Morphological Survey of Placenta in Trombophilia Related Hypoperfusion of Maternal-Fetal Blood Flow.

Complex and modern obstetric medical care provides a constant improvement for the pregnancy prognosis. Thus, young women with an undiagnosed pathology become pregnant and, during pregnancy, the previously undiagnosed pathology, without any clinical signs and symptoms, becomes present during pregnancy, having an unfavorable impact on the fetus and the health state of the pregnant woman. The gestational syndromes during pregnancy influence the woman's health state over a long period of time and the quality of the conception product. The recommendation, performance of laboratory tests and imagistic investigations at the right time during pregnancy, as well as a correct interpretation of their results, may prevent the onset of catastrophic occurrences including fetal death in utero and/ or maternal death. We report the case of a 30-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, severe preeclampsia, severe IUGR and thrombophilia.

The role of spleen in the pathogeny of aplastic anemia related to increased number of CD3+ CD8+ FcR+ cells.

The role of spleen in the pathogeny of aplastic anemia (A.A.) related to excessive suppression, and the value of splenectomy in the treatment of this disorder is still debated and unclear. In an attempt to find out why some patients respond to surgery and others do not, an immunologic study was carried out in 16 patients with aplastic anemia. Lymphocytes surface markers CD3, CD4, CD8, HLA-DR, Fc receptors (FcR) and CD4/CD8 ratio were determined before and after splenectomy in the patients' peripheral blood, and in the spleen. In addition, the number of granulo-monocytic colony forming cells (GM-CFC) before and after splenectomy was estimated. Nine of the cases showed increased CD3+ CD8+ FcR+ cells, reversed CD4/CD8 ratios (both, in peripheral blood and in spleen), and a low number of GM-CFC. In all these cases, splenectomy induced an improvement of the clinical, hematological, and immunological parameters, thus suggesting that spleen represents an important "reservoir" for CD3+ CD8+ FcR+ cells, which seem to exert a suppressor effect on the hematopoietic progenitors. In splenectomized patients who did not respond to surgery, the pathogenic mechanism was probably related to defective help (3 cases with low values of CD4+ cells), to defective suppression (2 cases with decreased number of CD8+ cells), to a stem cell defect or a deficiency in the stem cell microenvironment (2 cases with normal helper/suppressor ratio). These observations support the conclusion that splenectomy is indicated and may be successful only when the phenotypic markers show an increased number of CD3+ CD8+ FcR+ cells.

Hairy cell leukemia. Immunological study.

The study has been performed on peripheral blood and splenic malignant cells from 16 patients with hairy cell leukaemia (HCL). The cell surface markers were identified by rosette techniques and using monoclonal antibodies (m Ab). The surface markers' expression of the hairy cells (HC) varied. The E receptors, the T-cell antigens, the HLA-DR antigens and smIgG were either expressed or not according to the affected organ, the progress of illness, or the treatment. The surface pattern changed sometimes in the same patient during the progress of illness. These observations demonstrate that HCL is a unique disease with malignant cells characterized by a marked variability of the cell surface markers. To demonstrate the ability of hairy cells to bind labile smIgG, the cells were studied by affinity chromatography on SpA-Sepharose 6MB and by ES-rosette assay. The percent of cells bound on SpA-Sepharose varied between 6% and 66%, representing the hairy cells with labile-bound smIgG. With affinity chromatography it was also possible to separate the hairy cells with a special phenotype: T3+ T4+ T8+ T11+ surface membrane labile-bound IgG+ (11gG+) FcR+, HLA-DR+ EACD+ (Ripley rosette forming cells), resembling a normal subset of large granular lymphocytes (LGL). The percentage of these cells varied between 60% and 86% of the bound cells. These observations suggest that in HCL, the malignant transformation might involve a common progenitor for the B, T and LGL lineages, the hairy cell being a hybrid type of malignant cell. Its main immunological peculiarity is the marked mobility of the surface membrane structures and hence the lability (plasticity) of the surface markers' expression.

A case of erythrophagocytic T4 lymphoma. Immunological and morphological peculiarities.

One case of T-cell lymphoma with atypical malignant cells is reported. Some of the clinical features, morphological characteristics and functional activity (erythrophagocytosis) of malignant cells suggested malignant histiocytosis. The malignant disease started with splenomegaly and developed with hepatomegaly, bone marrow infiltration, discrete lymphadenopathy and leukaemic picture. Proliferated cells were characterized by ambiguity. In addition to phagocytic capability, presence of complement receptors and ultrastructural features proper to the macrophagic lineage, the cells expressed T-cell determinants (E receptors, T3, T4 and T11 antigens) and were peroxidase and esterase-negative. Erythrocytes were partially or completely dehaemoglobinized and presented the phenomenon of autolysis in different stages of development. Because this lymphoma is difficult to diagnose and apparently resistant to therapy, its recognition and further study are warranted.

