Orbital and ocular adnexal Mucosa-Associated Lymphoid Tissue (MALT) lymphomas: a single-center 10-year experience.

Orbital and ocular andexal Mucosa-Associated Lymphoid Tissue Lymphoma (MALT) or ocular adnexal MALT lymphoma (OAML) is the most common of all eye non-Hodgkin lymphomas. Autoimmune inflammatory disorders and chronic infections are important etiological factors and CD5 and CD43 (sialophorin) tumor markers are significant negative prognostic factors. Disease signs and symptoms can occur a long time before diagnosis. Varieties of treatment options are available. The aim of this retrospective analysis was to compare the efficiency of different treatment options and to investigate disease outcome. Twenty OAML patients, diagnosed in the Clinic of Hematology, Clinical Centre of Serbia, between 2003 and 2013, were enrolled. In most cases, OAML developed in the eighth decade with greater incidence in the male population. Median age was 67.5 years. The median period between the appearance of local signs and symptoms and diagnosis was 7 months. The dominant sign at presentation was swelling of involved tissue (40%). The most common was orbital involvement (55%). All patients had localized disease. Observed laboratory parameters on presentation showed low disease activity. Sialophorin prognostic significance was not registered. Our patients were initially treated differently but there was no significant difference in progression-free survival (PFS) due to initial treatment option (p = 0.2957). Median PFS was 22 months (3-89), and 5-year PFS was 60%. Median overall survival (OS) was 43 months (1-105) and 5-year OS 95%. Eight patients (40%) relapsed and one patient died due to non-hematological complications. In our experience, most modern induction treatment options appear to result in the same, favorable outcome.

[Histopathologic characteristics of bone marrow in patients with aplastic anemia]. / Histopatoloske osobine kostne srzi kod osoba obolelih od aplasticne anemije.

INTRODUCTION: Histopathologic findings in bone marrow biopsies in patients are with aplastic anaemia crucial for the diagnosis of the disease. Changes observed by the examination of bone marrow such as cellularity, histopathologic type, presence of irregular cells maturation in all three blood lineages, condition of medullar stroma can be of great prognostic significance [1, 2, 4, 5]. The aim of the study was to make histopathological analyses in patients with aplastic anaemia and to establish parameters significant for the prognosis of the disease. PATIENTS AND METHODS: Thirty-three patients with aplastic anaemia treated in the Institute of Haematology, Clinical Centre of Serbia, from 1988 to 1995 were included in the study. Bone marrow specimens were analysed for: cellularity, number of megakaryocytes, condition of medullar stroma, presence/absence of blood and oedema, lymphoid elements, presence of plasma and reticular cells, and determination of histopathologic type on the basis of bone marrow changes. For data description we used the arithmetic mean and standard deviation for parametric results. Results of analyses were explained by Kaplan-Mayer's method and two factors analysis of variance. RESULTS: In all analysed marrow biopsy specimens a 100% hypocellularity was observed: 1. Weak hypocellularity in two specimens (6%); 2. Mild hypocellularity in six cases (19%); 3. Severe hypocellularity in 24 (75%), In one case (3%) the finding was not known. In 25 specimens (75%) megakaryocytes were not found, in 5 (16%) they were rare; in two cases (6%) they were numerous. Medullar stroma changes were not found in 30 (94%) byopsies, but in two (6%) they were found. Blood and oedema liquid were found in 26 (81%) cases and not in 6 (19%). Lympho-plasmocytic bone marrow infiltration was found in 23 specimens (72%) and not in nine (28%). First histopathologic types two (one-a and one-b) were present in 25 (78%) cases, histopathologic type two in 5 (16%) and type three in 2 (6%) specimens. The two factors analysis of variance regarding proportions between dead and alive patients revealed a significant difference in proportions according to histopathologic types (FD = 7.52; DF = 2; p = 0.002). Significant statistical differences were found between alive and dead patients in all three histopathologic types, tip one (one-a and one-b) (FD = 8; DF = 1; p = 0.06); type two (FD = 4.286; DF = 1; p = 0.041) and type three (FD = 4.762; DF = 1; p = 0.031). Histopathologic type two had the best prognosis regarding survival probability; p = 0.800; in histopathologic type two survival prognosis was worse p = 0.300, and type three it was the worst, p = 0.000. With regard to survival time, there was no statistical difference in patients with weak and mild bone marrow hypocellularity (p = 0.487). We also compared patients with severe bone marrow hypocellularity with patients with weak and mild hypocellularity. The difference in survival was statistically significant (p = 0.026), Consequently, survival was shorter in patients with severe bone marrow hypocellularity. DISCUSSION: Bone marrow biopsy and histopathologic examination are necessary for definitive diagnosis of aplastic anaemia [1-3]. Cellularity estimation in bone marrow based on biopsy and histopathologic examination is more reliable than that made by bone marrow aspiration [7]. Aplastic anaemia is a disease that can be associated with abnormal clones development. Most frequently paroxysmal nocturnal haemoglobinuria, acute leukaemias and myelodysplastic syndrome occur. Therefore, repeated bone marrow biopsies are necessary to follow-up the course of the disease [10, 11]. The presence of megakaryocytes in bone marrow specimens has favourable prognostic significance. Their appearance is a reliable sign of disease improvement [6, 7]. However, lymphocytosis, plasmocytosis and damaged marrow stroma are markers of bad prognosis [7]. (ABSTRACT TRUNCATED)

[Anemia in hypothyroidism]. / Anemije u hipotireozi.

