Bullous pyoderma gangrenosum as a manifestation of leukemia cutis.

The authors present the case of a 67-year-old patient in whom bullous pyoderma gangrenosum was the first symptom of acute myeloid leukemia. Histologically leukemic cells were found in the skin infiltrate, on the basis of which this lesion satisfied the criteria of leukemia cutis. It was underlined that in the background of such atypical bullous cases there are often hemoblastoses or their malignant transformation. Finally the connection between bullous pyoderma gangrenosum and atypical vesiculous Sweet syndrome is discussed.

[Leukemic neutrophilic dermatosis]. / Leukaemiás neutrophil dermatosis.

A case of a 67 year-old female patient with acute myeloid leukemia is presented. As the first manifestation of the disease, the patient had symptoms of Sweet's syndrome, later signs of gangrenous pyoderma have developed. This transient form is termed as a "leukemic neutrophilic dermatosis". The authors focus on the important diagnostic and prognostic value of this entity.

[Therapeutic possibilities in the management of gastrointestinal bleeding in thrombocytopenic patients]. / Terápiás lehetöségek thrombocytopeniás beteg gastrointestinalis vérzésének kezelésében.

Gastrointestinal bleeding is often fatal in elderly. The danger could be multiplied by thrombocytopenia or by other disorder of the coagulation system. In a thrombocytopenic patient with myelodysplastic syndrome life threatening gastrointestinal bleeding occurred which could not be controlled by conventional methods (cimetidine, antacids, aminocaproic acid, platelet transfusions, blood transfusion 400-1200 ml/day). Continuous i.v. infusion of somatostatin [250 micrograms/hour Stilamin (Serono)] and per os omeprazole [2 x 1 capsule Losec (Astra)] resulted in the cessation of bleeding in 24 hours. Adverse effect was not observed.

[Experience with results of treatment of non-Hodgkin's lymphoma]. / Gastrointestinalis nem-Hodgkin lymphomák kezelésével szerzett tapasztalataink.

Thirty primary gastrointestinal non-Hodgkin's lymphoma treated between 1983-1990 were reviewed to reveal the efficacy of various treatment strategies. The average age at the diagnosis 53.6 (18-76) years. The histologic material were evaluated according to the Kiel classification: 22 patients had high grade malignant lymphoma (centroblastoma 8, immunoblastoma 6, lymphoblastoma 2, non classifiable 5, T-cell lymphoma 1) 8 patients low grade malignant lymphoma (lymphocytic 2, immunocytic 2, MALT lymphoma 1, centrocytoma 1, non-classifiable 1, pleomorph small cell lymphoma 1). 21 were primary gastric lymphoma, 5 involved the small intestine, 2 the ileocecal region, and 2 the large intestine. According to the Ann Arbor staging system 7 patients were stage I/E, 16 patients stage II/E, 5 patients stage III/E and 2 patients stage IV/E. Every patients underwent surgical resection. After surgical treatment high grade malignancies were treated with ProMACE-COPP (9) and CHOP-Bleo (10) polychemotherapy; low grade malignancies received VEP (5) and CVP (3) chemotherapy. 23 of 30 patients achived complete remission. The patients with low grade malignancy are in remission. All but one patients with high grade malignant gastric lymphoma achieved complete remission with a median of 37 (3-81) months relapse-free survival. Out of 5 cases in the small intestine only in 1 case was remission achieved. Histological type (Kiel) and surgical resection were the most important prognostic factors.

[Lymphomatoid granulomatosis]. / Lymphomatoid granulomatosis.

Lymphomatoid granulomatosis (LG) is characterized as an angiodestructive cell proliferation. It occurs commonly in the lung, but skin manifestations are present in 45% of the patients and the involvement of the central nervous system is not rare, too. The progression into malignant lymphomas is 13-53%. The authors review the history of two patients with LG. The involvement of the lung with LG was in the first case. The histological investigation of the lung after pulmonectomy has given the diagnosis. Coombs positive hemolysis and antinuclear factor positivity were found in this patient, too. She has not been transformed into lymphoma in 3 years. In the second case LG was diagnosed after large bowel resection. After a half year follow-up the liquor investigation showed the central nervous system manifestation of lymphoma.

[Factors influencing leukemic transformation in myelodysplastic syndrome]. / A leukaemiás átalakulást befolyásoló tényezök myelodysplastikus syndromában.

Prognostic factors affecting the leukemic transformation were studied in 43 patients with myelodysplastic syndrome (MDS). Acute leukemia developed in 17 cases and it was nonlymphocytic leukemia in every case. No remission was achieved following antileukemic therapy and most of the cases proved to be true drug-resistant leukemia. Initial granulopenia, thrombopenia or anemia alone did not influence the occurrence of leukemic transformation but pancytopenia indicates bad prognosis. According to FAB classification especially refractory anemia with excess of blasts (RAEB) and RAEB in transformation (RAEB-T) were often followed by leukemic transformation. The granulocyte-macrophage progenitor cell (GM-CFC) content of bone marrow were also studied. The GM-CFC content was decreased in each patient. There was no correlation between GM-CFC number and leukemic transformation, the growth-pattern in agar-gel culture, however, turned out to have prognostic importance. Leukemic type of growth, namely always preceded leukemic transformation.