of lupus anticoagulant hypoprothrombinemia (LAHPS). LAHPS is a rare disease and it is reported to be most frequent in young females with/without systemic lupus erythematosus or in healthy children who are suffering with a viral infection. In such cases, steroid therapy is usually effective in normalizing the biological abnormalities and controlling the bleeding problems. A 34-year-old previously healthy man was admitted to our department because of his prolonged coagulation times; these abnormalities were discovered before performing orthopedic surgery. The prothrombin time (PT) was 15.2 sec, and the activated partial thromboplastin time (APTT) was 37.7 sec. A 1:1 dilution of patient plasma with normal plasma nearly corrected the PT, but this failed to correct the APTT. Evaluation of the clotting factors revealed decreased levels of factors II, V, VIII, IX and XI. The presence of LA was demonstrated by the dRVVT test, and the patient was diagnosed with LAHPS. He was successfully treated with corticosteroid before performing the orthopedic surgery.

Small Cell Carcinoma of the Kidney

Up to 5% of all small cell carcinomas develop at extrapulmonary sites. Primary small cell carcinomas originating in the kidney are extremely rare neoplasms. Here we report a case of primary small cell carcinoma of the kidney. A nephrectomy was performed on a 52-year-old female patient to remove a large tumor located in the right kidney. The histology and immunohistochemistry of the resected tumor revealed a pure small cell carcinoma with invasion into the renal capsule. The patient received postoperative adjuvant chemotherapy with etoposide and cisplatin. The patient has been monitored with regular check ups and remains stable with no recurrence at 28 months after the initial diagnosis.

A Patient with Mixed Type Evans Syndrome: Efficacy of Rituximab Treatment

Mixed type Evans syndrome is a very rare hematologic disease. Although mixed type Evans syndrome may initially respond well to steroids, this disease usually runs a chronic course with intermittent exacerbations. We describe here a 46-yr-old female with the steroid-refractory, mixed type Evans syndrome, and she had a prompt response to rituximab. She was diagnosed as having the mixed type Evans syndrome with the clinical features of symptomatic anemia, jaundice and thrombocytopenia. Prednisone therapy was commenced and her hemoglobin and platelet level returned to the normal. However, after 15 weeks, she relapsed with hemolytic anemia and thrombocytopenia. We started rituximab at the dose of 375 mg/m2 once weekly for a total of 4 doses, which was well-tolerated and this induced the normalization of hemoglobin, bilirubin and lactic dehydrogenase, and there was also a significant increase of the platelet count.

Effect on Cell Growth, c-myc mRNA Expression and Telomerase Activity by Transforming Growth Factor-beta1 in Malignant Lymphoma and Leukemia Cell Line

BACKGROUND: Transforming growth factor-beta1 (TGF-beta1) is known to be a potent growth inhibitor of many cell types, including most epithelial cells. However, the mechanism of TGF-beta1 action on cell growth in lymphomas and leukemia still remains to be elucidated. c-myc is a central regulator of cell proliferation and apoptosis, and telomerase is believed to play an important role in carcinogenesis. The aim of the study was to determine the effects of cell growth, c-myc gene expression and telomerase activity due to TGF-beta1 and examine its mechanism of action in lymphomas and leukemia. METHODS: The cell growths of Jiyoye (Burkitt lymphoma), H9 (T cell lymphoma), and CCRF-CEM (acute lymphocytic leukemia, T cell) cell lines due to TGF-beta1 were measured using the MTT assay. RT-PCR was also performed to monitor the expression of the c-myc gene in these cells with the telomerase activity measured using a TRAP assay. RESULTS: There was significant inhibition of cell growth in TGF-beta1 (5ng/mL) treated Jiyoye cells. When treated with TGF-beta1, the Jiyoye cells exhibited marked decreases in the levels of c-myc RNA and telomerase activity. However, TGF-beta1 treated H9 and CCRF-CEM cells showed no cell growth inhibition or reductions in the levels of c-myc mRNA and telomerase activity. The effect of TGF-beta1 on cell growth was noted to closely correlate with c-myc mRNA expression and telomerase activity. CONCLUSION: These results suggest that TGF-beta1 may inhibit cell growth in Jiyoye cells by a mechanism involving down-regulation of the c-myc gene, which in turn, reduces the telomerase activity.