INTRODUCTION: Anemias are diagnosed in 20-60% patients with hypothyroidism. Real values of the degree of anemia are estimated by radioisotopic analysis due to the lower volume of plasma in hypothyroidism causing false high levels of hemoglobin in blood. Anemia is often the first sign of hypothyroidism. Diagnosis of hypothyroidism should be considered in every case of anemia with uncertain etiology because sometimes signs of overt hypothyroidism needn't necessarily be evident. Microcytic, macrocytic and normocytic are regularly described anemias. CLASSIFICATION: Microcytic anemia is usually ascribed to malabsorption of iron and loss of iron by menorrhagia. Macrocytic anemia is caused by malabsorption of vitamin B12, folic acid, pernicious anemia and inadequate nutrition. Pernicious anemia occurs 20 times more frequently in patients with hypothyroidism than generally. Macrocytosis is found in up to 55% patients with hypothyroidism and may result from the insufficiency of the thyroid hormones themselves without nutritive deficit. Normocytic anemia, so-called uncomplicated anemia, arises due to thyroid hormones deficit itself not followed by nutritive deficit. This type of anemia is considered to be an adaptation to a decreased basal metabolism. Thyroid hormones directly or indirectly, through erythropoietin, stimulate growth of erythroid colonies (BFU-E, CFU-E). Normocytic anemia is characterized by reticulopenia, hypoplasia of erythroid lineage, decreased level of erythropoietin, mainly regular erythrocyte survival. Acanthocytosis findings in cytologic blood smear suggest hypothyroidism in about 90% of cases.

[Aplastic anemia--clinical characteristics and survival analysis]. / Aplasticna anemija--klinicke odlike i analiza prezivnjavanja.

UNLABELLED: Aplastic anaemia is a relatively rare disease, characterized by the loss of haemopoietic "stem" cells in the bone marrow, exchanged with fat cells and pancytopenia. The treatment of this disease consists of supportive therapy with blood products and finally phase, where there are two possibilities: immunosuppression and bone marrow transplantation. Immunosuppression means the use of antilymphocyte or antithymocyte globulins, anabolic steroids, Cyclosporine A, corticosteroids, and recently haemopoietic growth factors [1]. The advantage of bone marrow transplantation compared to other kinds of treatment has been established in multicentric trials [2]. Goals of study: 1. To show and analyze clinical characteristics in patients with aplastic anaemia; 2. To study survival according to gender, age and kinds of treatment. METHODS: Thirty three patients with aplastic anaemia are included in the study. They were treated at the Institute of Haematology, Clinical Centre of Serbia, from 1988 to 1995. For description of data we used parameters for the arithmetic mean and standard deviation; for nonparametric tests-median. Student's T-test was used for comparison of differences among the mean values from nonparametric analytic models. From nonparametric models, Fisher's test was used. For data analysis of survival Kaplan-Mayer's model was used. RESULTS: Thirty three patients with aplastic anaemia were examined. There were 17 (52%) men and 16 (48%) women. The youngest patient was 15 and the oldest 73 years. The average age of patients was 40.18 years. In the group up to 30 years there were 16 (48%) patients. In the group from 31 to 45 years there were 4 (12%) patients. In the group from 46 to 60 years there were 4 (12%) patients, and in the group from 61 to 75 years 9 (28%); clinical signs (fatigue, exhaustion) and anaemic signs (pallor) were present in all patients (33). In 12 (36%) patients high body temperature was established and in 21 (64%) patients there was no temperature. Signs of haemorrhagic syndrome were established in 26 (79%) patients and 7 (21%) patients had no such signs. No significant statistical difference in survival (Lee-Desu = 0.071; DF = 1; p = 0.789) related to sex, was observed. According to the duration of the disease by year, and over this period, the difference was statically very significant (Lee-Desu = 20.735; DF = 1; p = 0.000). Therefore, in patients with a longer duration of the disease than one year the chance for a longer survival is better. We compared the group of patients treated with antilymphocytic globulin with the group treated with other methods (androgenic hormones and Prednisolone, Cyclosporine A and bone marrow transplantation). Between these two groups the difference was statistically significant (Lee-Desu = 2.742; DF = 1; p = 0.018). Therefore, survival of patients of the second group was longer thanks to a successful bone marrow transplantation. The group of patients treated by bone marrow transplantation was compared with the group of patients treated with other three methods; the difference was statistically significant (Lee-Desu = 7.346; DF = 1; p = 0.006). The best method of treatment is bone marrow transplantation in comparison to the other three methods. Survival was also analyzed in all four studied age groups. No statistically significant difference was found. CONCLUSIONS: Aplastic anaemia is a serious, relatively rare illness, appearing with almost equal frequency in men and women. Two peaks were noticed: in the younger age group up to 30 years (48%) and over 60 years (27%). According to survival, there was a group with short survival, up to 12 months, and a group with longer survival, over 12 months. Gender and age had no influence on duration of survival. Only the duration of the disease had a positive effect on survival. In comparison to other methods, the most efficacious treatment was allogenic bone marrow transplantation.