Acute promyelocytic leukemia with T-cell markers and particular response to treatment. Report of a case.

A case of acute leukemia with atypical malignant cells is reported. The clinical picture and coagulation studies were consistent with a disseminated intravascular coagulation syndrome. Morphologically, the leukemic cells from the peripheral blood and bone marrow showed azurophilic granules. More than 80% of cells were hypergranulated, resembling the macrogranular type of promyelocytes. Ultrastructural studies and the pattern of endogenous peroxidase were consistent with the microgranular type of promyelocytes in about 20% of the leukemic cells. Auer bodies were present in both types of atypical promyelocytes. Cytochemically, the whole malignant population exhibited intense peroxidase activity. Studies with monoclonal antibodies showed that about 45% of the proliferating cells expressed T-cell markers T3, T4, T8 and T11, but the cells were not reactive with OKM1 monoclonal antibodies. The chemotherapy for acute promyelocytic leukemia was inefficient, and the prompt disappearance of the blood abnormalities was observed only when chemotherapy for acute lymphoblastic leukemia was started. Therefore, it seems that in some cases of leukemia with hybrid types of malignant cells the morphological features determine the clinical picture, while the patient's response to the therapy is conditioned mainly by the cell surface phenotype.

[Acute lymphoblastic Ph1-positive leukemia with a hybrid phenotype. The significance of the Ph1 anomaly and the hybrid phenotype]. / Leucemia acuta limfoblastica Ph1 pozitiva cu fenotip hibrid. Semnificatia anomalie Ph1 si a fenotipului hibrid.

The present paper reports on a case of acute lymphoblastic leukemia with t(9q+; 22q-) and surface markers specific of the B and T lymphoid line (hybrid phenotype). The fundamental (genotypical and phenotypical) and practical aspects (nosologic and therapeutical aspects) of this particular subtype of Ph1-positive acute leukemia and hybrid phenotype are discussed.

Epstein-Barr virus (EBV). VI. Incidence of EBV antibodies in patients with malignant lymphoproliferative diseases.

Serum samples from 52 patients with malignant lymphoproliferative diseases and 12 clinically healthy subjects were tested by indirect immunofluorescence (IF) reaction for the presence of specific EB antibodies anti-VCA and active EBV infection. The tests revealed EB antibodies anti-VCA in 32 patients with lymphoproliferative diseases and in 2 clinically healthy subjects and active EBV infection in 18/32 and in 0/2 EB anti-VCA positive patients and clinically healthy subjects, respectively.

A particular case of large granular lymphocytes lymphoma.

A patient with non-cutaneous lymphocytic lymphoma with leukaemic spread is reported. The large majority of the peripheral blood mononuclear cells formed rosettes with sheep erythrocytes (E), had receptors for the Fc portion of IgG (Fc gamma R) and displayed an unusual enzymatic profile. Part of these cells had also labile bound surface membrane IgG. The leukaemic cells were morphologically characterized as large granular lymphocytes (LGL) and consisted of two different types of cells: lymphoid cells and monocytoid cells. The histopathological diagnosis was T-cell lymphoma, pleomorphic type, diffuse. Despite their morphological heterogeneity, all the proliferative cells had the same immunological phenotype, showed normal ADCC activity but no NK activity. After three months, without specific treatment, the surface pattern changed: the cells resembled mature LGL and the NK activity increased. The cytochemical study of the leukaemic cells revealed an enzymatical peculiarity: besides an enzymatic profile characteristic for relatively mature LGL, the cells also displayed peroxidase activity. This unusual aspect--the expression by an individual malignant cell of markers believed to be restricted to a single cellular lineage--might be interpreted as a lineage infidelity or lineage promiscuity. The observation that this lymphoma developed in a patient with a long history of hypogammaglobulinaemia is of particular interest.

Bone marrow patterns in chronic lymphocytic leukaemia related to various clinical and haematological findings. A preliminary report.

In a retrospective study of 55 CLL cases subjected to bone-marrow biopsy, the histological pattern of the bone-marrow was correlated to the clinical and haematological data. Instead of the four histological patterns described by Rozman et al., five patterns have been established. The clinical staging according to the Montserrat score, compared with the bone-marrow pattern, showed a good correlation, when maintenance or replacement of normal haematopoiesis was considered. The bone-marrow pattern with maintained haematopoiesis was predicting a favourable clinical correlation; those with replaced haematopoiesis corresponded to a poor prognosis. The correlation is a useful index of severity and prognosis of CLL.