A Case of Focal Segmental Glomerulosclerosis Associated with Aplastic Anemia

The pathogenic mechanism of focal segmental glomerulosclerosis (FSGS) and aplastic anemia are associated with immunologic events which lead to glomerular cell injury or hematopoietic cell destruction. We present an extremely rare case of FSGS with aplastic anemia in a 30-yr-old woman. The laboratory examination show-ed hemoglobin 7.2 g/dL, white blood count of 4,200/microliter, platelet count 70,900/microliter. Proteinuria (2+, 3.6 g/day) and microscopic hematuria were detected in urinalysis. The diagnosis of FSGS and aplastic anemia were confirmed by renal and bone marrow biopsy. She was treated with immunosuppressive therapy of prednisone 60 mg/day orally for 8 weeks and cyclosporine A 15 mg/kg/day orally. She responded with gradually improving her clinical manifestation and increasing peripheral blood cell counts. Prednisone was maintained at the adequate doses with tapering after 8 weeks and cyclosporine was given to achieve trough serum levels of 100-200 ng/mL. At review ten month after diagnosis and initial therapy, the patient was feeling well and her blood cell counts increased to near normal (Hb 9.5 g/dL, Hct 32%, WBC 8,300/microliter, platelet 123,000/microliter) and renal function maintains stable with normal range proteinuria (0.25 g/day).

Disseminated Intravascular Coagulation Associated with Aortic Dissecting Aneurysm

Disseminated intravascular coagulation (DIC) is an acquired coagulation disorder that occurs when the normal hemostatic balance is disturbed, primarily by excessive thrombin formation. Moreover, while DIC is a rare complication of aortic dissecting aneurysm, it is also a well-recognized one. We reported a case of DIC associated with aortic dissecting aneurysm in a 55-year-old woman who was transferred from another hospital because of chest pain radiating to her back and thrombocytopenia. Laboratory findings showed DIC with severe thrombocytopenia, and she was diagnosed as having an acute aortic dissection and DIC. After medical treatment on the aortic dissecting aneurysm, her DIC profile recovered.

Myeloperoxidase (MPO) Isozymes of Normal Neutrophils from Normal Persons and Reactive Neutrophils from Patients with Neutrophilia; Using 10% Native PAGE and Activity Stain for MPO / 대한혈액학회지

BACKGROUND: MPO is an antimicrobial enzyme in the primary granule of neutrophil. MPO exhibits MPO-I, MPO-II, MPO-III using chromatography in human peripheral leukocytes. we investigated MPO isozymes from human leukocytes of peripheral blood. METHODS: Neutrophils were prepared from 5-8mL of peripheral blood in the group of normal persons (normal group) and the group of patients with neutrophilia (patient group). Their cells were adjusted to 2.4X10(7) cells and sonified. We got finally the crude MPO from which native PAGE was performed and treated with diaminobenzine and H2O2. RESULTS: Normal neutrophil MPO had MPO-1 and MPO-2. The expression rates of MPO-1 and that of MPO-2 were respectively 100%, 67.5% in the normal group and 56.6%, 30.2% in the patient group (P=0.000, P=0.000). The expression rate of combined MPO-1 and MPO-2 and that of MPO-1 without MPO-2 were respectively 67.6%, 32.4% in the normal group and 28.3%, 28.3% in the patient group (P=0.000, P=0.000). The expression of MPO-2 without MPO-1 and that of no MPO isozymes were respectively 0.0%, 0.0% in the normal group and 1.9%, 41.5% in the patient group (P=0.000, P=0.000). CONCLUSION: Normal neutrophil MPO expresses MPO-1 and MPO-2 usig native PAGE. The main MPO isozyme is MPO-1. Expressions of MPO isozymes are variable in the patient group.

Tsutsugamushi Infection-Associated Acute Rhabdomyolysis and Acute Renal Failure

Rhabdomyolysis is a rare complication that emerges in a variety of infectious diseases, such as tsutsugamushi infection. In this study, we report a 71-year-old female patient with tsutsugamushi infection who exhibiting rhabdomyolysis and acute renal failure. On admission, an eschar, which is characteristic of tsutsugamushi infection, was found on her right flank area. Moreover, her tsutsugamushi antibody titer was 1: 40960. The elevated values of serum creatinine phosphokinase (CPK), aldolase, creatinine and dark brown urine secondary to myoglobinuria are consistent with indications of rhabdomyolysis and acute renal failure due to tsutsugamushi infection. Her health improved without any residual effects after treatment with doxycyclin and hydration with normal saline.