[Chondrosarcoma and hemipelvectomy]. / Hondrosarkom i hemipelvektomija.

Unlike osteosarcoma and Ewing's sarcoma chondrosarcomas are primarily surgically managed as they are resistant to chemo- and radio-therapy. A female patient, aged 36 years, was operated in 1992 for pelvic chondroma; a year later she was reoperated due to local recurrence, and diagnosis of chondrosarcoma was established. Because of tumour regrowth she was referred to our institution for hemipelvectomy. The operative team consisted of and orthopaedic surgeon, an urologist, and a general surgeon. A (large) tumour was completely removed. The patient's recovery was rapid, and she is now able of controlling urination and defecation. This kind of operation is extensive and traumatic, but it is useful in appropriately selected cases.

[Non-Hodgkin's lymphoma of the thyroid gland--2 case reports]. / Nehockinski limfomi stitaste zlezde--prikaz dve bolesnice.

The authors present two female patients with Non-Hodgkin's lymphoma of the thyroid gland. The first had Non-Hodgkin's lymphoma, follicular, diffuse of centrocytic cells (FCC-intermediate grade risk), and the second had an immunoblastic Non-Hodgkin's lymphoma with large cells (high grade risk). After "staging" procedures, it was estimated that the first patient was in I EA and the second in II EB clinical stage. They were treated by surgical removal of involved tissue, combined chemotherapy and local radiotherapy. A complete remission was achieved in both patients without signs of recidivation for 8 months in one patient and 18 months in the second subject, after treatment. The elder patients more often manifest this type of lymphoma, especially if they already had chronic thyroiditis of Hashimoto's type. Using the combined, contemporary treatment, the overall five-years survival is about 56 +/- 7 percent.

[Orbital lymphomas]. / Limfomi orbite.

Lymphomas are relatively rare in the orbit: only about 8-11% of all orbital tumours. The most common histological type is diffuse well-differentiated lymphocytic lymphoma (DWDLL--Rappaport's classification)--70%. Orbital lesions are always curable by radiotherapy, but in some 40% of these patients local recurrence or dissemination occur. The authors present two patients with diffuse well-differentiated lymphocytic lymphoma, and one patient with FCC lymphoma of centrocytic type (Kiel classification) localized in the orbit. Two of them were irradiated after an unsuccessful treatment by chemotherapy. In the third patient local radiotherapy is still in the course.

[Accessory spleen causing recurrent idiopathic thrombocytopenic purpura (case report)]. / Akcesorne slezine kao uzrok recidiva idiopatske trombocitopenijske pupure (prikaz bolesnice).

Idiopathic thrombocytopenic purpura is an autoimmune disease in which macrophages of reticuloendothelial system, mainly in the spleen, remove platelets covered by autoantibodies from circulation. By removing the spleen 60-80% of patients are cured. Partial remission is achieved in 10-20% of cases. Recurrence of idiopathic thrombocytopenic purpura in a splenectomized patient achieving complete remission, may be caused by hypertrophy of one or more of the retained accessory spleens. We describe a 41-year-old wonam in whom splenectomy for idiopathic thrombocytopenic purpura was performed 10 years ago. After quick and full remission which lasted almost 10 years, a full reccurrence of the disease with severe thrombocytopenia and haemorhagic syndrome appeared. With ultrasonography, computed tomography and scintigraphy accessory spleens in the splenic fossa were found. Removal of 3 accessory spleens, 21 gram of weight, led to quick and full remission of the disease. A number of platelets stayed over 200 x 10(9)/l with no additional treatment.

[Obstructive icterus caused by hydatidosis of the liver]. / Obstukcioni ikterus zbog hidatidoze jetre.

Hydatid illness still presents a serious surgical problem and in the case of obstrukioni ikterus an operation is indispensable method in the treatment of illness. Applying the method of omentoplexia in our case we witness its justification because together with cholecystectomia and relieving "T" drainage the secretion is reduced to minimum as well as the possibility of appearing of closed purulent content. The number of hospitalised days after the operation is reduced in average from 45 to 21 days.

Radiometric determination of submicrogram amounts of mercury.

A radiometric method for the determination of submicrogram amounts of mercury (down to 5 x 10(-10)g ml ) is described. The method is based on the exchange reaction between mercury and silver-110m dithizonate. Only palladium, gold, silver, and large amounts of copper and bismuth interfere in the determination, and must be removed.