Type I cryoglobulinemia presenting as hemorrhagic crusted leg ulcers.

Cryoglobulins (CGs) are serum proteins that reversibly precipitate when the serum is cooled below 37 degrees C. Cryoglobulinemias are associated with a variety of diseases, including hematologic, autoimmune, and infectious. Isolation of CGs requires handling the specimen with extreme care. We describe a 70-year-old man, recently diagnosed with chronic lymphocytic leukemia, who developed hemorrhagic crusted skin ulcers on his legs that were pruritic and painful. Results of skin biopsies showed dilated superficial, mid-dermal and deep-dermal blood vessels containing pink amorphous material and red blood cells. Cryoglobulinemia was suspected; however, an initial search for CGs was negative. There was concern about suboptimal handling of the specimen, and the test was repeated. Two percent CGs with IgM kappa specificity were detected. This case illustrates the importance of the proper handling of specimens for evaluation of cryoglobulinemia.

Dutcher bodies in chronic synovitis.

Dutcher bodies are periodic acid-Schiff-positive intranuclear pseudoinclusions found in plasma cells in mucosa-associated lymphoid tissue lymphoma, Waldenstrom macroglobulinemia, and myeloma. We describe the case of a 68-year-old woman with chronic synovitis containing multiple Dutcher bodies. The patient's workup for lymphoma was negative. Hematoxylin-eosin- and periodic acid-Schiff-stained sections of 7 cases of marked chronic synovitis selected from the files spanning a 10-year period at Memorial Hospital of Rhode Island (Pawtucket, RI) were examined, and none showed Dutcher bodies. This case illustrates that Dutcher bodies may rarely occur in benign reactive conditions, such as chronic synovitis.