Analysis of Bone Tissue Condition in Patients with Diffuse Large B-Cell Lymphoma without Bone Marrow Involvement.

We studied changes in the bone tissue in patients with diffuse large B-cell lymphoma at the onset of the disease (N=41; before chemotherapy) and 5-16 years after the end of treatment (N=47). Osteodensitometry, biochemical markers of osteoporosis in the blood and urine, and gene expression in multipotent mesenchymal stromal cells were analyzed. In multipotent mesenchymal stromal cells of all patients, the expression of genes associated with bone and cartilage differentiation (FGF2, FGFR1, FGFR2, BGLAP, SPP1, TGFB1, and SOX9) was changed. In primary patients, the ratio of deoxypyridinoline/creatinine in the urine and blood level of ß-cross-laps were increased, while plasma concentration of vitamin D was reduced, which indicates activation of bone resorption. No differences between the groups were revealed by osteodensitometry. No direct relationship between changes in gene expression in multipotent mesenchymal stromal cells and osteoporosis markers was found. The presence of a tumor in the body affects the bone marrow stroma, but achievement of remission and compensatory mechanisms provide age-appropriate condition of the bone tissue.

Microalbuminuria is associated with impaired glomerular permselectivity in lymphoma patients.

Slightly increased urinary albumin excretion is frequently found in patients with lymphoma and other malignancies but the pathophysiological mechanisms have yet to be clarified. In this study, parameters of renal function in lymphoma patients with microalbuminuria were evaluated. Sixty-seven patients with histologically proven diffuse large B-cell lymphoma were included in the study at diagnosis. Urinary albumin excretion was measured by immunoturbidimetry and microalbuminuria was defined as an excretion rate between 20 and 200 microg/min. Glomerular function was further estimated by renal clearance of creatinine and IgG, and the IgG/IgG4 charge selectivity index. Tubular function was evaluated by renal clearance of beta(2)-microglobulin. The median value of IgG clearance was increased in the microalbuminuric patients (0.22 versus 0.18 microl/min; p = 0.03). The median selectivity index was significantly lower in patients with microalbuminuria (1.0 versus 2.2; p<0.0001). Urinary albumin excretion was correlated with both the renal clearance of IgG (p<0.0001) and the selectivity index (p<0.0001). These data suggest that a slightly elevated level of urinary albumin excretion in a population of patients with aggressive lymphoma reflects altered glomerular permselectivity probably due to a defect in charge selectivity. The glomerular sieving dysfunction may be associated with an inflammatory response to the malignancy. Further studies are needed to validate the clinical impact of the renal parameters in lymphoma patients.

Urinary immunocytology for primary bladder B cell lymphoma.

Urinary immunocytology is described as a diagnostic tool in a patient with a primary high-grade, large-cell, B cell lymphoma of the bladder. Lymphoma cells were distinguished from abundant leukocytes by immunocytologic staining for CD20. This technique might be useful in the differential diagnosis of patients with chronic bladder inflammation accompanied by pyuria.

Primary vesical malignant lymphoma of histiocytes detected by urine cytology.

Urinary cytology performed in a woman aged 64 revealed an uncommon cell population with malignant features highly suggestive of a lymphoma. Histologic and immunohistochemical investigations of a polypoid endovesical mass surgically resected showed a lymphoma of histiocytes in the lamina propria of the bladder wall. Clinical, operative and pathologic staging demonstrated that the tumor was confined to bladder. The case repeats the typical features of primary vesical lymphoma reported in the literature. The favourable follow up six years after surgery confirms the good prognosis of bladder Iymphoma treated by aggressive therapy.

Ki-1-positive large cell anaplastic lymphoma diagnosed by urinary cytology. A case report.

Cytomorphologic and immunocytochemical findings in urinary cytology in a case of Ki-1-positive large cell anaplastic lymphoma in the left cervical region in a 42-year-old man are reported. Smears stained with Papanicolaou or Wright-Giemsa stain showed a cytomorphologic spectrum that varied from immunoblastlike cells to large neoplastic cells with pleomorphic nuclei and vacuolated cytoplasm. Neoplastic cells with multilobulated, bizarre nuclei and mitosis were also observed. Immunocytochemistry on urinary sediments showed that the tumor cells were of a "null" phenotype and strongly expressed the Ki-1 antigen and "activation" markers of HLA-DR, Tac (CD25) and OKT9 (CD71). Histology and immunohistochemistry confirmed these findings.

Potassium-wasting nephropathy secondary to chemotherapy simulating Bartter's syndrome.

A patient with a potassium wasting nephropathy secondary to chemotherapy simulating Bartter's syndrome is described. A 64-year-old woman with diffuse histiocytic lymphoma developed persistent hypokalemia following a course of Cytoxan (cyclophosphamide), Adriamycin (doxorubicin), vincristine, and prednisone (CHOP)-Bleo. The diagnosis of a functional Bartter's syndrome was concluded following evaluation of serial plasma renins, aldosterone levels, and urinary electrolytes. Evidence is suggestive that a subpopulation of patients receiving chemotherapy may develop a functional Bartter's syndrome, and it is important to consider this diagnosis in patients who develop hypokalemia subsequent to chemotherapy introduction.

Urinary cytodiagnosis of renal involvement in disseminated histiocytic lymphoma.

Two cases of patients with disseminated histiocytic lymphoma are presented in which positive urine cytology provided evidence of renal involvement. In addition to malignant cells, the urine sediment characteristics included renal tubular epithelial cell exfoliation, renal epithelial fragments and pathologic cast formation, which distinguished renal from lower urinary tract involvement. Such cytologic observations may be useful in differentiating among the various causes of renal disease in patients with malignant lymphomas.

Excretion of metabolites of biogenic amines in patients with irradiated brain tumours.

The metabolities of biogenic amines were determined in the 24-hour urine samples of patients submitted to surgical removal of a malignant brain tumour and subsequently to telecobalt therapy of the corresponding head region. A significant increase in the excretion of 5-hydroxyindoleacetic acid (5-HIAA), vanillinmandelic acid (VMA) as well as of free 3-methoxy-4-hydroxy-phenylglycol (MHPG) during the period of irradiation was found. This increase is presumably the result of radiation induced release of their parent amines from the brain; in the case of VMA the secondary response of the peripheral sympathetic system might occur.

Amino acid metabolism in Wegener's granulomatosis.

The urinary excretion of amino acids and their derivatives in cases of Wegener's granulomatosis have been examined, and the excretion of urinary amino acids in such cases was different from normal and reticulum cell sarcoma. In Wegener's cases, the amino acids which were always found in readily detectable amounts totaled 33; urinary phenylalanine was 4-5 times higher than in normal subjects. From these experimental results, we believe that the observation of amino acid excretion into urine is an important indicator for the diagnosis of Wegener's granulomatosis. In addition, the results of quantitative examination on the urinary amino acid excretion were compared with normal and reticulum cell sarcoma. Comparison of the analytical data on urinary amino acids of the normal and patient groups indicated significant metabolic abnormalities of some amino acids at the earliest stage of Wegener's granulomatosis.