Two cases of pancytopenia induced by ticlopidine / 대한내과학회지

Ticlopidine is an inhibitor of platelet aggregation used in the management and prevention of thromboembolic disorders. Hematological toxicity is one of the most important side effects of ticlopidine, including neutropenia, thrombocytopenia and more seriously aplastic anemia. We reported here two cases of very severe aplastic anemia developed after the use of ticlopidine. Both patients suffered from an acute cerebral infarction. Both patients developed pancytopenia 56 days and 51 days after treatment with 500 mg of ticlopidine daily. Both patients were hospitalized and received empiric antibiotic therapy and G-CSF. Twenty-three days and thirty days after the withdrawal of ticlopidine, the hematologic parameters of each patient improved.

Change of Interstitial Cells of Cajal (ICC) and Intestinal Motility in Murine Small Bowel Obstruction / 대한해부학회지

Interstitial cells of Cajal (ICC) are the pacemakers in gastrointestinal slow wave, and also transduce signal inputs from the enteric nervous system to smooth muscle. The abnormal motility corresponded to a lack or decreasing of ICC and a disruption of electrical slow waves. So we developed partial obstruction model in murine small intestine and investigated changes in the ICC networks and electrical activity in the obstructed bowel using c-kit immunohistochemistry and intracelluar electrophysiological techniques. Two weeks following the onset of a partial obstruction, the small intestine increased in diameter and muscular hypertrophy was developed oral to the obstruction site. ICC were absent or only weak at 1 ~25 mm oral to the occlusion site, and this disruption was accompanied by the loss of electrical slow wave. ICC networks and slow waves were normal appearance aboral to the clip. In conclusion, The present results showed that partial intestinal obstruction induced the loss of ICC networks and slow waves. These result will provide a valuable aid for understanding pathogenesis of intestinal motility disorder, and this model may be an important tool for evaluating genetic or molecular factor for the therapeutic opportunities of motility disorder in human.

Leukemic Phase of Mantle Cell Lymphoma, Blastic Variant / 대한혈액학회지

A case with mantle cell lymphoma, blastic variant, involving the peripheral blood in a 78- year-old female was described. The circulating blast-like cells suggested the possibility of acute leukemia. The WBC count was 28.0x109/ L with the absolute lymphoctyosis, 14.0x109/L. The peripheral blood smears showed a medium to large-sized lymphocytes with blast- like chromatin and conspicuous nucleoli. Atypical cells showing cleaved or indented nucleus were frequently observed. By flow cytometric analysis, immunophenotype of the circulating leukemic cells expressed B-cell associated antigens (CD 19, CD20), coexpressed CD5, lacked CD23, and expressed monoclonal surface immunoglobulin. Bone marrow aspiration and bone core biopsy confirmed diffuse infiltration of lymphoma cells. Immunohistochemicalstain for cyclin D1 (PRAD1/Bcl-1) protein was strongly reactive in the nucleus and cytoplasm of the infiltrative lymphoma cells in the bone marrow. Cytogenetic analysis of the bone marrow aspirates showed the complex abnormalities. Heterotransplantations of the blastic mantle cell leukemic cells, 4x104/microliter, into the peritoneum of the severe combined immunodeficiency (SCID) mouse showed tumor formation and infiltration of malignant lymphoid cells into peritoneum, liver, bone marrow, diaphragm, spinal cord and testes. The histopathology, immunophenotype and cyclin D1 protein expression of xenotransplanted tumor showed identical findings that of the original peripheral blood.

Influence of Total Ginseng Saponin on Contractile Responses of Vasoconstrictors in the Isolated Rat Aorta

BACKGROUND: It has been known that Ginseng extract causes the hypotensive action while it rather produces the hypertensive action. Some studies have suggested that Ginseng extract causes a biphasic response on blood pressure, namely, transient fall followed by prolonged elevation. It has been also shown that administration of Korean Red Ginseng powder has no effect on blood pressure in normotensive and hypertensive rats. The present study was designed to examine the effect of total Ginseng saponin on contractile responses of vasoconstrictors in the rat aorta and to establish the mechanism of its action. METHODS: The ring segment of aorta was mounted in a muscle bath filled with oxygenated Krebs solution for the measurement of isometric tension. After the equilibration period, under the presence of total Ginseng saponin, isometric tension induced by some vasoconstrictors were observed and compared to the control responses. The data were expressed as % of the control tension. RESULTS: Phenylephrine (an adrenergic alpha1-receptor agonist) and high potassium (a membrane depolarizing agent) caused greatly contractile responses in the rat aorta, respectively. However, in the presence of total ginseng saponin (600 g/ml), the contractile responses of phenylephrine (10(-6) and 10(-5) M) and high potassium (3.5 x 10(-2) and 5.6 x 10(-2) M) were markedly potentiated whereas prostglandin F2alpha(5 x 10(-6) M)-induced contractile responses was not affected. The contractile responses induced by phenylephrine (10(-5) M) and high potassium (3.5 x 10(-2) M) even under the presence of total ginseng saponin (600 g/ml) were greatly inhibited by the pretreatment of nicardipine (10(-6) M), a calcium channel blocker. CONCLUSION: Taken together, these experimental results suggest that total ginseng saponin can enhance the contractile responses evoked by stimulation of adrenergic alpha1-receptor and the membrane depolarization in the isolated rat aortic strips, which seems to be associated to calcium influx.

