RESUMO
The simultaneous occurrence of a small B-cell lymphocytic neoplasm and a T-cell lymphoma in the same lymph node biopsy specimen is documented in two patients. The biopsy from the first patient, who had a 5-year history of chronic lymphocytic leukemia, showed evidence of a small B-cell lymphocytic neoplasm coexisting with a large-cell lymphoma of T-cell phenotype. The lymph node biopsy specimen from the second patient showed features of small lymphocytic lymphoma of B-cell phenotype, coexisting with a small-cell pleomorphic lymphoma of T-cell phenotype. The lymph node specimens from both patients met strict criteria for composite lymphomas. The clinical and morphologic findings in the first patient are those of "Richter's transformation" of chronic lymphocytic leukemia. The lymph node biopsy specimens from these two patients demonstrate that small B-cell lymphocytic neoplasms may coexist with T-cell lymphomas.
Assuntos
Leucemia Linfocítica Crônica de Células B/complicações , Linfoma de Células B/complicações , Linfoma de Células T/complicações , Idoso , Biópsia , DNA de Neoplasias/genética , Rearranjo Gênico da Cadeia beta dos Receptores de Antígenos dos Linfócitos T/genética , Rearranjo Gênico da Cadeia delta dos Receptores de Antígenos dos Linfócitos T/genética , Rearranjo Gênico da Cadeia gama dos Receptores de Antígenos dos Linfócitos T/genética , Humanos , Imuno-Histoquímica , Incidência , Leucemia Linfocítica Crônica de Células B/epidemiologia , Leucemia Linfocítica Crônica de Células B/genética , Linfonodos/patologia , Linfonodos/ultraestrutura , Linfoma de Células B/epidemiologia , Linfoma de Células B/genética , Linfoma de Células T/epidemiologia , Linfoma de Células T/genética , Masculino , FenótipoRESUMO
The authors present data from four patients with acute heterophil-negative mononucleosis-like illnesses who were initially thought to have primary Epstein-Barr virus (EBV) infections but eventually were shown to be seroconverting to the human immunodeficiency virus (HIV). Widespread lymphadenopathy and blood smears indistinguishable from those typically encountered in the acute phase of infectious mononucleosis were present in all cases. There were also varying combinations of fever, sore throat, and malaise, as well as mild abnormalities of hepatic function and elevated cold agglutinins (anti-I). Anti-HIV was detected by both enzyme-linked immunosorbent assay and Western blot techniques in all cases, with increasing titers noted in two of three serially studied cases. In one patient, a dual infection with the hepatitis B virus was also documented. Diagnostic possibilities in patients with acute mononucleosis-like illnesses dominated by prominent lymphadenopathy should include primary seroconversions to HIV.
Assuntos
Anticorpos Heterófilos/análise , Soropositividade para HIV/complicações , Mononucleose Infecciosa/complicações , Linfócitos/patologia , Linfocitose/etiologia , Humanos , Mononucleose Infecciosa/sangue , Mononucleose Infecciosa/imunologiaRESUMO
A prospective, randomized, double-blind study was designed to determine the effectiveness and toxicity of nandrolone phenpropionate in the treatment of anemias due to bone marrow failure. Twenty-four patients were initially entered; 21 now may be evaluated: seven with aplastic anemia, six with myelofibrosis, and eight with refractory anemia. Six patients improved, but only three were taking nandrolone, the other three placebo. Response did not correlate with type of anemia. No serious drug toxicity was noted. One patient with myelofibrosis improved dramatically with placebo therapy alone, no longer requiring frequent transfusions because of a hemoglobin level increase from 5.4 to 15.8 gm/100 ml. We conclude that no substantial improvement of anemia due to marrow failure can be ascribed to nandrolone as given, and that clinical trials in these conditions should be controlled to exclude spontaneous remissions as a cause of apparent improvement.