A Study of Epstein-Barr Virus Nuclear Antigen in Nodal and Extranodal Non-Hodgkin Lymphomas in Areas of Head and Neck / 대한혈액학회지

BACKGROUND: Epstein-Barr virus (EBV) is closely associated with African Burkitt lymphoma, B-cell lymphoproliferative disorders arising in immunocompromised individuals, and nasopharyngeal carcinoma. Whether EBV is also associated with non-Hodgkin lymphoma (NHL) in patients without pre-existing immunocompromized status is less clear. The authors examined the clinical, morphologic, immunohistochemical features of 42 sporadic NHLs in areas of head and neck and aslo analyzed the presence of EBV genome by using polymerase chain reaction (PCR). METHODS: All lymphoma cases examined were classified according to the Working Formulation and also determined the immunophenotype using paraffin-embedded sections. For PCR, DNA was extracted from formalin fixed, paraffin-embedded tissue using chelating resin with some modifications, and processed amplification with EBV genome primers. RESULTS: Morphologically, the cases consisted of 21 diffuse large cell, 7 diffuse mixed cell, 5 large immunoblastic, 4 follicular, two small cleaved cell, two small lymphocytic and one lymphoblastic lymphoma in Working Formulation classification. Immunohistochemically, 29 cases were of B-cell lineage, 11 cases were of T-cell lineage and two cases were of non-B and non-T cell immunophenotype. EBV genome was detected in 8 of 42 cases (19%) including 3 of 29 B-cell lymphomas (10%), and 5 of 11 T-cell lymphomas (45%). CONCLUSION: These findings suggest that EBV play a role in the development of B and T-cell lymphoma.

A Study on the Tropism of Epstein-Barr Virus / 대한암학회지

PURPOSE: The Epstein-Barr Virus (EBV) is associated with a variety of human lymphocytic and epithelial malignancies. EBV is thought to display exclusive tropism for B lymphocytes, follicular dendritic cells, and pharyngeal epithelia via specific receptors (C3d receptors, CR2, CD21). Recent evidence, however, challenged this belief. We designed this experiment to determine the incidence of EBV receptor in various malignant tumor cell lines and normal lymphocyte subsets. MATERIALS AND METHODS: We have examined the incidence of EBV receptor, CD21 on the 10 healthy adult peripheral blood (PB), 10 umbilical cord blood (CB), 4 immortalized lymphoblastoid B cells by EBV infection (CSUP-1, CSUP-2, CSUP-3, CSUP-4), 3 EBV-positive B cell lymphoma cell lines (Jiyoye, IM-9, PTLC-1), 1 EBV-negative B cell lymphoma cell line (JeKo-1), 3 T cell lymphoma and leukemia cell lines (CCRF-CEM, H9, CEM-CM3), one histiocytic lymphoma cell line (U-937) and 5 gastric cancer cell lines (KATO III, AGS, SNU-1, SNU-5, and SNU-16). EBV receptor, C3d receptor was identified by flow cytometry (FACSCalibur) using FITC-conjugated or PE-conjugated CD21 monoclonal antibody. Also we investigated the expression of CD3, CD5, CD7, CD19, CD20, IgM, IgG, Ig and Ig by using FITC-conjugated or PE-conjugated monoclonal antibody, on above cell lines. RESULTS: The expressions of CD21 molecule were 10.99 3.84% and 9.22 5.39% in adult PB lymphocytes and CB lymphocytes, respectively. The anti-human CD21 antibody was positive for CD19-positive or CD20-positive B lymphocytes. The CD3-positive or CD7-positive T lymphocytes were negative for anti-human CD21 antibody in PB and CB. But, CD21 antibody was weakly positive for CD5-positive lymphocytes. EBV-positive cell lines expressed variable ranges from 0.9% to 5.2% for CD21 antigen, while EBV-negative lymphoma cell line, JeKo-1 expressed 5.5%. All T lymphoma and leukemia cell lines and gastric cancer cell lines did not express CD21 antigen. But U-937 expressed 14.4% for CD21 antigen. CONCLUSION: These results suggested that the CD21 antigen was expressed in CD20 or CD19-positive mature B cells, CD5-dim positive lymphocytes, some EBV-positive and negative B cell lymphoma cell lines, and a histiocytic lymphoma cell line. Further evaluation on the nature of CD5-dim positive cells, which was expressing CD21 molecule, is revealed, especially in reference to EBV association in some peculiar subtypes of peripheral T cell lymphoma.

Establishment and Characterization of an Epstein-Barr Virus-negative B-cell Line from a Patient with Dissemination of Peripheral Blood and Bone Marrow by Malignant Lymphoid Cell

A human malignant lymphoid cell line(JeKo-1) was established from a Korean patient with retroperitoneal tumor presenting peripheral blood and bone marrow involvement by malignant lymphoid cells. This cell line was established from peripheral blood, and the cell line had the identical immunophenotypic features as malignant cells from the peripheral blood. The established cell line had features of a mature B-cell phenotype with no evidence for commitment to other lineages. The JeKo-1 grows in suspension with a doubling time of 33 hours. By light and electron microscopic examination, the established cells had a follicular center showing, a small, cleaved, lymphoid appearance, and had a large amount of cytoplasm containing few vacuoles and an irregular cytoplasmic membrane. Immunophenotypic analyses with monoclonal antibodies using flow cytometry showed a monoclonal IgM kappa and CD5- B-cell phenotype. The cells were non-reactive for T-cells and myeloid/monocyte antigens, and no evidence of Epstein-Barr virus nuclear antigen by polymerase chain reaction. DNA analysis showed a hypodiploid stemline with a DNA index of 0.83. The established cells were strongly reactive for bcl-2 and c-myc onco-protein, but lacked expression of multidrug resistance gene protein, p-glycoprotein by Western blot analysis. Karyotypic analysis of JeKo-1 showed 40-41 chromosomes. This cell line should be a valuable tool to study the dissemination of malignant lymphoma into the peripheral blood and bone marrow.

An Immunohistochemical Study on the Expression of the Bauhinia Purpurea in the Reed-Sternberg Cells

The diagnosis of Hodgkin's disease is based on the morphologic identification of Reed-Sternberg (RS) cells and its variants in paraffin-embedded sections. The origin of RS cells remains a subject of controversy, and cells resembling RS cells are observed in some non-Hodgkin's lymphoma of T-cell lineage. In this study, eighteen cases of Hodgkin's disease (3 nodular sclerosis, 6 diffuse lymphocyte predominance, and 9 mixed cellularity) were studied with peanut agglutinin(PNA), anti-Leu-M1(CD15), LN2(CD74), Ber-H2(CD30) and bauhinia purpurea (BPA) by the avidin-biotin-peroxidase complex(ABC) method in paraffin-embedded sections. RS cells and their variants revealed positive reactions with one or more of the reagents in all examined cases. BPA staining was positive in 17 of 18 cases (94.4%), PNA staining was positive in 9 of 18 cases (50.0%), Leu MI was positive in 7 of 18 cases(38.9%), Ber-H2 was positive in 11 of 18 cases (61.1%), and LN2 was positive in 8 of 18 cases(44.4%). The staining properties of examined markers were recognized as paranuclear, diffuse cytoplasmic and cellular membranous patterns, but LN2 disclosed diffuse cytoplasmic staining in the positive cells. BPA also showed dense cytoplasmic staining reaction with macrophage-histiocytes. BPA reactivity was not affected by fortnalin fixation or paraffm embedding. Thirty six cases of non-Hodgkin's lymphomas(IO T-cell and 26 B-cell type) were also examined. The neoplastic cells of those cases did not stain positive with BPA, PNA, and Leu-Mi, but stained positively with LN2 in 3 cases of T-cell lymphomas and 14 cases of B-cell lymphomas, and BeT-H2 in T-cell lymphomas. In conclusion, to facilitate the detection of RS cells and related variants in paraffm sectionse of Hodgkin's disease, BPA can be used as a useful marker because of its high-detection rate, reproducible staining pattem, and resistance to fixative.